Electronic Prescribing Medicine Administration

(ePMA)

Christine Walters Director of IM&T

The Pennine Acute Hospitals NHS Trust10th July 2013

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 conceptUnderstand efficiencies to be gained & benefits for patient safety

The Prescription Problem

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The Problem with Medicines

Mark Twain 1835 -1910

On a daily basis I see things that could in some way cause patient harm. Sometimes through omitting regular 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 2011

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."

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

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

Benefits of EPMA

No hand writingNo transcriptionChoice of medication is rationalReflects on concurrent treatmentGives clear continuity during episodes of careNo lost cardsEasy review Safer handovers

Benefits of EPMAAll medicines coded and can be recalled into other documents – discharge lettersCan be made available for review by GP after patient has been discharged homeDisplayed on ward round Forms part of life record once electronic much easier to storeTransportable especially if web accessReduced LOSControl drug spending

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

What is EPMA?It’s Not

• An extension of a pharmacy system• About the dispensing and delivery of

medicines• Solely concerned with the writing of

prescriptions

What is ePMA?It Is

• 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

Electronic Prescribing

Utilising wireless technology to bring

together all necessary information regarding the patient and medicines, to enable prescribing at the

point-of-care.

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

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

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

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

Route to success• Proof of concept

• 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

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

Demonstrate ROI

Example ROI Forecast

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

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 1835 -1910

‘Those who fail to learn from history are doomed to repeat it.’Winston Churchill 1874- 1965

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 (1809-1882)founder of modern evolution theory

Questions