Transcript E-Discharge with formulary control

E-Discharge with formulary
control
David Rose
Clinical Design Lead
Introduction
• Good Afternoon!
• Not Rhian Rice
• Technical design architect
• e-Discharge
• e-Formulary (drug file)
• Importance of this
• Budget control – least important aspect
• David Rose
• Clinical Design Lead (NWIS)
• Senior Pharmacist – Lead IM&T ABMU HB
• Overview of what’s going on in Wales
Why Me
• Implemented an e-discharge system in 800 beds
6 years ago
• At least 80% of Pts have a completed
discharge summary within 48hrs
• NWIS invited me to help out with design of WCP
• E-discharge & medicines management tool
• involved with the clinical design
• UCD sessions across Wales
• Worked closely with the developers / clinicians
• Designed the pharmacy elements of WCP
• 3 yr process
Background
• Different in Wales
• No CfH
• NWIS
• No money!
• Limited resources / funding from
Welsh Government
• Use it wisely!
• Enter the Welsh Clinical Portal
Clinical Information Flow
Out of hours
Individual
Health
Record
GP
Systems
My Health On Line
Welsh
Clinical
Portal
Integration on one platform
Existing Hospital and community
systems
•PAS – administration
•RADIS2 – radiology system
•CANISC
•Pharmacy
•TELPATH – pathology system
•PACS - radiology image store
New information Services
Pathology ordering
Radiology ordering
PACS Sharing ( GE )
Laboratory Information M.S.
(Intersystems)
Creation and viewing of letters,
clinical notes, discharges
Welsh Clinical Portal
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One stop shop for clinicians
PAS
Biochemistry
Radiology
Information sharing
Medication
• Not e-Prescribing tool
What about Pharmacy?
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Information retrieval
Drug reconciliation
e-discharge
Supply of medication from ward
level
• One stop dispensing
• Patient counseling / production
of compliance aids for pts
• Information entered ONCE only
• Re-used
Audience Participation
• Process map patient pharmacy journey
• How many times does a list of drugs
get transcribed?
• 4,5,6,7 maybe more depending on
your systems
• Huge opportunity for error!
• 5 % at each transcription
Where do you start?
• Looked at existing systems across Wales and England
• Commercial offerings
• Didn't fit the model that we wanted
• We couldn't afford to adapt them
• There is NO standard drug file!!!!
• Complex beast…..
• Previous speakers have eluded to this
• VTM, AMD, VMP
• Large no of sites in Wales use a legacy pharmacy system
• EDS
• Drug files are very different
• Decided to build our own
If you build it they will come!
The Issues
• We needed a common formulary
• Look up tool
• Information resource
• Most sites use EDS
• JAC: 1 site
• Ascribe: 1 site
• Massive differences between files
• Worked with FDBE to map the files
• Created a common file
• Linked it to dm&d codes
The Solution......
• Medusa
• Purchased UCHL “Inform” product
• 2009
• Used dm&d codes
• Mapped this to every item in Wales
• Allows us to share info with GP
systems
• Community pharmacy
• WCCG
2011
• Each site has it's own version of the master
formulary
• Locally and nationally maintained
MASTER FORMULARY
SITE 1
SITE
SPECIFIC
LOGIN
SITE 2
WELSH
CLINICAL
PORTAL
SITE 3
Benefits
• Guides selection for data input
• Reduces selection options
• eg: Paracetamol
• 22 lines
• Hundred + products
• Provides point-of-care information
• Links to e-BNF, SPC and IV guide
Lets have a look!
So What!
• Formulary now in operation
• Medicines management system built around this
• This in turn is built around the patient
management software (WCP)
• Developed and agreed a common dose syntax
across Wales
• ShareD this with the medical schools and SOP
undergraduates
• Iterative development
• About to pilot across hospitals in Cardiff & Vale
Health Board
Summary
• We are trying different things
• We hope that we are moving in the right
direction
• Trying to link everything together
• This is NOT an e-Prescribing system
Questions?