Transcript Whats wrong with a piece of paper”

“What’s wrong with a
piece of paper?”
The Electronic Transfer of Care
Princess of Wales Hospital
Rowena Lewis
Electronic Transfer of Care
(e-TOC)
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Clinical information
Medication information
Sent electronically to GP
10 medical wards over two sites
2 mental health wards
2 orthopaedic wards
The situation that had to
change
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“Mind the gap!”
Carbon copy paper take-home prescription
Patient had to transfer information
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Varying clinical summary sent or not sent at all
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GPs asked for better communication
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Aims of e-TOC project
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Improve discharge communication from
hospital to primary care.
Improve patient safety and reduce clinical risk
by providing better medication information to
GPs.
GPs to receive in a timely manner with a
target of 80% discharge summaries within 5
working days.
Objectives
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Carbon copy → typed medication list
Transfer electronically to GP immediately
Reasons why medicines are started and
stopped - NICE/NPSA medicines
reconciliation
Provide GP with full clinical details in uniform
format
Method
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Designed by clinicians
Produced by our IT
department
Accessed via PIMS+
Hospital wide wireless
network
Ward Process
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Junior doctor enters initial information
Updated during patient stay
Doctor marks “ready for discharge”
Pharmacist verifies medication list
Junior doctor completes clinical info
Consultant approves it for GP
Implementation
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One ward pilot
Many improvements made initially
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Dosage codes taken from the pharmacy system
Colours and symbols distinguish between new,
changed and stopped medicines
Format of printed list of medication to improve
clarity
Screen icons to aid communication between staff
Laminated crib sheets
Helpful hints boxes
Key Success Factors
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Gradual roll out
Dedicated project manager
Multidisciplinary training sessions
Regular feedback from all users
Key Success Factors
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Frequent updates to system
Regular audits of doctors input
On site IT support
Determination to succeed
Training within Pharmacy
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Pharmacist users
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Entering medication
Verifying medication
Signing off medication
Trouble shooting
Regular updates
Listening to feedback
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Ward Technicians
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Marking drug chart
Dispensing from drug
chart
Dispensary staff
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New format of discharge
prescriptions
Printing medication
orders
Benefits of e-TOC
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Patient
Pharmacist
Doctor
Nurse
GP
96% of patients have verified medication
sections sent to their GP on day of discharge
– includes diagnosis and follow up
arrangements
Time taken and percentage of discharge summaries
received by GPs
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
89%
70%
40
35
30
25
20
15
10
5.7%
5
0
Paper system
Average of eTOC w ards
Best performing eTOC
w ard
Percentage of discharge summaries received by GP
Time taken to receive summary (days)
How much have we achieved?
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Increased number of summaries sent to GPs
Improved timeliness of communication to
primary care
Gradual implementation helped acceptance
of system in hospital
Have targets been reached?
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Not achieved on all wards yet!
Average is 70% in 9 days
Much better than 5.7% in 37 days
Changes to practice have been challenging
Sharing workload has helped
Benefits to Pharmacists
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Medication on e-TOC system prior to
discharge
Order function linked to dispensary
Access to previous e-TOCs
Legible list to give patient at discharge
Lessons learned
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Thorough training
required
Need modern
computers
Helpful IT staff
available to assist
Regular updates to
system
Enthusiasm and
determination
The future
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Finish implementation across hospital
Electronic learning package for users
Medication reminder cards
Pharmaceutical care plan
Summary
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Clear communication
Greater detail of medication changes
Transfer of information to GP is guaranteed