Electronic Prescribing In Hospitals: Speaker news and updates
This conference looks at moving forward with Electronic Prescribing and Medicines Administration (EPMA) in a hospital setting and where eprescribing fits within your digital roadmap to a paper free at the point of care service. Electronic Prescribing has the potential to support the medicines use process that can be delivered at every stage from prescribing to administration, it can provide management of prescriptions and will also give immediate access to medicines information.
Sessions will provide delegates with the understanding of how to implement and move forward with Electronic Prescribing in practice. Through learning from experienced implementers and case studies the conference will look at critical success factors in going live with eprescribing, and will particularly focus on moving forward with your eprescribing system into more complex areas with case studies in oncology, mental health, intensive and critical care and paediatrics. There will be case studies on Electronic Prescribing which will highlight the clinical benefits and engaging the clinical staff and the impact of eprescribing on prescribing and medication errors. The final session will discuss maintenance of existing prescribing systems and developing new functionality including transitioning between systems.
Speaker News & Presentations
ePrescribing in a Digital NHS
Ann Slee Digital Technology NHS England
- where eprescribing should fit in your digital roadmap
- developing effective measures of eprescribing maturity
- standardizing eprescribing across hospitals
- learning from the digital exemplar sites
- how can we use eprescribing to change prescribing behavior
- moving forward: critical success factors
In her presentation Ann stated:
“National funding is also ways the thorny issues and always the first question – we need to allocate funding and its needs to be a phased approach.”
“We need local/ regional learning networks to support implementation and improvement – we do have exemplar sites.”
“We need to keep that it’s not all about the technology it’s about the people as well”
“Global Digital exemplars – set the pace for paper free NHS – leadership across local systems, 16 acute providers confirmed. They are given a 2-3.5 year timbale to meet ambition.”
“We want exemplars to inspire others by showing how information technology can help deliver a clearly articulated strategic clinical vision.”
“Applications for Global digital exemplars – have a strong buy in, support and collaboration form boards and clinical leadership”
“We will work to develop and sign off a specific blue print for deployment and dissemination across the NHS”
“This is not about technology – its is about digital technologies supporting/ facilitating transformational change”
Ann Slee’s Abstract:
Ann’s session will provide an update on the work that has been progressing around creating a paperless NHS making reference to the work of the National Information Board, the Wachter report and the plans to support advancing digital maturity across the NHS.
Ann Slee’s Biography:
Ann is a pharmacist, an expert in electronic prescribing and a former clinical lead for ePrescribing for England. She has extensive experience in both the development and deployment of ePrescribing systems. She has also worked at Director of Pharmacy level in the NHS leading the development of clinical pharmacy and the modernization of the service using robotics and health-IT. She holds a number of honorary clinical academic appointments, has held a Health Foundation Leadership Fellowship and been a member of the NHS Evidence and NCAS Advisory Boards.
She is currently part of the steering group for the NIHR research grant evaluating the introduction of ePrescribing into secondary care and is leading the ePrescribing work underway as part of the Integrated Digital Care Record initiative with NHS England.
Electronic Prescribing: learning from two decades of experience
Brian Power Lead Informatics Pharmacist Wirral University Teaching Hospitals NHS Foundation Trust
- embedding an electronic prescribing system to drive changes in clinical practice
- engaging clinicians in electronic prescribing and medicines administration
- our approach, experience, critical success factors and developments
- lessons and learning from two decade of electronic prescribing
- challenges in migrating to a new electronic prescribing system
Brian Power’s Full Presentation Click Here
In his presentation Brain stated:
“We have accounts for the majority of in-patient prescribing with some exceptions chemotherapy and a number of ad hoc paper prescribing charts. And are live in all areas except neonatal unit, maternity wards and out-patients”
“Learn from the experience of other sites – see it for real.”
