nhs england powerpoint template - eprescribing toolkit€¦ · • ams part of justification in...
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www.england.nhs.uk
6th November 2019
ePrescribing
Masterclass
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www.england.nhs.uk
Masterclass 6th November 2019
1.00pm Welcome & Introductions
Ann Slee, Associate CCIO, NHS X
1.05pm A level up for Gentamicin
Zainab Hussain, Associate Chief Clinical Information Officer,
Lewisham & Greenwich NHS Trust
1.35pm Using ePMA to support Antimicrobial Stewardship
Marianne Taylor, ePMA Lead & Abimbola Olusoga, Advanced
Clinical Pharmacist, Leeds Teaching Hospitals NHS Trust
1.50pm Summary and Next Steps
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A LEVEL UP FOR GENTAMICINZainab Hussain
Associate Chief Clinical Information Officer
Lewisham and Greenwich NHS Trust
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LEWISHAM & GREENWICH NHS TRUST
• Est 1 October 2013
• Serves population of 526,000 across Lewisham, Greenwich & Bexley
• Comprises of:• Queen Elizabeth Hospital in Woolwich
• University Hospital Lewisham
• Community health services in Lewisham
• Services at Queen Mary’s Hospital in Sidcup
• 38 inpatient wards
• ~900 inpatient beds
• ~6500 staff
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THE CONTEXT
• Already live with PAS on Cerner
• Go-live with EPMA in all adult inpatient wards and
ED over a weekend in May at UHL and June at QEH
• Established process for TDM drugs on paper charts
• Harder to replicate this with EPMA
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STEP 1UNDERSTAND THE CURRENT PROCESS
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MEDICINES USEPROCESS
GENTAMICIN
Prescribing
Pharmacy Screening & TDM
Advice
Dispensing
Therapeutic Drug
Level Monitoring
Medicines Administration
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PAPER DRUG CHART
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STEP 2DESIGN & IMPLEMENT
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PRESCRIBE
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PHARMACY REVIEW
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PHARMACY REVIEW
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PHARMACY REVIEW
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NURSING WORKFLOW
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NURSING WORKFLOW
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ADMINISTER
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ADMINISTER
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ADMINISTER
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TDM MONITORING
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TDM MONITORING
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STEP 3EVALUATE THE PROCESS
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TITLE
BENEFITS AREAS TO IMPROVE
› Minimised duplication of entry
› Relevant information available in context of:
› Prescribing
› Administration
› Pharmacy screening
› Weekend and future dose instructions
› Medication administration window
displays last recorded instructions
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STEP 4ADOPTION AND OPTIMISATION
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EXPANSION
• Gentamicin
• Amikacin
• Vancomycin
• Tobramycin
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FACTORS FOR SUCCESS
Involve end-
users early on
Ensure the process
is intuitive
Use clinical decision
support effectively
Minimise
duplication of work Continue to evaluate
after implementation
Minimise disruption
to staff
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Thank You
@ZainabH_ssain
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www.england.nhs.uk
Using ePMA to support
antimicrobial stewardship
Abimbola Olusoga – Advanced Clinical Pharmacist,
Antimicrobials
Marianne Taylor – eMedicines Lead Pharmacist
Leeds Teaching Hospitals NHS Trust
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www.england.nhs.uk
Antimicrobial stewardship (AMS) at LTHT
• 2007 - MRSA/HCAI Improvement Programme
• Guidelines development
• Antimicrobial usage/expenditure
• Antimicrobial incidents
• Reactive AMS approach
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www.england.nhs.uk
Patients
prescribed &
given
antimicrobials
where allergy
stated
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www.england.nhs.uk
• Implemented between 2015 and 2018
• Used in all adult and paediatric inpatient areas (approx
2300 beds)
• Almost all intravenous antimicrobials now prescribed
electronically
ePMA at LTHT
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www.england.nhs.uk
• AMS part of justification in ePMA business case and
written into OBS
• Early decisions:
• Mandate indication
• Build duration into standard prescriptions
• Antimicrobial protocols built for guidelines
AMS considerations - ePMA
implementation
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www.england.nhs.uk
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www.england.nhs.uk
• Over 150 antimicrobial
treatment protocols
• Linked to antimicrobial
guideline
• Duration: 5 days or as
dictated by indication
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www.england.nhs.uk
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www.england.nhs.uk
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www.england.nhs.uk
48 hour clinical review of IV
antibioticsClinical reviews automatically “pop-up”
on opening a patient’s eMeds
prescription
• A prompt to “focus” antibiotic
treatment based on initial response
to best guess antibiotics and culture
results.
• Select cease to change or stop
antibiotics – state why e.g. IVOS
• Select edit to continue and set a
new review date, or to refine the
diagnosis
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www.england.nhs.uk
AMS opportunities with ePMA
• Safer prescribing and administration
• Allergy incidents
• Timing of doses and serum level monitoring
• Promote guideline use / standardise
• Promote clinical review
• Proactive AMS approach
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www.england.nhs.uk
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www.england.nhs.uk
AMS challenges with ePMA
• Alert fatigue?
• Antimicrobial consumption
• Making the most of eMeds data
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www.england.nhs.uk
Any questions?
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www.england.nhs.uk
Masterclass 11th December 2019
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www.england.nhs.uk
Save the date!
All presentations are on the ePMA NHS Futures Website and the toolkit – www.eprescribingtoolkit.com