HA Convention 2015 by
Dr CB Leung Chairman, IPMOE@NTEC Taskforce
Cluster Coordinator (Clinical Informatics)
Implementation Journey of
Inpatient Medication Order
Entry Project in Prince of
Wales Hospital
Background
• Medication Incidences are significant Risk
to patients and Health Care Providers
• HA decided to look into different ways to
decrease risk to patients – IPMOE（住院病人藥物處方系統）is one of the
measures
Background (2)
• Prince of Wales Hospital is the third HA
Hospitals to implement IPMOE
• To try out different mobile devices (流動裝置) for different user groups
– Ward-based mobile devices with storage
facilities with charging utilites
• First Live run on July 9, 2014 in a general
medical ward (10A)
1. Doctors prescribe via IPMOE
2. Nurses login and view MAR via IPMOE
3. Nurses scan Barcode on drug bag to verify Right drug & Right time
System auto-assign schedule & sort out drugs due for administration
Patient Identity & Drug data are transmitted to scanner via Bluetooth
4. Nurses scan Barcode on patient wristband to verify Right patient
Drug administration details are clearly documented in the system
Pharmacists receive the order,
vet and dispense drugs to ward
Administration record can be seen in pharmacy to facilitate drug refill
Drug order details are sent to Pharmacy System electronically
IPMOE: Close Loop & Paperless System
Doctors
• Can enter / review patient medications at
their bedside (real time)
• Avoid unnecessary transcriptions to save
time and enhance safety
• IPMOE medications can be directly
selected and copied from previous
prescriptions and to discharge prescription
Hardware Provision: For Prescription
Wall mount CMS
iPAD air iPAD mini
For doctors: Desktop computers and mobile devices to access computer system.
– Processing around 3000 inpatient
prescriptions daily
– Benefits of IPOE
• Real time profile update
• Verify against the eMAR
• Minimize redundancy
• Minimize drug return
• Minimize drug wastage
• Improve track-and-trace along the
dispensing process
Pharmacy
Handwritten
-Difficult to read
-Error-prone for look-alike-sound-alike drugs
-Transcription required
Electronic
-Clear & complete details
-NO transcription
Tedious & incomplete
transmission Delayed update of
profile
Dispense by receiving orders,
no priority setting
Lot of paper used
Today …
Hardware Provision: For Drug
Administration
Toughpad
For nurses: Tablet Set (T-set): A tablet mounted in a drug trolley mapped with assigned bluetooth printer and barcode reader.
Preparation - Quality and Safety
• risk assessment
• preparation of rollout
• systematic techniques for failure analysis
using Failure Mode and Effects Analysis
(FMEA)
• drill was arranged before rollout
Prescription
Dispensing
Administration
IPM
OE
p
rocess
Risk Assessment and Actions – overseas literatures and local understanding
Single IPMOE process
50 Potential failure modes (3 IPMOE related, 9 actionable)
13 Action items
Significant scenarios
23 Potential failure modes (8 IPMOE related, 7 actionable)
7 Action items
Significant scenarios along patient’s journey
A real play !! Pilot Ward, Pharmacy,
CMS Team,
HOIT Call Centre, Q&S
Risk Matrix (居安思危，未 雨綢繆)
Q CONSEQUENCE
Insignificant Minor Moderate Major Extreme
LIK
EL
IHO
OD
Alm
ost
cert
ain
L
ike
ly
Po
ssib
le
Un
like
ly
Re
mo
te
IPMOE
Preparation – Engagement with Key
Stakeholders: NTEC IPMOE Forum
17
PWH iPMOE web http://ntec.home/pwhipmoe/pwhipmoe_main.htm
18
IPMOE Usage in PWH • Close loop and Paperless System
– Doctors (drug prescription)
– Pharmacy (drug dispensing)
– Nurses (drug administration)
• Use of Mobile Computing technology
– REDUCE Medication Error減少錯誤
– IMPROVE Patient Safety改善安全
– IMPROVE Efficiency提高效率
IPMOE Usage in PWH (2)
• Time 天時
– Development of a corporate system
• Place 地利
– Good AOM culture and standardization
– Strong quality and safety team
– Good local IT support and Infrastructure
• Person 人和
PWH is the first hospital in HA
to have IPMOE in … • Early involvement of Quality and Safety Team
• Extensive use of Mobile Devices to facilitate workflow of
frontline staff in ward setting
• ALL in-patient wards and areas providing service to in-
patients (e.g. Endoscopy, Radiology, Operation
Theatre), in particular,
– Obstetrics wards, including labour ward (a big bang)
with standing order
– Intensive Care Unit, using CITRIX connection to CMS
in CIS workstations (medical network)
– Paediatrics (including CCC, PICU and NNU)
– Oncology
IPMOE “In-Patient Medication Order Entry”
• IPMOE first rollout in ward 10A on July 9, 2014.
• Successfully rolled out in about 90% of wards
• Tentative date of EM ward rollout on 3/6/2015
• Visits by other hospitals for experience
sharing
– AHNH (5/3/2015)
– PYNEH (9/3/2015)
– NDH (23/3/2015)
– TMH / POH (6/2015)
IPMOE “In-Patient Medication Order Entry”
• IPMOE team in the NTEC Annual Plan Media
Briefing on Aug 29, 2014
IPMOE “In-Patient Medication Order Entry”
Prince of Wales Hospital
Thank You!
