Learning from Wirral University Teaching Hospitals NHS Foundation Trust's two decades of experience in Electronic Prescribing
Brian Power, Lead Informatics Pharmacist, Wirral University Teaching Hospitals NHS Foundation Trust share’s Wirral University Teaching Hospitals NHS Foundation Trust’s extensive experience in Electronic Prescribing at today’s conference.
In his presentation Brian discussed:
- 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 is available for download at the end of this page.
In his presentation Brain Stated:
"The key is to try and make sure you've got buy in from outside the pharmacy department"
"It's got to be fast reliable and easy to log on"
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The original EPR system was used for over two decades but it has been replaced by the Cerner Millennium system.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 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.
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Download: Brian Power"s full presentation6 October 2015