Electronic Prescribing Medicine Administration (epma)

Transcription

1 Electronic Prescribing Medicine Administration (epma) Christine Walters Director of IM&T The Pennine Acute Hospitals NHS Trust 10 th July 2013

2 How to get IM&T to be seen as a benefit not just a cost Example of securing clinical and executive support for a EPMA proof of concept Understand efficiencies to be gained & benefits for patient safety

3 The Prescription Problem

4

5 The Problem with Medicines On a daily basis I see things that could in some way cause patient harm. Sometimes through omitting regular Mark Twain medicines accidently we may be extending stays as they are without their important medication when they are unwell and really need it. NHS Pharmacist May Copyright 2010 isoft. All rights reserved.

6

7 Independent Special report: Prescription medicines Each year, Britons are dying in their thousands because of the side effects of prescription and over-the-counter medicines. Reported deaths are up 155 per cent in a decade and experts are seeking new safeguards. Nina Lakhani reports Published: 21 October 2007 The report in August 2007 showed that the NHS faced an 8.2bn bill for prescription medicines in England in 2006, as doctors issued 51 per cent more drugs than they did 10 years earlier. An international conference on drug safety which was recently convened in Bournemouth heard that "too little progress" has been made in the past 15 years in training doctors to use medications more safely. Professor Saad Shakir, director of the Drug Safety Research Unit at Southampton University, said: "Doctors need to know how to use medications this is the most important ethical responsibility for us. Surgeons wouldn't conduct an operation they haven't studied and trained for, and these same standards should apply to medications. By using a correctly programmed computer, we believe you can reduce prescribing errors by 90 per cent."

8 Problems with non computerised EPMA 10% of hospital patients are known to suffer an adverse drug error 1,200 lives could be saved per year Each adverse error can extend patient stays by 8.5 days Direct costs to the NHS > 500m Significant year on year increase in reported adverse drug errors c. 76% attributable to acute care

9

10 Common Problems Illegible, ambiguous, incomplete drug charts Time wasted locating charts and deciphering information Missed / late doses that can be harmful or lethal Poor and inconsistent allergy recording / checking Poor communication between clinicians regarding changes or additional doses (e.g. stat meds) Medication charts not re-written in a timely manner Poor visibility of performance and outcome data

11 Benefits of EPMA No hand writing No transcription Choice of medication is rational Reflects on concurrent treatment Gives clear continuity during episodes of care No lost cards Easy review Safer handovers

12 Benefits of EPMA All medicines coded and can be recalled into other documents discharge letters Can be made available for review by GP after patient has been discharged home Displayed on ward round Forms part of life record once electronic much easier to store Transportable especially if web access Reduced LOS Control drug spending

13 Option to do nothing? Paper-based medicines systems are not fit for a modern NHS Ever increasing problem Therapeutic sophistication Increasing complexity of acute care Greater pressures on resource Ageing demographic Making mistakes is human, but carrying on with them is devilish. Philosopher Seneca

14 It s Not What is EPMA? An extension of a pharmacy system About the dispensing and delivery of medicines Solely concerned with the writing of prescriptions

15 It Is What is epma? Concerned with improving the flow of information and communication between prescribers, nursing and pharmacy Concerned with helping to improve the appropriateness, safety and timeliness of medicines that are prescribed and administered to patients A means by which clinical and operational performance can be continually monitored and improvements identified

16 Electronic Prescribing Utilising wireless technology to bring together all necessary information regarding the patient and medicines, to enable prescribing at the point-of-care.

17 Key Characteristics of an epma Solution Real-time clinical decision support Allergies Interactions Dosing (min/max/cumulative) Contra-indications Workflow alerts Intuitive prescribing Clarity of drug selection Formulary control (content, structure, access) Simple and complex prescribing (enterprise scale) Electronic drugs chart Similar format to paper charts Single view of of prescribing, administration and pharmacy activity Indication of time critical doses and alerted prescriptions Audit capability Visibility of decisions (what, when, by whom, outcome) Reporting and data analysis capability Enterprise class Embed with existing systems Flexibility of access Secure and robust

18 Electronic prescribing in hospitals has proven to be extremely challenging It is not a single discipline system consider Primary Care prescribing Doctor Patient Secondary Care Nurse acts as supplier to patient Could also be Self Medication patient All processes need reviewing and updating Development costs have been high and lengthy Need a multidisciplinary approach - VITAL

19 Route to success Top management of hospital to agree to do it Chief Exec to commit resource to set up a team of clinical and IT professionals for a defined project period with milestones to achieve - multidisciplinary approach - VITAL The resource committed must realise that once EPMA is set up it can never be allowed to fail because it will be even harder to introduce a second time

20 Route to success Proof of concept Prove product works Streamline/revise processes until fit for purpose Training approach/mechanisms demonstrated to work Strong Clinical leads Doctors/Pharmacy Clinical staff e.g. nurses to support implementation / training of staff ROI - benefits demonstrated as realistic and achievable benchmarking prior to and at conclusion of the proof of concept Clinical champions from early adopters

21 Proof of concept Route to success Understand mobile access needs pilot with clinical staff/supplier Partnership working Supplier & Trust s IT / Clinical Staff Ability/willingness to modify solution / responsive supplier Speedy response to issues Patient safety paramount at all times Demonstration of proven working solution to senior clinical staff and Execs at earliest opportunity Communicate success to the organisation via doctors/nursing/pharmacy meetings newsletters/intranet film staff and solution in action Proceed at a pace that will help to gain confidence in the solution

22 Solution Orientated Approach Not about installing software Requires investment from the software supplier and customer to develop a deep understanding of local clinical and operational process Full appreciation of the impact of the software on clinical and operational process and patient experience Requires an agile approach to implementation through which a solution definition evolves (flexibility with discipline) Focus on outcomes and improvements

23 Demonstrate ROI

24 Example ROI Forecast

25 In Summary Paper-based medicines systems cannot meet the needs of a modern health service Technology can offer significant benefits for patient safety, operational performance and clinical outcomes Technology is not about installing software Technology will support the transformation of patient care management with the right approach Clinical/senior management leadership vital for success Demonstrate and prove ROI at the earliest opportunity Success breeds success

26 Final Thoughts He wrote in a doctor s hand, which from the beginning of time has been so disastrous to the pharmacist and so profitable to the undertaker Mark Twain Those who fail to learn from history are doomed to repeat it. Winston Churchill

27 Final Thoughts It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. Charles Darwin ( ) founder of modern evolution theory

28 Questions