Transcript Benefits of EPMA at QEH, Birmingham

Benefits of EPMA at
QEH, Birmingham
Asif Sarwar
History of PICS at QEHB
• 1,200 bedded tertiary referral and University teaching
hospital
• £545million new development opened June 2010
• EPMA across all in-patient beds
– Not yet in A&E, theatres, dialysis
From this
to this
using these
Description
Information
Hospital
1200+ beds
PICS Specialties
17
PICS registered users
Weekly logins
Peak concurrency
>5000
3900
- 960 doctors
- 2470 nurses
500+
Weekly prescriptions
Weekly administrations
32,000
137,000
OPD episodes
10,000 per week
Support people who work with medicines – “A guide on the side”
EPMA provides us with:
– Legible instructions
– Reviewing medications history
– Access to further information
– Clear guidance on what to do next
• Expert error detection
– Rules based surveillance with alerts outside order entry
– → Reduce errors of omission or commission
Rules-based clinical decision support
Prescribing
• defaults
• dose validations
• interactions
• drug
• clinical condition
• serological state
• duration of scripts
• by specialty where
necessary
External/Internal links
Lab results Cross-Referencing
PICS – a developing Electronic Clinical Record
Laboratory
Flow Sheets
Fluid
Balance
Urinalysis Charts
Infection
Control
Clinical Flags
Operation
Noting
Physiological
Observations
Electronic observations charts
Recognising and Responding to the Deteriorating Patient
• Automated text
messaging /pager alerting
• Evaluation of the
recognition of
deteriorating patients
• Can be linked into
medication rules
However...
• It still requires human interactions
IT related errors
• Look-alike drugs
• Picklist choice/keystroke errors
• Alert fatigue
• Workarounds
What about pharmacy?
• Reduced missed doses
• Intervention logging
• Records of drug histories
• Warfarin alerts
• High-risk drug flag
• Formulary enforcement
Its greater than the sum of its parts
• Bee aware
• E-transfer of discharge letters to GPs
• 100% compliance with thrombosis assessment
• Compliance with dementia screens
• Barcode scanning of patients to confirm identity
So what....
• Every click is auditable
• Improved patient safety
• Juniors at weekends don’t have to re-write charts; more
time on actual patient care
Clinical Dashboard
Turning data into information
Antibiotic - % Missed Doses
Date
A
15 April 2009
Pause function for doctors
B
04 August
2009
15 December
2009
24 February
2010
30 March 2010
Missed Doses go live on clinical dashboard
C
D
*
D
*
Step change in % missed
doses when information
shared with clinicians /
managers
Further highly
significant change when
CEO started RCA
meetings
Intervention
Introduction of coloured indicators to show due /
overdue drugs
NPSA Rapid Response Alert
Chief Executive Missed Dose Root Cause Analysis
meetings
Thank you – Any Questions?