Post on 17-Jan-2018
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Introducing ePMA into a Paediatric ITU
Will Hall - Lead Pharmacist for ePMA
ObjectivesIntroduction to the St Georges EPR projectBrief explanation of the challenges of paper
on PICUChange management strategiesLesson’s Learnt – What would we do
differently?
Item MetricNumber of core facilities 3
Number of beds 1,000
Full Time Equivalent 7,173
Total Headcount 7,700
Number of IP admissions /year 107,976
Number of IP Daycases / year 26,925
Number of OP attendances / year 683,490
Number of ED attendances / year 163,810
Number of operating theatres 29
Number of births /year 5,118
Number of critical care beds 90
‘The error of one moment becomes the sorrow of whole life.’
A Chinese Proverb
Medicines safety is a key concern Errors do occur, UK studies show that:
o Prescribing errors occur in 1.5 - 9.2% of medication orders written for hospital inpatients
o Dispensing errors are identified in 0.02% of dispensed items
o Medication administration errors occur in 3.0 - 8.0% of non-intravenous doses and about 50% of all intravenous doses
The use of ePrescribing can help reduce such errors
Source: Vincent C, Barber N, Franklin BD, Burnett S.The contribution of pharmacy to making Britain a safer place to take medicines.
Royal Pharmaceutical Society of Great Britain: London; 2009.
Our Quest towards Comprehensive Medication Safety
Medication Safety:Long term global vision
To perfect the medication delivery system to be safe for every patient, every time, while
making it easy for caregivers to do the right thing, and impossible to do the wrong thing.
Comprehensive Medication Safety1990 Pharmacy Information System
2007 CPOE Chemotherapy (Prescribing and Admin) 2009-11 Smart Infusion Technology Hospital Wide 2010 Cerner PAS2010 Robotic Medication Dispensing in Pharmacy 2012
Cerner CPOE (Radiology & Laboratory)
06/2014 Cerner ePMA & Clinical Docs
06/2014 Cerner Care Administration
Initial Aim’s and Scope of ePMAEliminate End of bed charting
combining vital monitoring and medication rates
Provide Safety in Medication Administration process with
Barcode Medication Administration
Eliminate additional charts associated with medication
trust wide
Convert all prescription’s to an electronic system
Eliminate Medication Charts Trust Wide
• Adult ICU• Paed ICU• Patient• Drug, Dose, Time• Epidural• Warfarin• Inpatient Discharge• Outpatient
• Complete CPOE
Specific Challenges in PICU
PICU Project3 Month projectSupplement to Enterprise Wide Solution2 Nursing Leads, 1 Consultant Lead
Change Management
Ready for go-live?
Task Responsibility Time before go-live
Date Signature
Task Group initiated PM Awareness sessions complete CM
Workflow identified, in-scope and out of scope documentation agreed
CM
Agreed Hardware complement deployed DM VDI in place DM
VDI access for individual staff DM Clinical leads responsible training target: CM Nursing:
Clinical
Medical:
Clinical
Minimum 80% staff trained Clinical/Training Super Users identified Clinical
Super Users trained Training Smartcards supplied and active Clinical
Policies agreed PM Policies delivered PM
Downtime documentation identified Clinical Downtime Packs in situ PM 724 computer available PM/DM
724 printers in place and connections checked DM 724 training has been provided CM
Appropriate staff added to “Service Bulletins” email distribution list
CM
Staff communication sent PM Pocket Guides provided and printed Clinical
Staff have received the Staff Readiness Checklist and completed the actions
Clinical
Communications sent to all Clinical Staff PM for Clinical All clinical staff have correct Smartcard access
(including clinician tick for all prescribers) Clinical/PM/ back office
Temporary access cards available and procedure and documentation available
Clinical/PM
Patients/Carers informed of change Clinical Downtime poster displayed CM/Clinical
Posters displayed on ward RE: access to clinical champion users and floor walking support
DM
Email iclipepma to remove prescribing restrictions CM 1.5 weeks Ward debrief time scheduled All
Transcription strategy agreed by Clinical Leads CM/Clinical 2-3 weeks Daily email distribution list been decided for FAQ’s
and issue/resolution log Clinical
Superusers
Champion users
Pocket Guides
DeploymentAccess to ePMA staff (
epma@stgeorges.nhs.uk) Listen, Action, Listen, Action
Ward handoverAudit
RedesignSafety comes first
Lesson’s LearntScope2
IntegrationLeadership is keyEducation and TrainingTask GroupClinical Champion’s and Super users
Integration
This is only the beginning..This enables improvements to clinical care