Electronic Prescribing and emar. Jonathan Sheldon Consultant Physician and Clinical Lead for Electronic patient records
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1 Electronic Prescribing and emar Jonathan Sheldon Consultant Physician and Clinical Lead for Electronic patient records
2 AIMS To discuss the support needed for the successful conclusion of this project To show the benefits of an INTEGRATED EPR system To show how we actually use our Electronic Prescribing system integrated within our whole Hospital Electronic patient record To show how to engage with Clinicians To show the prescribing and administering of Medications Demonstrate some decision support Some lessons learnt
3 Electronic Prescribing Overriding commitment to Governance, Patient Safety and Quality Best if integrated within a full Electronic patient Record. Use the EPR to deliver decision support. All of this gives a full audit record. Allows an accurate electronic discharge summary
4 Justification for an EP system Why do we need Electronic Prescribing and administration??
5 Typical Need I Drug say more?? Card
6 Absolute requirements The Chief Executive must lead the project and chair the project board The Medical director or very senior clinician must be the champion leader The non clinical Project manager leads the day to day work with a team of experts and Clinical and non clinical enthusiasts Clinicians must be fully involved and committed to make this work Managers must be fully supportive of the project There must be an acceptance that it needs funding properly
7 Find your patient and summary screen
8 Alerts found here on every clinical screen
9 Height, Weight, Alerts, allergies All added just once per visit and updated as necessary
10 Problem list screen
11 Audit trail
12 Altering the Allergies
13 Home meds convert to active meds
14 To find the SCR you need to enter the NHS spine
15
16
17 Ordering a new medicine
18 Choosing your medicine
19
20 Always have to enter your pin
21 An order set
22 Home and Active Meds on summary screen
23 ALL orders whether Meds,Bloods, xrays or physio
24 This is the MAR
25 To Demonstrate decision support To Demonstrate decision support
26
27
28 Dosage calculated by EP Dose calculated by EP
29 Warfarin Warfarin prescription
30 Decision Support
31 Protocols Protocols
32 Monograph Monograph
33 Show how to taper the dose Show how to taper the dose
34 TTO active medication screen TTO Active Meds screen
35 TTO home meds screen TTO Home Meds screen
36 Control of the Drug formulary We use First Data Bank Medicines can be restricted instantly by access Dramatic effect!! Problems with C.Difficile
37 ABx Doses C.difficile cases CDI v Antibiotic therapy CDAD v ABx Cephalosporins Quinolones Clostridium difficile Apr Aug Dec Apr Aug Dec Apr Aug Dec Apr Aug Dec Apr Aug Dec Apr Time ( May)
38 emar Electronic Medicines Administration Clear unambigious medication instructions Full audit trails Dose timing and variance limit warnings Integration with therapeutic monitoring Gentamicin, digoxin, warfarin, Oxygen sats Warnings allergies, interactions etc Graded drug interactions dose timings, monitoring (electrolyte), Alerts electrolytes, blood counts etc Direct links into labs (blood counts chemotherapy) Integration with assessments and care plans e.g. Chemotherapy toxicity (Vomiting, diarrhoea,)
39 Electronic Prescribing and emar What is next: Further enhanced decision support Further integration with patient records Improved medicines reconciliation Electronic Referrals and Electronic GP summary patient record Bedside verification (Barcode scanning) Enhanced clinical access via internet (web enablement, Tablets etc)
40 PGD s Easy way of restricting prescribing to those with specialist training. Stoma nurse, aroma therapy, chemotherapy, Rheumatology, Dermatology, Respiratory etc
41 PGD options
42 If you don t have access you cant prescribe If you don t have training you wont get access
43
44 Training NOONE has access to any prescribing without training There is No sharing of their own password This is a dismissible offence Takes about 1 hour to train then able to use Electronic record Need ward champions to trouble shoot
45 Requirements to deliver Absolute support from the top Clinicians (not just Doctors) to be involved Enough resources found upfront to back fill for training. Adequate team to build the system Have absolute back up and clinical confidence in system Need Consultant Champions
46 Go Live day Everyone has been trained and with a password Wards have own champions Expert team to support the go live areas Need floor walkers day and night for 2 weeks Prescribing probably the most difficult
47 Clinical Advisory Group The CAG chaired by a senior clinician Broad based members, clinical, admin and computer representatives All computer requests to be brought to this group to ensure overall compliance and stop vested interest group. Meet often enough to encourage and monitor progress
48 Any Questions?
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