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Introducing ePMA into a Paediatric ITU Will Hall - Lead Pharmacist for ePMA Objectives Introduction to the St Georges EPR project Brief explanation of the challenges of paper on PICU Change management strategies Lesson’s Learnt – What would we do differently? Item Metric Number 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 nonintravenous 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 Safety 1990 Pharmacy Information System 2007 2009-11 2010 2010 CPOE Chemotherapy (Prescribing and Admin) Smart Infusion Technology Hospital Wide Cerner PAS 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 ePMA Eliminate End of bed charting combining vital monitoring and medication rates • Adult ICU • Paed ICU Provide Safety in Medication Administration process with Barcode Medication Administration • Patient • Drug, Dose, Time Eliminate additional charts associated with medication trust wide • Epidural • Warfarin Convert all prescription’s to an electronic system Eliminate Medication Charts Trust Wide • Inpatient Discharge • Outpatient • Complete CPOE Specific Challenges in PICU PICU Project 3 Month project Supplement to Enterprise Wide Solution 2 Nursing Leads, 1 Consultant Lead Ready foro-live go-live? Checklist – Sign-off Ward(s):________________ Task Responsibility Task Group initiated Awareness sessions complete Workflow identified, in-scope and out of scope documentation agreed Agreed Hardware complement deployed VDI in place VDI access for individual staff Clinical leads responsible training target: Nursing: DM DM DM CM Clinical Medical: Clinical Minimum 80% staff trained Super Users identified Super Users trained Smartcards supplied and active Policies agreed Policies delivered Downtime documentation identified Downtime Packs in situ 724 computer available 724 printers in place and connections checked 724 training has been provided Appropriate staff added to “Service Bulletins” email distribution list Staff communication sent Pocket Guides provided and printed Staff have received the Staff Readiness Checklist and completed the actions Communications sent to all Clinical Staff PM CM CM Clinical/Training Clinical Training Clinical PM PM Clinical PM PM/DM DM CM CM PM Clinical Clinical PM for Clinical Time before go-live Date Signature Superusers Champion users Pocket Guides Deployment Access to ePMA staff ([email protected]) Listen, Action, Listen, Action Ward handover Audit Redesign Safety comes first Lesson’s Learnt Scope2 Integration Leadership is key Education and Training Task Group Clinical Champion’s and Super users Integration This enables improvements to clinical care