Workstream 1: Project Management System Configuration and
Business as normal Andrew Heed Kathy Wallis 17 June 2013 Slide 2
Agenda Some background to us Trust and ePrescribing Project
Workshop structure Pre-Go Live planning Roll-out considerations
Maintenance and Support Any questions?? Slide 3 University Hospital
Southampton 1100 beds Provides services for 1.3M people in
Southampton and south Hampshire specialist services such as
neurosciences, cardiac services and children's intensive care to
more than 3 million people in central southern England and the
Channel Islands major centre for teaching and research in
association with the University of Southampton and partners
including the Medical Research Council and Wellcome Trust treat
around 140,000 inpatients and day patients, including about 50,000
emergency admissions Slide 4 Project timeline Slide 5 Newcastle
upon Tyne Hospitals Freeman Hospital Transplantation, Cancer
Centre, Cardiothoracic Surgery, ENT, Vascular Royal Victoria
Infirmary Neurosciences, Emergency care, Childrens Services,
Plastic Surgery, Ophthalmology, Dermatology, Maternity Beds 1792
(Inpatient) & 205 (Day case) Activity Inpatients 192,000
Outpatients 870,000 Lab/ Rad requests 3 million ePrescriptions 1.7
million eAdministration 7.2 million Slide 6 ePx Project Cerner
Millennium system ePx, electronic orders, A+E, Theatre scheduling,
PAS, documentation. Project timelines: Work started April 2008
Go-live November 2009 Adult In-patient rollout completed March 2011
Paediatric ward Feb 2013 (ongoing) Starting 2 nd system upgrade.
Documentation ongoing. Never-ending story Slide 7 Workshop Session
1 Pre-Go Live Planning Design Considerations Testing Hardware
Roll-out plan Training . Slide 8 Workshop Session 1 Feedback /
Discussion Slide 9 Design Considerations The drug catalogue VTM,
AMP, AMPP Terminology Routes, forms, frequencies. Decision support.
Dosing sentences. Alerts (interaction / dose checking / allergy
others) Order sets Future -proofing Slide 10 Scope What can you
actually do? System limitations Do you need documentation Where can
you do it? Other systems? What can you afford / support. Slide 11
Hardware Can you ever have enough? What kind? Dispensing trolley?
Security / cleanliness / durability. People will have better
hardware at home Or even in their pocket. But what can an App
actually do? Slide 12 Training Who to train? When to train? What to
train on? How many people? How to get bums on seats? What about the
night shift? Who will do this in the long term? Should we even
bother? Slide 13 Workshop Session 2 Roll-Out Considerations Support
Mixed Media Prescribing Bank and Agency Staff Real time PAS / ADT
issues . Slide 14 Workshop Session 2 Feedback / Discussion Slide 15
Roll Out planning Start upstream or downstream? Time between wards
go lives transfer of patients and outliers Dual systems paper and
electronic Slide 16 Roll Out planning Big Bang vs staggered
rollout. What can you support? Staggered: Arranged by directorate,
patient flow How does geography affect things What is your transfer
mechanism Is it realistic Too fast or too slow. Slide 17 Dedicated
ePrescribing support 24/7 ePrescribing team manager (Pharmacist)
plus 5 full-time team members (Nurses or Pharmacy Technicians)
On-site 24 hour support for 7 days post go live; otherwise 0730
2300 on site and on-call over night Used extra support for Theatres
when surgical wards first went live (anaesthetists and recovery
staff) Bank staff to support staff shortages Moving to be able to
provide less on-site support over weekends Key success area for the
project: awarded Hospital Heroes team prize of Education and
Support Slide 18 Agency nurses and locum doctor access Use NHS
professionals and multiple other agencies High agency usage wards
could not operate if agency staff not able to use the system Agreed
process where agency nurses (and locum doctors) access and complete
training before starting their first shift Agencies responsible for
completing System Access Forms Built into the performance metrics
for the agencies Difficult for first few wards, but easier as more
wards are live Slide 19 Real-time ADT Was an on-going issue for the
Trust to have a accurate electronic bed-state not a clinical task
With ePrescribing: Patient must be admitted to be able to
administer medications (can prescribe if pre-admitted) If patient
not admitted or transferred to the correct ward, they do not appear
on the list of patients due medication If patient not discharged,
they will continue to appear on list of patients due medications
each ward needs to clear all non-administered medications overnight
to be able to administer medications the next day Nursing staff now
complete ADT when ward clerk not on duty (also have a central ADT
team to support) ADT available on the drug trolleys therefore can
complete transfers etc on the fly Also supports the use of other
systems (e.g. Doctors Worklist; Bed Management tools Slide 20
Workshop Session 3 Maintenance and Support Responding to incidents
Handling prescription errors On-going maintenance of the system
Training Managing Expectations Reporting Data for audit Upgrades
Downtime Slide 21 Workshop Session 3 Feedback / Discussion Slide 22
Responding to Incidents We now have something to blame! Who does
this now? Who does this after go-live? System fault? or user fault?
But what is the system? software, user, computer, Wi-Fi, power
cable, the workmen digging the road up 3 miles away? Trend
monitoring. Feedback to users / training central team or
department. Slide 23 Consultant review of the drug chart / Drug
Chart Viewer surgical consultant ward rounds anaesthetist review
pre procedure (Demo) Slide 24 On-going modification of build Link
to stock control system limits naming of prescribable items:
Inclusion of strength and formulation Modification of existing
protocols general prescribing practice is more open Increasing list
of protocols standardise care and ease of prescribing Slide 25
On-going maintenance Everything goes through the system New
policies Clinical trials Who designs or build this Can the system /
team become a bottleneck? How do we handle changes to the system?
En masse change vs drip feed. How does the system handle change?
Change control Do we need a down-time. Slide 26 Future Proofing Try
to plan for every area you will be going to.. Or you potentially
have a large rebuild / renaming process Try to take the long view
and avoid short cuts. ??? Slide 27 Benefits: Error rates Slide 28
Benefits: Drug Round times Drug Round pre / post eprescribing Avg
time / patient (Mins) Avg difference (mins / patient Ward 1Ward
2Ward 3Ward 4Ward 5Ward 6Ward 7Ward 8 am
pre11.4977.956.456.917.318.68.15
post6.476.177.576.187.076.886.79.470.92 lunch
pre8.683.754.713.433.824.08104.12
post3.152.734.113.114.474.193.723.71.67 Eve
pre9.2156.054.533.966.63 5.85 post5.214.533.454.365.53.253.3741.68
Night pre10.4754.264.814.55.4712.658.71
post5.786.424.95.435.396.459.3810.570.19 Slide 29 Slide 30 Slide 31
Slide 32 Slide 33 Questions?
