Implementation Journey of Inpatient Medication Order Entry Project in Prince of Wales Hospital

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1 Implementation Journey of Inpatient Medication Order Entry Project in Prince of Wales Hospital HA Convention 2015 by Dr CB Leung Chairman, Taskforce Cluster Coordinator (Clinical Informatics)

2 Background Medication Incidences are significant Risk to patients and Health Care Providers HA decided to look into different ways to decrease risk to patients IPMOE( 住院病人藥物處方系統 )is one of the measures

3 Background (2) Prince of Wales Hospital is the third HA Hospitals to implement IPMOE To try out different mobile devices ( 流動裝置 ) for different user groups Ward-based mobile devices with storage facilities with charging utilites First Live run on July 9, 2014 in a general medical ward (10A)

4 IPMOE: Close Loop & Paperless System 1. Doctors prescribe via IPMOE 2. Nurses login and view MAR via IPMOE Drug order details are sent to Pharmacy System electronically System auto-assign schedule & sort out drugs due for administration 3. Nurses scan Barcode on drug bag to verify Right drug & Right time Patient Identity & Drug data are transmitted to scanner via Bluetooth Administration record can be seen in pharmacy to facilitate drug refill Pharmacists receive the order, vet and dispense drugs to ward 4. Nurses scan Barcode on patient wristband to verify Right patient Drug administration details are clearly documented in the system

5 Doctors Can enter / review patient medications at their bedside (real time) Avoid unnecessary transcriptions to save time and enhance safety IPMOE medications can be directly selected and copied from previous prescriptions and to discharge prescription

6 Hardware Provision: For Prescription ipad air ipad mini For doctors: Desktop computers and mobile devices to access computer system. Wall mount CMS

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8 Processing around 3000 inpatient prescriptions daily Benefits of IPOE Pharmacy Real time profile update Verify against the emar Minimize redundancy Minimize drug return Minimize drug wastage Improve track-and-trace along the dispensing process

9 Handwritten -Difficult to read -Error-prone for lookalike-sound-alike drugs -Transcription required Electronic -Clear & complete details -NO transcription

10 Tedious & incomplete transmission Delayed update of profile Dispense by receiving orders, no priority setting Lot of paper used

11 Today

12 Hardware Provision: For Drug Administration For nurses: Tablet Set (T-set): A tablet mounted in a drug trolley mapped with assigned bluetooth printer and barcode reader. Toughpad

13 Preparation - Quality and Safety risk assessment preparation of rollout systematic techniques for failure analysis using Failure Mode and Effects Analysis (FMEA) drill was arranged before rollout

14 IPMOE process Risk Assessment and Actions overseas literatures and local understanding Prescription Significant scenarios along patient s journey Dispensing Administration Significant scenarios 23 Potential failure modes (8 IPMOE related, 7 actionable) 7 Action items Single IPMOE process 50 Potential failure modes (3 IPMOE related, 9 actionable) 13 Action items

15 A real play!! Pilot Ward, Pharmacy, CMS Team, HOIT Call Centre, Q&S

16 Remote Unlikely LIKELIHOOD Possible Likely Almost certain Risk Matrix ( 居安思危, 未雨綢繆 ) Q CONSEQUENCE Insignificant Minor Moderate Major Extreme IPMOE

17 Preparation Engagement with Key Stakeholders: NTEC IPMOE Forum 17

18 PWH ipmoe web 18

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20 IPMOE Usage in PWH Close loop and Paperless System Doctors (drug prescription) Pharmacy (drug dispensing) Nurses (drug administration) Use of Mobile Computing technology REDUCE Medication Error 減少錯誤 IMPROVE Patient Safety 改善安全 IMPROVE Efficiency 提高效率

21 IPMOE Usage in PWH (2) Time 天時 Development of a corporate system Place 地利 Good AOM culture and standardization Strong quality and safety team Good local IT support and Infrastructure Person 人和

22 PWH is the first hospital in HA to have IPMOE in Early involvement of Quality and Safety Team Extensive use of Mobile Devices to facilitate workflow of frontline staff in ward setting ALL in-patient wards and areas providing service to inpatients (e.g. Endoscopy, Radiology, Operation Theatre), in particular, Obstetrics wards, including labour ward (a big bang) with standing order Intensive Care Unit, using CITRIX connection to CMS in CIS workstations (medical network) Paediatrics (including CCC, PICU and NNU) Oncology

23 IPMOE In-Patient Medication Order Entry

24 IPMOE In-Patient Medication Order Entry IPMOE first rollout in ward 10A on July 9, Successfully rolled out in about 90% of wards Tentative date of EM ward rollout on 3/6/2015 Visits by other hospitals for experience sharing AHNH (5/3/2015) PYNEH (9/3/2015) NDH (23/3/2015) TMH / POH (6/2015)

25 IPMOE In-Patient Medication Order Entry IPMOE team in the NTEC Annual Plan Media Briefing on Aug 29, 2014

26 Prince of Wales Hospital Thank You!