“Get the technology and infrastructure right – network including wireless and devices that are fit for purpose”
“Introduce simpler functionality first and move onto complex”
“Respond to problems/issues – make it easy for staff to report problems”
“Clinician engagement is crucial to the success of any clinical IT project – medical staff, nursing, pharmacy and allied health professionals”
“Engage early and at all stages of the project. Don’t rely on 1/2 enthusiasts. Try and get engagement across a range of experiences and roles (junior doctor and ward nure). EPMA not seen as a pharmacy project but a Trust one”
There have been a number of critical success factors that have allowed us to go on for so long:
- System characterises - easy to logon, fast, reliable
- Strong culture of information governance – robust audit trail available
- Integrated system – PAS, Laboratory, Radiology, Prescribing, Drug administration, Discharge letter, Clinical Documentation
- A stable informatics team with a good range of clinical analysts – prescribing team
- Flexible, agile system that is locally customisable
- Organisational leadership and support
- Continuing clinical engagement
- Mandatory training - No training - no code for all permanent staff
- Electronic data warehouse - For research and audit purposes
The key learning points include
- Evolution – the system is not static. You need to be able to respond to changes, i.e local (formulary or risk changes), National (CQUIN targets for BTE assessment or discharge letters)
- System must have near prefect identity management
- Promotes drug formulary management if have good Drug and Therapeutics committee structure
- The system can fail – downtime procedures need to be in place
- Proactive decision support preferable – too many alerts ignored, promote path of least resistance
- Reduces risks in many areas – eliminates many basic prescribing errors
- Errors will still happen – need the system to capture these problems, do not always blame the users, try and design error out of the system and evaluate changes to ensure they have the desired outcome
Brian Power’s Abstract:
Wirral Hospitals were at the forefront of the implementation of electronic patient record (EPR) systems in the UK. As part of the resource management initiative in the late 1980s the American TDS 7000 system was procured. This included a patient administration system (PAS) and clinical modules and was called PCIS. The challenge of taking this American system and customising it to the UK was undertaken by a team of technical and clinical staff. The initial work entailed rolling out the PAS system followed by ordering and resulting for laboratory and radiology tests. Electronic prescribing and medicines administration (EPMA) were implemented in the early 1990s. This was piloted in a number of wards first before being extended to the majority of wards in the hospital.
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. Again the challenges have been adapting a US system to a British healthcare environment and EPMA was implemented in November 2014.
There are many key learning points from over two decades of experience. One of the key ones being that the system can never stand still. PCIS was continuously maintained and customised in response to drug formulary changes, risk management issues and national initiatives. This is also the case with Cerner. Having adequate resources is essential to ensuring that the EPMA system can be maintained and new functionality added. A robust PAS system is essential as well as having steps in place to promote near perfect identity management to try and prevent wrong patient selection and the serious clinical risk that this brings. EPMA has been instrumental in reducing many of the errors associated with drug prescribing but it is not a panacea and can increase certain types of error.
The success of the system has been due in no small way to the fact that it is easy to log on and that it is fast and reliable. There has been a strong information governance culture with staff being aware of the importance of protecting patients’ data and not sharing passwords. It has been a big advantage having a single integrated system for most clinical applications. This has been seen as a Trust wide system and not just something being imposed on clinicians by the pharmacy department. Continuing clinician engagement is also essential not only not ensure the successful implementation of the system but also to ensure that it is embedded into the hospital to support and improve clinical practice.
The transitioning from one electronic patient record system to another at Wirral was a huge undertaking that took careful planning and required significant investment in terms of resources and technology.
Brian Power’s Biography:
Brian is Lead Informatics Pharmacist at Wirral University Teaching Hospital. He has worked at Wirral since 1999 and he is responsible for the maintenance and development of the electronic prescribing system. In recent years this has involved being part of the team tasked with replacing the legacy electronic patient record system. This culminated with the implementation of the Cerner electronic prescribing and medicines administration system in November 2014. He has also been involved with developing and implementing systems for venous thromboembolism assessment. He has worked clinically as Lead Clinical Pharmacist for the Elderly Care directorate at Wirral and continues to provide a regular clinical commitment.
Future events of interest:
Towards the Digital Hospital
Multi Agency Information Sharing & Information Governance Summit
Electronic Prescribing in Mental Health
Digital Imaging 2017: Radiology Information Systems and PACS
Delivering a Paperless NHS: Intelligent Electronic Document Management in Healthcare
27 January 2017