connecting an electronic medication management system …connecting an electronic medication...

Connecting an electronic

medication management system

with a third party antimicrobial

stewardship approval system

Louis CheungeMEDs Design Lead

South East Sydney Local Health District

Smarter Safer Better


ACSQHC

Governance and systems

Infection prevention and controls

Managing patients

Antimicrobial stewardship

Cleaning, disinfection and sterilisation

Communicating with patients and carers

Standard 3: Preventing and Controlling Healthcare Associated Infections


Antimicrobial Stewardship

Safe and appropriate antimicrobial prescribing is a strategic goal

of the clinical governance system

Priorities

• Optimise antimicrobial use to improve patient outcomes

• Ensure cost-effective therapy

• Reduce adverse sequelae of antimicrobial use, including resistance

Systems

• Monitor usage and resistance with feedback to prescribers

• Restrict broad-spectrum and later generation antimicrobials to specific patients

• Obtain specialist advice for difficult clinical conditions


SESLHD

• 5 major teaching and referral hospitals

− Prince of Wales Hospital

− Royal Hospital for Women

− St George Hospital

− Sutherland Hospital

− Sydney/Sydney Eye Hospital

• Resident population > 800,000

• Large metropolitan geographical area


Paper medication charts with minimal enforcement of antimicrobial policy

District Guidance Medication Council to oversee clinical governance system

Implementation of eMEDs to replace paper medication charts

Introduction of GuidanceMS to monitor restricted antimicrobial use

Paper

Guidance

GMC

eMEDsElectronic antimicrobial medication orders and potential integration with GuidanceMS

Develop GuidanceMS in line with antimicrobial policy and provide clinical decision support

Antimicrobial use restricted by pharmacists during business hours

Clinical management, oversight, assessment and assurance of quality and safety

SESLHD


eMEDs

eMEDs Scope and design deliverables

• National Inpatient Medication Chart

− Warfarin

− Clozapine

− VTE

− Antimicrobials

• National Medication Management Plan

• ACI Subcutaneous Insulin Prescribing Chart

• SESLHD Depot Medication Chart

Proposed

Interim

Final

• Developed in consultation with key stakeholders

• Design and build in non-production domain

• Validation by key stakeholders

• Subject to testing

• Approved for implementation in production domain

• Subject to monitoring and review


Design and Implementation

Collaborating with AMS team to develop a comprehensive solution design

POW

Emergency

RHW• For all antimicrobials

− Mandatory indication

− Indications filtered by medication

• For restricted antimicrobials

− Mandatory approval number

− Link to GuidanceMS portal

• For highly restricted antimicrobials

− Mandatory approval number

− Contact #s for ID and Microbiology

− Pharmacy alerts if highly restricted

Benefits

Assessment

Working with AMS and Guidance

Support

Training

Testing

eMEDs

Change and

Adoption

Processes

https://thenounproject.com/term/hospital/2230








2015 Specialty / Ward

Oct Geriatrics

Nov Cardiology, Cardiothoracic Surgery

Dec Respiratory, Stroke, Unit, General Rehab

2016 Specialty / Ward

Feb Surgical, Corrections Health Unit

Mar Haematology, Oncology, Renal, Palliative Care

Apr Emergency Department, Spinal, Neurology

May Mental Health Unit

Jun Royal Hospital for Women


Results

279

93

525

267

0

100

200

300

400

500

600

Medical Wards Surgical Wards

Standard Approvals in GuidanceMS

Mar - Jun 2015

Mar - Jun 2016


Results

473

234

161

115

0

100

200

300

400

500

600

Medical Wards Surgical Wards

Pharmacist Alerts in GuidanceMS

Mar - Jun 2015

Mar - Jun 2016


Results

Data Source: Ross Vergios, Antimicrobial Stewardship Support Pharmacist


Results

5

25

132

20

25

50

75

100

125

150

Standard Approvals Pharmacy Alerts

Emergency Department

May - Jun 2015

May - Jun 2016


Results

Data Source: Ross Vergios, Antimicrobial Stewardship Support Pharmacist


Optimisation and Outcomes

• Patient safety

− Access to information at the appropriate time

− Facilitate intuitive and proper workflows

− Consistent use of clinical decision support across sites

• User Acceptance:

− Standardised indications

− Notify only when antimicrobial is restricted

− Obtain approval and document within same medium

• Compliance with district, state and national policies

• Alignment with state and national terminology and standards (e.g. TG, CEC, NAPS)

• Standardisation and adoption of content and design across district and state

• Facilitation of reporting requirements for local and national use


“I Don’t Need One” “Someone Else Will Do It”“Anything

Goes”

“I’ll Make My

Own”No Access

Not obtained Clin OT broe pending XXXXXXXX 1550371UNABLE to

login

n/a Clinically re’d As per Dr.SU Awaiting 10 742367 Unable to put

Not needed emerg ID TBC X 2587-98 Unable

As per

regularRESUS UNABLE

DW ID

consultant

As per med

regPHR-1605-X XX25556 No access

Not required Resus ID please Unknown

Tasking on

admisOn from home TBA ….

Indicated Commenced ICU Prof Lloyd Xxxx

EDPost surg

prophylaxID approval Xxx

Sepsis

empiricED consultant As per team

ICU OngoingDay team to

do Data Source: Ross Vergios, Antimicrobial Stewardship Support Pharmacist

Optimisation and Outcomes


Sutherland Hospital

Sydney/Sydney Eye Hospital

eMEDs

Integration with clinical workflows e.g. sepsis

Options to minimize gaps in CDS and policy

Potential interface between two systems

eMEDs-GuidanceMS

Oversight of indication-based prescribing

Targeted monitoring of antimicrobial use

Intervention at clinician or medical service level

eMEDs-AMS

Sydney

Wollongong

Sutherland St George

Future Directions

RHW

POW













Thank you


connecting an electronic medication management system …connecting an electronic medication...

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