Introducing ePMA into a Paediatric ITU

Will Hall - Lead Pharmacist for ePMA

ObjectivesIntroduction to the St Georges EPR projectBrief explanation of the challenges of paper

on PICUChange management strategiesLesson’s Learnt – What would we do

differently?

Item MetricNumber of core facilities 3

Number of beds 1,000

Full Time Equivalent 7,173

Total Headcount 7,700

Number of IP admissions /year 107,976

Number of IP Daycases / year 26,925

Number of OP attendances / year 683,490

Number of ED attendances / year 163,810

Number of operating theatres 29

Number of births /year 5,118

Number of critical care beds 90

‘The error of one moment becomes the sorrow of whole life.’

A Chinese Proverb

Medicines safety is a key concern Errors do occur, UK studies show that:

o Prescribing errors occur in 1.5 - 9.2% of medication orders written for hospital inpatients

o Dispensing errors are identified in 0.02% of dispensed items

o Medication administration errors occur in 3.0 - 8.0% of non-intravenous doses and about 50% of all intravenous doses

The use of ePrescribing can help reduce such errors

Source: Vincent C, Barber N, Franklin BD, Burnett S.The contribution of pharmacy to making Britain a safer place to take medicines.

Royal Pharmaceutical Society of Great Britain: London; 2009.

Our Quest towards Comprehensive Medication Safety

Medication Safety:Long term global vision

To perfect the medication delivery system to be safe for every patient, every time, while

making it easy for caregivers to do the right thing, and impossible to do the wrong thing.

Comprehensive Medication Safety1990 Pharmacy Information System

2007 CPOE Chemotherapy (Prescribing and Admin) 2009-11 Smart Infusion Technology Hospital Wide 2010 Cerner PAS2010 Robotic Medication Dispensing in Pharmacy 2012

Cerner CPOE (Radiology & Laboratory)

06/2014 Cerner ePMA & Clinical Docs

06/2014 Cerner Care Administration

Initial Aim’s and Scope of ePMAEliminate End of bed charting

combining vital monitoring and medication rates

Provide Safety in Medication Administration process with

Barcode Medication Administration

Eliminate additional charts associated with medication

trust wide

Convert all prescription’s to an electronic system

Eliminate Medication Charts Trust Wide

• Adult ICU• Paed ICU• Patient• Drug, Dose, Time• Epidural• Warfarin• Inpatient Discharge• Outpatient

• Complete CPOE

Specific Challenges in PICU

PICU Project3 Month projectSupplement to Enterprise Wide Solution2 Nursing Leads, 1 Consultant Lead

Change Management

Ready for go-live?

Task Responsibility Time before go-live

Date Signature

Task Group initiated PM Awareness sessions complete CM

Workflow identified, in-scope and out of scope documentation agreed

CM

Agreed Hardware complement deployed DM VDI in place DM

VDI access for individual staff DM Clinical leads responsible training target: CM Nursing:

Clinical

Medical:

Clinical

Minimum 80% staff trained Clinical/Training Super Users identified Clinical

Super Users trained Training Smartcards supplied and active Clinical

Policies agreed PM Policies delivered PM

Downtime documentation identified Clinical Downtime Packs in situ PM 724 computer available PM/DM

724 printers in place and connections checked DM 724 training has been provided CM

Appropriate staff added to “Service Bulletins” email distribution list

CM

Staff communication sent PM Pocket Guides provided and printed Clinical

Staff have received the Staff Readiness Checklist and completed the actions

Clinical

Communications sent to all Clinical Staff PM for Clinical All clinical staff have correct Smartcard access

(including clinician tick for all prescribers) Clinical/PM/ back office

Temporary access cards available and procedure and documentation available

Clinical/PM

Patients/Carers informed of change Clinical Downtime poster displayed CM/Clinical

Posters displayed on ward RE: access to clinical champion users and floor walking support

DM

Email iclipepma to remove prescribing restrictions CM 1.5 weeks Ward debrief time scheduled All

Transcription strategy agreed by Clinical Leads CM/Clinical 2-3 weeks Daily email distribution list been decided for FAQ’s

and issue/resolution log Clinical

Superusers

Champion users

Pocket Guides

DeploymentAccess to ePMA staff (

epma@stgeorges.nhs.uk) Listen, Action, Listen, Action

Ward handoverAudit

RedesignSafety comes first

Lesson’s LearntScope2

IntegrationLeadership is keyEducation and TrainingTask GroupClinical Champion’s and Super users

Integration

This is only the beginning..This enables improvements to clinical care