Presentation slides from CLAHRC WM Programme Steering Committee on 21st September 2015 - Theme 1: SPACER project, Albert Farre

1. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
The implementation of electronic
paediatric prescribing in paediatric hospital
ward settings (IePP)
Albert Farre1 2 and Carole Cummins1
1 School of Health and Population Sciences, University of Birmingham
2 Research and Development, Birmingham Children’s Hospital NHS Foundation Trust

2. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Background
• Need for greater use of ‘soft intelligence’ on quality and
safety.
• Key lessons learned from previous national research on eP.
• Broader field of HIT implementation studies, growing
evidence on the importance of ‘sociotechnical’ process
evaluations.
• Focus on quality and safety of care provision and everyday
practice from clinicians’ perspective.

3. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Objectives
1. To understand the complex organisational reality in which
ePP will be introduced, and the nature of ePP-related
change processes.
2. To explore staff perspectives in relation to currently
established practices and processes involved in the
prescribing and administration of medicines in the ward
setting.
3. To assess the impact of implementing ePP on care provision
and hospital work in the ward setting from the perspective
of nurses, doctors and managers.

4. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Methods
• Process and impact evaluation.
• Qualitatively-driven mixed-method study.
• 3 interrelated sub-studies.
• Embedded design - including a primary qualitative study and
two embedded supplementary sub studies, qualitative and
quantitative respectively.
• Data collection before, during and after the intervention.

5. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Methods
Interviews +
Focus Groups
Questionnaire (1)
Questionnaire (2)
Observation (1)
Observation (3)
Observation (2)
PRE
implementation
stage
POST
implementation
stage
PILOT stage

6. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Methods (Sub-study 1)
Interviews +
Focus Groups
Questionnaire (1)
Questionnaire (2)
Observation (1)
Observation (3)
Observation (2)
PRE
implementation
stage
POST
implementation
stage
PILOT stage
Understanding change in the ward
setting
• Ethnographic research, including non-
participant observation and informal
conversational interviews
• Approximately 350 hours of
observation (150h phase 1, and 200h
across phases 2 and 3)
• 2-3 wards and 30 informal interviews

7. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Methods (Sub-study 2)
Interviews +
Focus Groups
Questionnaire (1)
Questionnaire (2)
Observation (1)
Observation (3)
Observation (2)
PRE
implementation
stage
POST
implementation
stage
PILOT stage
Exploring staff perspectives on
currently established practices
• Qualitative in-depth interviews and, where
possible, focus groups.
• Staff directly involved in the prescribing and
administration of medicines in the ward (i.e.
doctors, nurses and pharmacists) in
addition to any relevant managerial roles.
• 6-12 interviews and 3-6 focus groups.

8. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Methods (Sub-study 3)
Interviews +
Focus Groups
Questionnaire (1)
Questionnaire (2)
Observation (1)
Observation (3)
Observation (2)
PRE
implementation
stage
POST
implementation
stage
PILOT stage
Measuring impact
• Online self-completion questionnaire.
• Before-and-after design.
• To be developed based on qualitative
data emerging from sub-study 2.
• Face and content validity assessment
through panel of experts. Reliability
assessment through interviews after
completion.
• Addressed to any members of staff
involved in the ward setting.

9. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Data analysis and integration
• Qualitatively-driven design – overall data analysis will draw on
qualitative reasoning.
• Theoretically informed by Normalization Process Theory.
• Qualitative and quantitative data will be connected and
integrated at various stages – 3 at PRE stage (QUAL-qual; qual-
quant; quant-QUAL) and 1 at POST stage (quant-QUAL).
• Data collection and data analysis will take place concurrently
so that issues raised in earlier rounds of fieldwork can be
explored in subsequent ones.

10. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Participation
• To combine engagement with (i) key ward stakeholders in the
hospital, and interested members from (ii) the CLAHRC-WM
PPI advisory group; (iii) the Trust’s young people advisory
group; and (iv) the Trust’s special interest group on eP.
• The views of those involved may help to…
a) enhance and challenge our coding framework and
interpretation of the data.
b) increase the meaningfulness and encourage ownership
of the findings.

11. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Where we are at?
• Study protocol was written and peer reviewed
through the CLAHRC WM.
• REC application was submitted and favourable
opinion from REC has been obtained.
• R&D form has been validated.
• SSI form under review at BCH.

12. Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands
Thank you!