ePMA Benefits RealisationThe RBHT’s Approach…
Elsa NgDarzi Fellow/ Paediatric Cardiac Pharmacist
September 2015
About RBHTOur Work & Hospitals
Harefield Hospital Royal Brompton Hospital
• The largest specialist heart and lung centre in the UK • One of the largest heart and lung centres in Europe• Total of 520 beds in the Trust, including level 1, 2 and 3• Around 30,000 inpatients every year
Digital Care Transformation Programme (DCTP)
ePMA Respiratory RBH
HarefieldHospital
Continue rolling out in adult level
one wards
Paediatrics & OP
EDM User workshop & testing Building EDM Scanning records
Records available on screen
PASPreparation
&Initiation
Building PAS &new processes
Testing &
TrainingNew PAS
2015 2015 2016 Summer Winter
Five Principles of ePMA Benefits Realisation
1. Aligning ePMA benefits with organisational goals2. Creating ePMA benefits profiles3. Estimate benefits using ‘evidence-based approach’4. Linking ePMA benefits with QI initiatives5. Establishing good data management
Principle 1
Aligning ePMA benefits with organisational goals
Vision and Values
Trust vision: To be the UK’s leading specialist centre for heart and lung disease.
The Trust will achieve this mission by:• Improving patient safety and satisfaction. • Providing world class specialist treatments that others cannot offer. • Bringing innovation to clinical practice through our research partnerships. • Attracting, developing and retaining world class clinical leaders. • Investing in services, technologies and facilities to support new service
models at both sites.
Driver Diagram
Decrease fuelcosts 1
Reduce price per litre 2
Reduce miles driven 3
Increase mpg 4
Improve car efficiency 5
Improve driving patterns 6
Limit speed7
Use appropriategear 8
Drive smoothly 9
AimPrimary drivers
Secondary drivers
Tertiary drivers
Actions/ Interventions
Buy a diesel car next time
Stick to 70 mph on motorway
Get into highest gear more quickly
Accelerate more slowly
Book onto AA course
Benefits
Safety
Quality
↓Errors Transcription
Omitted Doses
Experience
Patients
Users/ Staff
Governance
Med Rec
VTE Assessment
Antimicrobial Stewardship
Efficiency Work Duplication Transcribing
Financial
ePMA Benefits Driver Diagram
Benefits Strategic Goals Benefit Category Benefit Details Measure
Principle 2
Creating ePMA benefit profiles
Benefit Profile
Benefit 1: Safety - Transcription Errors
> 14 days
Level 1Inpatient Re-written
Drug charts
Safety – Transcribing Errors
Methods• Identify patients stay > 14 days• Estimate number of transcription • Estimate number of transcribed medication orders• Transcribing error rates
Safety – Transcription Errors
Results• Estimated between 1500 – 1800 drug charts required
transcribing per annum • Approx. 10 medicines/ chart• Hence 15000 – 18000 transcribed prescriptionsLiterature search• Transcription error rates = 16.8% (Doormaal et al., 2015)
Principle 3
Estimate benefits using ‘Evidence-Based Approach’
Estimating Number of Transcription Errors at RBHT using literature
Transcribed Orders
• 15000 - 18000 items/ annum
Transcription Error Rates
• 16.5% (Doormaal et al., 2015)
Estimated Error
• 2500 – 3000 / annum
Transcription Error Categories
A: an error occurred but error did not reach the patient
B: An error occurred and reached
patient, but did not cause harm
C: An error occurred that reached that
patient and required monitoring
D: An error occurred and resulted in harm
Estimating number of transcription error by categories
A (84.6%)
• 2115-2540
B (13.9 %)
• 350-420
C (0.4%)
• 10-12
D (1%)
• 25-30
Results estimated based on RBHT PAS data and Doormaal et al., 2015A: An error occurred but error did not reach the patientB: An error occurred and reached to patient, but did not cause patient harmC: An error occurred that reached that patient and required monitoring D: D: An error occurred and resulted in harm
Benefit 2: Efficiency Gain
Prescribers/ Pharmacists• Assume each transcription task takes 5
mins• Efficiency gained by EPMA (prescribers’
time) ~ 17 – 20 work days/annum
Estimated value gainedSHO £3300
+ Pharm £3300Value gain £6600 (per annum)
Calculation based on SHO salary ~ £ 40KPharmacist salary ~ £40K
Principle 4
Linking ePMA with Quality Improvement (QI) initiatives
Administration time of IV antimicrobials
0 4 8 12 16 20 24
-180
-120
-60
0
60
120
180
240
300
360
Administration time of IV Antimicrobials
Time (24hrs)
Tim
e di
ffere
nce
(min
s)
ePMA & QI
Analgesia Administration
Time (ePMA)
Length of Stay
Patient Experience
Process Measure
Outcome Measures
Pain Scores
SMART Aim
BaselineMeasure
Principle 5ePMA generates data.
Data is an asset. Asset requires owners.
Owners translate data into information. Information breeds behaviours.
chrysalis
Who owns ePMA
Avoid My Baby Problem
Five Principles of ePMA Benefits Realisation
1. Aligning eP benefits with organisational goals2. Creating eP benefits profiles3. Estimate benefits using ‘evidence-based approach’4. Linking eP benefits with QI initiatives5. Establishing good data management
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