www.england.nhs.uk

6th November 2019

ePrescribing

Masterclass

www.england.nhs.uk

Masterclass 6th November 2019

1.00pm Welcome & Introductions

Ann Slee, Associate CCIO, NHS X

1.05pm A level up for Gentamicin

Zainab Hussain, Associate Chief Clinical Information Officer,

Lewisham & Greenwich NHS Trust

1.35pm Using ePMA to support Antimicrobial Stewardship

Marianne Taylor, ePMA Lead & Abimbola Olusoga, Advanced

Clinical Pharmacist, Leeds Teaching Hospitals NHS Trust

1.50pm Summary and Next Steps

A LEVEL UP FOR GENTAMICINZainab Hussain

Associate Chief Clinical Information Officer

Lewisham and Greenwich NHS Trust

LEWISHAM & GREENWICH NHS TRUST

• Est 1 October 2013

• Serves population of 526,000 across Lewisham, Greenwich & Bexley

• Comprises of:• Queen Elizabeth Hospital in Woolwich

• University Hospital Lewisham

• Community health services in Lewisham

• Services at Queen Mary’s Hospital in Sidcup

• 38 inpatient wards

• ~900 inpatient beds

• ~6500 staff

THE CONTEXT

• Already live with PAS on Cerner

• Go-live with EPMA in all adult inpatient wards and

ED over a weekend in May at UHL and June at QEH

• Established process for TDM drugs on paper charts

• Harder to replicate this with EPMA

STEP 1UNDERSTAND THE CURRENT PROCESS

MEDICINES USEPROCESS

GENTAMICIN

Prescribing

Pharmacy Screening & TDM

Advice

Dispensing

Therapeutic Drug

Level Monitoring

Medicines Administration

PAPER DRUG CHART

STEP 2DESIGN & IMPLEMENT

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PRESCRIBE

PHARMACY REVIEW

PHARMACY REVIEW

PHARMACY REVIEW

NURSING WORKFLOW

NURSING WORKFLOW

ADMINISTER

ADMINISTER

ADMINISTER

TDM MONITORING

TDM MONITORING

STEP 3EVALUATE THE PROCESS

TITLE

BENEFITS AREAS TO IMPROVE

› Minimised duplication of entry

› Relevant information available in context of:

› Prescribing

› Administration

› Pharmacy screening

› Weekend and future dose instructions

› Medication administration window

displays last recorded instructions

STEP 4ADOPTION AND OPTIMISATION

EXPANSION

• Gentamicin

• Amikacin

• Vancomycin

• Tobramycin

FACTORS FOR SUCCESS

Involve end-

users early on

Ensure the process

is intuitive

Use clinical decision

support effectively

Minimise

duplication of work Continue to evaluate

after implementation

Minimise disruption

to staff

Thank You

@ZainabH_ssain

www.england.nhs.uk

Using ePMA to support

antimicrobial stewardship

Abimbola Olusoga – Advanced Clinical Pharmacist,

Antimicrobials

Marianne Taylor – eMedicines Lead Pharmacist

Leeds Teaching Hospitals NHS Trust

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Antimicrobial stewardship (AMS) at LTHT

• 2007 - MRSA/HCAI Improvement Programme

• Guidelines development

• Antimicrobial usage/expenditure

• Antimicrobial incidents

• Reactive AMS approach

www.england.nhs.uk

Patients

prescribed &

given

antimicrobials

where allergy

stated

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• Implemented between 2015 and 2018

• Used in all adult and paediatric inpatient areas (approx

2300 beds)

• Almost all intravenous antimicrobials now prescribed

electronically

ePMA at LTHT

www.england.nhs.uk

• AMS part of justification in ePMA business case and

written into OBS

• Early decisions:

• Mandate indication

• Build duration into standard prescriptions

• Antimicrobial protocols built for guidelines

AMS considerations - ePMA

implementation

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www.england.nhs.uk

• Over 150 antimicrobial

treatment protocols

• Linked to antimicrobial

guideline

• Duration: 5 days or as

dictated by indication

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www.england.nhs.uk

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48 hour clinical review of IV

antibioticsClinical reviews automatically “pop-up”

on opening a patient’s eMeds

prescription

• A prompt to “focus” antibiotic

treatment based on initial response

to best guess antibiotics and culture

results.

• Select cease to change or stop

antibiotics – state why e.g. IVOS

• Select edit to continue and set a

new review date, or to refine the

diagnosis

www.england.nhs.uk

AMS opportunities with ePMA

• Safer prescribing and administration

• Allergy incidents

• Timing of doses and serum level monitoring

• Promote guideline use / standardise

• Promote clinical review

• Proactive AMS approach

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AMS challenges with ePMA

• Alert fatigue?

• Antimicrobial consumption

• Making the most of eMeds data

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Any questions?

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Masterclass 11th December 2019

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Save the date!

All presentations are on the ePMA NHS Futures Website and the toolkit – www.eprescribingtoolkit.com