Clinical Documentation in AED AED Poisoning Case Management Form

Dr. Joseph Yao

Health Informatics

Hong Kong Hospital Authority

Poisoning incidents are

common

Background • According to The Hong Kong Poison Information

Centre (HKPIC), there were around 4,000 poisoning cases reported in 2010 in Hong Kong

• Most of the patients were admitted via AEDs and received immediate treatment

• The Poison Form was developed to align with the enhanced features of CMS III, as well as the readiness for electronic clinical documentation in AEDs

Challenges in AED • High patient volume

• Timing critical

• Interacting with multiple patients and team members at any one time

• Vast variety of clinical conditions

• Sentinel point for the whole community

• …..

Efficiency

Mobility

Knowledge support

Connect to the Community

Goal ...

• Full electronic clinical documentation in AEDs

• Poisoning Case Management Form as a trial Most cases are clinically less critical Data items standardized Case load not too heavy

AED record

Free Text

Future interface

Induce frontline staff to adopt electronic documentation at AEDs

Contact

Awareness

Understanding

Trial Use

Adoption

Institutionalization

Acquisition

Time

% of User Adoption

How do we record Poisoning Cases in AEDs??

Current situation

• Poisoning cases in A&E are manually recorded:

i. Handwritten AED card

ii. Locally-developed manual forms

• Wide range of non-standardized information captured among different hospitals.

Limited standardized data captured in A&D card

Limitations • Difficult to retrieve information based on paper

forms and AED card image • Few standardized data available and most data

cannot be reused • Storage of manual forms and enquiry of

previous records difficult • Difficult to analyse poisoning-related data

among AEDs • Handwritten errors and potential

misinterpretation of handwriting

Analysis of Poisoning Data

Number of Ketamine abuse cases? Number of Chinese herbal poisoning cases? Number of snake bites?

AED Poisoning Case Management Form workflow

Nurse at Triage Station

Clinical

assessment &

documentation

by doctor

Clinical data captured by AED

Poisoning Case Management Form

Clinical information

uploaded to ePR

Clinical information retrieved in

ward

Clinical Workflow in using AED Poisoning Case Management Form

Poisoning Case Management Form interface

Poisoning-related information (input in Four tab pages)

1. Clinical History

2. Clinical Findings

3. Emergency Management

4. Progress and Monitoring

(1) Clinical History

(1) Clinical History Poison informaton

Poisons list Alcohol Ampicillin Insulin Warfarin Sleeping pill Digoxin Carbon monoxide Ciguatoxin Amoxil Mixtard Aspirin Diazepam Nitrates Burnt charcoal

Neurotoxin Amoxicillin Monotard Salicylates Midazolam TNG LPG

Cannabis Cloxacilin Protaphane Panadol Ativan Nitroglycerin Towngas Cocaine Augmentin Actrapid Paracetamol Dormicum Isordil Chlorine gas Ketamine Penicillin V Metformin Panadol extra Lorazepam Isordil Tembid Potassium cyanide Methamphetamine Unasyn Diamicron Naproxen Valium Elantan Sodium cyanide MDMA Nystatin Gliclazide Naprosyn Amitriptyline Isosorbide dinitrate Cyanide

Opioid Erythromycin Glibenclamide Indocid Imipramine

Isosorbide mononitrate

Parathion

Zopiclone Clarithromycin Daonil Indomethacin Dothiepin Lasix Malathion

Other abusive substance Azithromycin Amaryl Mefenamic acid Nortriptyline Furosemide Dichlorvos

Unknown abusive substance

Tetracycline Glimepiride Ponstan Largactil Frusemide Fenthion

Bamboo snake bite Minocycline Minidiab Brufen Chlorpromazine Allopurinol Dimethoate Cobra snake bite Doxycycline Glipizide Phenytoin Haloperidol Colchicine Chlorpyrifos King Cobra snake bite Rifampicin Glucobay Dilantin Quetiapine Dextromethorphan Adalat retard Other snake bite Cephalexin Acarbose Carbamazepine Clozapine Theophylline Amlodipine Unknown snake bite Cefuroxime Thyroxine Tegretol Risperidone Theodur Norvasc Bee or Wasp sting Zinnat Propylthiouracil Epilim Olanzapine Nueline Felodipine Centipede bite Ciprofloxacin Carbimazole Valproic acid Nitrazepam Slobid Plendil

Stonefish sting Levofloxacin Chlorpheniramine Phenobarbitone Zolpidem Aminophylline Diltiazem Jellyfish sting Metronidazole Piriton Luminal Zolpiclone Ethanol Herbesser Sea-urchin sting Dapsone Diphenhydramine Chloral hydrate Stilnox Methanol Verapamil Scorpion sting Septrin Benadryl Loratidine Imovane Rubbing alcohol Isoptin

Unknown Bites or stings Isoniazid Phenergan Methotrexate Propranolol Isopropyl alcohol Lithium

Chinese Herbal medicine Ethambutol Promethazine Vitamin A Inderal Kerosene Sulphuric acid

Proprietary Chinese medicine

Nitrofurantoin Zyrtec Ferrous sulphate Flecainide Chloroform Sodium hydroxide

Alternative medicine Oral contraceptive pills

Cetirizine Iron sulphate Amiodarone Trichloromethane Caustic soda

Other herbs Clarityne Hydrochloric acid Other Poison

Source: HKPIC

(2) Clinical Findings

(3) Emergency Management

(4) Progress and Monitoring

Benefits • Sharing of poisoning information in ePR

• Retrieval of clinical guidelines and antidote regimens

• Reporting and statistics

• Generation of diagnosis codes

Rollout Plan

Rollout schedule

TMH

QEH

1st Phase (2011/12)

2nd Phase (2012/13)

HKWC HKEC

KCC KEC KWC

NTEC NTWC

Number of Poisoning Cases recorded via AED Poisoning Case Management Form (1/6/2011 – 31/3/2012)

The way forward……

Generic electronic AED Forms

Paperless AEDs

Acknowledgement

HA HI team

• Dr N T Cheung

• Dr Anna Tong • Ms Karis Wong

• Mr Marcus Ng

HA IT team

• Mr Anthony Cheung

• Mr Tony Fung

• Mr Edmund Kwong

• Mr Alan Chan

AED IT WG

• Dr M H Ng

• Dr S H Tsui

• Dr S H Ng