News and updates from today’s conference looking at moving forward with Electronic Prescribing and Medicines Administration (EPMA) in a hospital setting and where eprescribing fits within Trust digital roadmaps to paper free at the point of care service.
Towards the Digital Hospital: Electronic Prescribing within EPR
Dr Mike Fisher, Chief Clinical Information Officer and Consultant Cardiologist, Royal Liverpool & Broadgreen University Hospitals NHS Trust
In his presentation Dr Fisher made the following comments;
Progress is sometimes overstated it has not been as great as we would like
Projects- always starts with a clinical problem
If your strategy/scope is too wide it will not be achievable
Forward planning is key to help prevent problems occurring
A digital road map is useful in planning
Advice, support and training- classroom does not work in - takes too long, people forget before going live- need to think about strategy- floorwalkers are critical
In this talk I will briefly address the drivers and rationale for ePrescribing, but will try and set this in the context of a framework for considering the potential pitfalls of clinical informatics projects generally. I will then use this framework to show how some of the potential problems may arise from only considering stand-alone prescribing systems and also try and suggest how time invested in deploying ePrescribing as part of a wider and more inclusive EPR, may deliver benefits in clinical usability, patient safety and ultimately in being able to deliver on national priorities.
Advanced Electronic Prescribing: Moving Forward
Brian Power, Lead Informatics Pharmacist, Wirral University Teaching Hospitals NHS Foundation Trust
Electronic prescribing has been described as “the utilisation of electronic systems to facilitate and enhance the communication of a prescription or medicine order, aiding the choice, administration and supply of a medicine through knowledge and decision support and providing a robust audit trail for the entire medicines use process”. Wirral Hospitals were at the forefront of the implementation of electronic patient record (EPR) systems in the UK in the late 1980s. The initial work entailed rolling out a patient administration system (PAS) system followed by ordering and resulting for laboratory and radiology tests. Electronic prescribing and medicines administration (EPMA) were implemented in the early 1990s. The original EPR system was used for over two decades but it has been replaced by the Cerner Millennium system. Cerner Millennium is another integrated EPR system and this has been implemented gradually over the past few years with EPMA implemented in 2014.
Many more acute trusts in the UK are implementing EPMA and NHS England has introduced the digital maturity index to allow Trusts to benchmark against each other and identify areas for development. This defines advanced e-prescribing as in-patient prescribing including chemotherapy and the use of decision support to optimise prescribing. Embedding EPMA into a Trust is a massive challenge and the key is to have good clinical engagement as early as possible in the project and on an ongoing basis.
To move forward and sustain and develop EPMA requires a system that is fast, easy to use and reliable. There needs to be a recognition that the system can never stand still. It needs to be continuously maintained and customised in response to drug formulary changes, risk management issues and national initiatives. Having adequate resources is essential to ensuring that the EPMA system can be maintained and new functionality added. It is important that the EPMA system is as comprehensive as possible and any paper prescribing charts are migrated to the electronic system where possible. This can be difficult to achieve with some of the more complex medicines.
Integration across care interfaces is another key priority in medicines management. This helps ensure optimal treatment and a reduction in medication errors. Again this involves a move from paper processes to digital ones. National initiatives such as the summary care record support this and ongoing work is required to allow the seamless transfer of electronic medicines information across different systems.
EPMA has been instrumental in reducing many of the errors associated with drug prescribing but is implicated in creating some new errors or having some unintended consequences. These errors can happen at all stages of the medicines use process and it is important that steps are in place to identify and mitigate these errors where they occur.
Future related events:
15 January 2018