ePMAimplementationin EDLessons Learnt

Atiyah MaroofePMA PharmacistLuton and Dunstable University Hospital

Agenda• L&D ePMA Project Plan• Options for ED Go Live• ED IT interface• Patient Pathways• L&D ePMA Go-Live in ED• Problems faced & Solutions

implemented

L&D ePMA Project Outline

Options to go live in ED

• Speciality teams review patients in ED

• If a Decision To Admit (DTA) is made subsequent medication is prescribing in ED

• Option 1: The whole ED Department• Complete prescribing/administration profile on ePMA • All ED admissions on ePMA system • LDUH ED department due to be rebuilt next year• Current ED infrastructure does not support for ePMA go live in

whole ED department• ePMA not yet implemented in Maternity and Paeds so will not

support patient flow.

Options to go live in ED

• Option 2: Patients being admitted into hospital only

• Speciality teams to transcribe patients onto ePMA at point of a DTA a patient

• Will help reduce current transcription burden on ePMA live areas

• Incomplete prescribing/administration profile on ePMA as ED will use paper

• ED admissions on paper and cannot be referred to easily

Options to go live in ED

• LDUH Preferred Option:• To Go Live with DTA to reduce current transcription

burden

• Followed by Option 1 once Maternity and Paediatrics live with ePMA and ED department has been re-built.

ED Interface

• This is not a simple step!

• Allow for plenty of time to liaise with all parties

• Vigorous testing is required

Patient presents in ED

ED attendance documented in Symphony

Episode opens on ePMA

Patient admitted into hospital

PAS episode takes over ED attendance

Patient Pathways

• Ensure that all patient pathways from ED are well mapped out

• Surgical/Medical/Contingency areas/Gynae/Critical Care/Paeds/Outliers

• Very complex pathways were identified

• Maintain a close working relationship with the ED teams

• Regular meetings were held with ED matron and lead ED consultant

• All process maps were approved and signed off by the relevant staff

EPMA Go-Live in ED• ED went live with DTA 7th July 2015

• IT interface issues caused the delay in rolling out

• Timing is everything!• Best time for go live was identified as 7am • Quietest time in ED & before all handovers

and safety briefings• ePMA attended ED and speciality team

handovers during implementation

EPMA Go-Live in ED

• ePMA floor walking support 24 hours/day for 7 days • Further 14 days 6am-11pm to encourage and help

support speciality teams

• At this point paper prescription charts were not removed as not all adult base areas were live with ePMA

• Gynaecology ward was outstanding• Maternity and Paeds emergency patients treated in separate

areas

Problems Faced

• Paper prescription charts were started by ED team, but were not being transcribed by speciality teams despite encouragement

• ePMA transcription service ceased at the point of ED go live

• Number of prescription charts increased on ePMA base wards

• Increased risk of dual process

• Not enough hardware in ED for speciality teams

• Hardware not fast enough in ED to help facilitate process

Problems Faced• Gynaecology ward was not live with ePMA

• Adult ED was live for DTA but could not include gynaecology patients

• Caused confusion amongst staff

• Surgical/medicals outliers placed on this ward

• Some senior clinicians required more support at this point as they had not used ePMA as much as junior doctors prior to ED ePMA implementation

Solutions implemented

• ED STAT chart introduced

• All paper prescription charts removed from ED and base wards

• Gynaecology ward go-live bought forward

• Additional desktop PCs with Virtual Desktop Infrastructure (VDI) deployed to ED to help facilitate process

• Further support given to speciality teams

What is next?

• Maternity and Paeds ePMA Go-live• Jan/Feb 2016

• Implementation of ED in whole ED department planned for March 2016

• To purchase bespoke handheld devices

Question Time