Transcript eMedicines Administration: Practical Implications

eMedicines
Administration:
Practical Implications
Chris Fokke RGN, BA Hons, MSc. IT
Chief Clinical Information Officer
Hampshire Hospitals NHS Foundation Trust
Session overview
• Share experiences from HHFT regarding changing from
paper-based to Emedicine administration
• Concentrate on practical approach on how roll out was
achieved successfully
• Lessons learnt and opportunities
Professional context to introduce
Emediciness administration
• Include operational & senior staff in preparing for Go Live
and process changes
• Nursing had anxiety regarding professional accountability
(NMC code of conduct)
Section 4
Standard 8
(NMC, 2010)
http://www.nmc-uk.org/Documents/NMCPublications/NMC-Standards-for-medicinesmanagement.pdf
Accurate and immediate recording needs to include reasons for withholding
or not administering medicines
Appendix B Medicines Policy
Process for Administering Medications using e-Prescribing system (JAC)
Nurse checks:
Log on to JAC and access the
Patient Record using CHART or
POE
Patient Name
Nurse checks
Date of Birth
Admin chart or 24 PAC
NHS number
for duplicates
Click Order Inquiry for
prescription details (as per
NMC guidelines)
Allergies
Observe Patient taking the
medication
Check wrist band
Information against the chart
Take drug, lap-top and a
witness (if required) to the
patient
Collect drug, check or calculate
dose check expiry date
Sign for admin by double
clicking the ‘Admin date
column’ then
Click green CHART button
Read any note attached to the
medication, take action if
applicable
Close note page
Log off the JAC using the Log off
button.
When the medication round is
completed close the JAC
records.
Once all medication given to a
patient close their record and
continue to the next
Complete the PRN section of
the CHART as the patient
requires
Training/Support when rolling out
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Training 3 weeks prior to go live – all shifts
Ward based Refresher session 1 week prior go live
Ward Based go live Support 24 x 7
Nurses – Group Dedicated Training
Doctors – One on One training
E-learning package
E-learning assessment
Practical deployment
• Avoid Mondays!
• Accompany all nurses on first shift and floor walk
• Attend Doctor ward rounds on rollout day and the next
day
• Pharmacy start early transcribing- electronic stickers on
notes
• Introduced Shift Work in project team.
• Programme manager accessible and responsive
Practical deployment
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High visible presence during rollout
Introduce a 24/7 bleep for help/support
Mobile phones for the team
Keep issue log and respond immediately
Allow emergency pain relief paper charting in critical areas
or situations (Recovery/ED)
• Set up user groups
Go live and day-to-day considerations
• Business continuity plan (BPC)
– Communicate to staff to revert back to paper
– Have local Disaster Recovery folder
– Be clear about roles and responsibilities
• How do paper charts get to wards
• How do patient profiles get to wards
• How do you transcribe back into electronic system
– Documentation of plan and triggers in IT support team
Emedicines administration – Quality/Safety
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Design and develop front-end using clinical engagement
No information is lost, strong IG/security
E-discharge information
Pin-pointing to root causes much easier
Re-use e-information for different purposes (e-Drug
chart/Admission/Discharge)
Customize views in clinical practice
Next EPR release will make E-Drug chart
Usable according to staff’s needs
Conclusion
Our experience of E-prescribing and administration
• Fast track change in practice works and minimises risk to
patients (transition of electronic versus paper)
– Kinder on users (many worry- unnecessarily- about change
in practice)
– Robust control of project due to short timeline
– Fast adaptation of new practice
– Needs careful investment and preparation to succeed
Conclusion
Beyond the embedding phase
• Flexible use of e-prescribing/medicine management
information
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Golden source of info regarding e-discharge summaries
DR/BAU needs to be regularly monitored/managed.
True clinical business critical system
Initial change in practice is difficult, but the rewards from a
safety and efficiency perspective is worth it
Thank you
Chris Fokke
Chief Clinical Information Officer
Hampshire Hospitals NHS Foundation Trust
Aldermaston Road
Basingstoke
RG24 9NA
01256 31(4936)
078272 34134
[email protected]