Transcript MedChart is live at SCDHB

MedChart is live at SCDHB
Helen Sharples
In May, South Canterbury DHB introduced
MedChart for the electronic prescribing and
administration of medicines at Timaru Hospital.
Timaru Hospital staff are pushing 30 new COWs
around the wards, but instead of distributing
milk these technical bovines are used for
medication. Relying on paper and pen attached
to a clipboard at the end of the bed will
eventually be over-ridden, now that MedChart is
here.
Affectionately called COWs (Computers on
Wheels) the trolleys have been individually
named with the quintessential Daisy and
Blossom monikers. They were installed for all
adult inpatient wards in May. Children's
medication dosage relies on a weight formula
and that aspect of the computer programme is
being developed in Dunedin.
The system was trialled in two of Dunedin Public
Hospital's medical wards in 2010 and has since
been rolled out there, Invercargill and some
parts of the Canterbury District Health Board. It
is hoped all hospitals in New Zealand will use
the system eventually as well as General
Practitioners and rest homes.
We know that paper-based prescribing, both in
NZ and overseas, is associated with a high rate of
medication errors. Electronic prescribing helps
with prescribing safely, staff with access can log
on to MedChart from anywhere in the hospital,
there are checks for errors and duplications,
automatic warnings show up if a higher-thanusual dose is prescribed, and it is very clear when
changes are made. Administration of medicines is
easier, because prescriptions are clear and there
is an overview of when medication is due.
Nursing staff at Timaru Hospital give dietary
supplements as prescribed on Medchart.
When meds are due an alarm clock icon appears
on the screen against the patient's name. An
alert also shows when medications/supplements
are late or if not given.
There is increased compliance with nursing staff
giving dietary supplements with good
documentation if supplements are declined or
with held.
Drug chart errors due to illegible hand writing a
thing of the past.
The Dietitians, Clinical and Nursing staff have
responded really positively to the significant
changes imposed by the move from paper
charts to the new system. The new system is
easy to use and clear.
Multiple back ups are in place in case of
computer malfunction and staff could revert to
paper again as a last resort. The introduction of
the $300,000 programme over three years was a
big task with 400 staff members undergoing
training for it. The system will have ongoing
costs of about $50,000 a year for the licensing
software, maintenance and replacements.
Support was provided by the Southern DHB
team who were onsite to help with the
implementation and training once the
Dietitian’s formulary was provided by our
team.
Only supplements/sip feeds/vitamins or
minerals/enzymes on the dietitian’s
formulary can be prescribed by the Dietitians
but of caution all meds can be ceased.
To cease a medication you need to enter your
pass word and the reason is asked for.
South Canterbury DHB Dietitian Formulary
Special Foods
For up to date information go to www.pharmac.govt.nz
Vitamin products
Vitamin A with vitamin D and C
Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops
Pyridoxine hydrochloride
Thiamine hydrochloride
Vitamin B complex
Ascorbic acid
Alpha tocopheryl acetate
Multivitamins
Vitamins
Folic acid
Mineral products
Tab 25 mg or Tab 50 mg
Tab 50 mg
Tab, strong, BPC
Tab 100 mg
Water solubilised soln 156 iu/ml, with calibrated dropper
Tab or Powder or Oral liq
Tab (BPC cap strength) or Cap (fat soluble vitamins A, D, E, K)
Tab 0.8 mg
Sodium fluoride
Ferrous fumarate
Ferrous fumarate with folic acid
Tab 1.25 g (500 mg elemental) or Tab 1.5 g (600 mg elemental)
or Tab 1.75 g (1 g elemental)
Tab 1.1 mg (0.5 mg elemental)
Tab 200 mg (65 mg elemental)
Tab 310 mg (100 mg elemental) with folic acid 350 μg
Ferrous sulphate
Tab long-acting 325 mg (105 mg elemental) or Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml)
Ferrous sulphate with folic acid
Tab long-acting 325 mg (105 mg elemental) with folic acid 350 μg
Potassium iodate (iodine)
Tab 268 mg
Calcium carbonate
Oral electrolyte replacement products
Compound electrolytes
Powder for soln for oral use 5 g
Dextrose with electrolytes
Soln with electrolytes
Potassium bicarbonate
Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium bicarbonate 350 mg
Potassium chloride
Tab eff 584 mg (14 m eq) with chloride 385 mg (8 m eq) or Tab long-acting 600 mg
Sodium chloride
Oral liquid
Pancreatic enzymes
Pancreatic enzymes
Cap 10,000 units
Oral electrolyte replacement products
Compound electrolytes
Powder for soln for oral use 5 g
Dextrose with electrolytes
Soln with electrolytes
Potassium bicarbonate
Tab eff 315 mg with sodium acid phosphate 1.937 g and sodium
bicarbonate 350 mg
Potassium chloride
Tab eff 584 mg (14 m eq) with chloride 385 mg (8 m eq) or Tab longacting 600 mg
Sodium chloride
Oral liquid
Pancreatic enzymes
Pancreatic enzymes
Cap 10,000 units
Sip feeds and food modules
Ensure Plus
Fortisip
Fortisip Muilti Fibre
Glucerna Select
Diasip
Fortijuce
Two Cal HN
Pulmocare
Suplena
Nepro
Renilon
Calogen
MCT oil
The formulary can include special foods and
supplements not on the Hospital Medicines List
( HML ) however prescribing these will come
with a warning and you need to select override
to continue. This could be used to include
supplements provided by the patient which can
then be prescribed.
A note can be entered in the qualifier box, such
as “continuation use patient’s own supply”
Fluids are still prescribed on fluid balance
charts.
Enteral feeding regimes are written on
enteral feeding charts by the Dietitians.
MedChart is then updated that an “Infusion
Chart Exists”
MedChart in summary
Pros
• Improved patient safety
• Access to prescribing records easier eg. audits possible
• Can easily check administration of supplements
• Automatic alerts
• Can include protocols
• Rapid access to hospital formulary
• Reference viewers eg. MIMS, Auckland Guidelines,
Medication resources etc.
Cons
• Cost to set up and administer
• Human error still possible