Pruebas Unitarias

Of the 20 nurses selected for interview before the implementation of Meditrol, 14 were interviewed. Of the 20 nurses selected for interview after the implementation of Meditrol, again 14 were interviewed. The grades of those selected and those interviewed are shown in table 9.1. During each phase 6 nurses were unavailable for interview due to the nature of shift patterns, annual leave, maternity leave or because they had moved jobs since the personnel list had been obtained. No nurses reftised to be interviewed.

Grade Num ber selected Num ber interviewed - before Num ber interviewed - after D 6 4 4 E 6 5 5 F 5 3 3 G 3 2 2

Table 9.1 Grades of nurses interviewed

Summary of nurse interviews before implementation of Meditrol

Before the implementation of Meditrol most nurses, when asked on their views on the importance of accuracy of timing of drug administration with respect to the time indicated by the doctor on the drug chart, felt that current practice led to an unacceptable deviation

from the prescribed time. However it was felt that this was the best that was possible given the available staff resources. Most considered that drug administration one hour either side of the prescribed time was acceptable for most drugs.

When asked what they considered to be an acceptable time lag between the time a drug is prescribed and the time a drug is available on the ward, answers ranged from immediately to 3 or 4 hours, though most nurses said it would depend on the drug. When specific examples of drugs were given it was thought antiarrhythmics and dopamine should be available immediately, antihypertensives within one hour, antibiotics for a urinary tract infection within one to three hours. Anusol ointment would be given a lower priority but this would be dependent on the level o f patient discomfort.

Generally the nurses had a positive expectation of the benefits of the Meditrol system. It was expected that following the implementation of Meditrol, drugs would be available more promptly and that the level of drug administration errors would decrease. There was a consensus that patient care would improve with respect to drug administration. There was a general expectation of increased efficiency in the drug supply system so that drug rounds would take less time. Although there was an overall positive outlook, there were some concerns over the decreased fiexibility of the Meditrol system with respect to timing of drug rounds and the increased dependence on computer technology. Some nurses felt they needed to try the system before forming an opinion. Most expected to have more contact with pharmacy staff although they were unclear whether the pharmacists would be ward or department based. Most nurses felt indifferent to the use of the new drug trolley and units of dose, though some felt they needed to tiy them first before forming an

although some anxieties were expressed particularly around the need for keyboard or computer skills, some had reservations as to the cost of the system and there was a suspicion as to why an outside agency would wish to install such a system into the hospital. Meditrol was seen by all as an opportunity for professional development, though a few nurses expressed some concerns around the confidentiality of stafif actions. When asked to choose whether they would prefer to use the traditional or Meditrol system all said that they would need to try Meditrol first before making a judgement.

Before implementation, most nurses said that pharmacists rather than doctors should enter prescription data onto the system. This was mainly due to the perceived greater drug knowledge of a pharmacist compared to a doctor. Some said it should be the doctor; reasons given were that it was the doctor’s professional role and that they were ultimately responsible for the patient. The doctor also had easy access to the patient and to their records.

Summary of nurse interviews after the implementation o f Meditrol

Following implementation most nurses, contrary to their expectations, said that more time was being spent on drug rounds (some specifically stated that the operation of the system involved the need to travel back and forth between the patient and the Meditrol cabinet during a drug round) and complaints had been received fi’om patients afier waiting too long for their medication. The majority felt that less time was being spent with patients, resulting in a reduction in the level of patient care. The concerns over the decreased flexibility of the timing of drug rounds continued. Most nurses were aware of a decrease in both the time spent on ordering of drugs and the need to travel to pharmacy for

supplies. Some nurses perceived that the number of drug administration errors had decreased, though some said that medical stafif had noticed examples of drugs doses being missed due to non availability o f medication. One nurse expressed her concern that there was no safety mechanism to restrict the quantity of a drug that could be obtained by nurses on a one-off basis (this function was used when a drug had been prescribed on the drug chart but had not yet been entered onto the system by the pharmacist).

The majority of interviewees felt that the trolley was predominantly of unsuitable design and involved excessive bending down, though individual patient drawers were useful and the ability to split the trolley into smaller sections enabled a greater degree of primary nursing. Most nurses disliked the units of dose, some had experienced problems with the packaging, finding it difficult to get drugs out and some thought that they were

particularly unsuitable for doses of drugs that involved opening several individual packages. It was thought that they were unsuitable for elderly patients or those with arthritis to open the packages themselves. Some felt that the units of dose involved less manipulation and hence were more hygienic and some felt that there was less waste with the unit doses. The majority of nurses felt comfortable with using a computer terminal to obtain drug doses (there was a perceived improvement in computer and keyboard skills), although in areas where there was a need to obtain drugs quickly it was felt to be

unsuitable. Some stated that stock control had improved though others said that stock levels of drugs were too small. Some thought that the information generated by Meditrol would be usefiil for costing purposes.

workload, and stress levels of pharmacy had increased. However there was perceived to be additional tension between nurses and doctors; that medical stafif had to wait for nursing stafif to obtain drugs for them from the Meditrol cabinet whereas before they would obtain drugs from drug cupboards themselves.

The majority stated that nursing stafif were more stressed and that Meditrol was leading to feelings of frustration and dread of drug rounds. However, a minority said they enjoyed using the Meditrol system. Meditrol was now balanced between being seen as a threat or an opportunity. The perceived threat to confidentiality of stafif actions remained.

After implementation the majority said the would prefer to return to the traditional system, though some nurses were happy to continue using Meditrol.

After implementation more nurses felt that it was a pharmacists role to enter the prescription data for the same reason. Additional reasons were that doctors are already very busy and are liable to make mistakes. Pharmacists were said to be trusted more to perform the task accurately.