Transcript E-Discharge with formulary control
E-Discharge with formulary control David Rose Clinical Design Lead
Introduction
• Good Afternoon!
• Not Rhian Rice • Technical design architect • e-Discharge • • e-Formulary (drug file)
Importance of this
• Budget control – least important aspect • David Rose • Clinical Design Lead (NWIS) • Senior Pharmacist – Lead IM&T ABMU HB • Overview of what’s going on in Wales
Why Me
• Implemented an e-discharge system in 800 beds 6 years ago • At least 80% of Pts have a completed discharge summary within 48hrs • NWIS invited me to help out with design of WCP • E-discharge & medicines management tool • involved with the clinical design • UCD sessions across Wales • Worked closely with the developers / clinicians • Designed the pharmacy elements of WCP • 3 yr process
Background
• Different in Wales • No CfH • NWIS • No money!
• Limited resources / funding from Welsh Government • Use it wisely!
• Enter the Welsh Clinical Portal
Clinical Information Flow
Out of hours Individual Health Record
Welsh Clinical Portal
GP Systems My Health On Line Integration on one platform Existing Hospital and community systems • PAS – administration • RADIS2 – radiology system • CANISC • Pharmacy • TELPATH – pathology system • PACS - radiology image store New information Services Pathology ordering Radiology ordering PACS Sharing ( GE ) Laboratory Information M.S. (Intersystems)
Creation and viewing of letters, clinical notes, discharges
Welsh Clinical Portal
• One stop shop for clinicians • PAS • Biochemistry • Radiology • Information sharing • Medication • Not e-Prescribing tool
What about Pharmacy?
• Information retrieval • Drug reconciliation • e-discharge • Supply of medication from ward level • One stop dispensing • Patient counseling / production of compliance aids for pts • Information entered ONCE only • Re-used
Audience Participation
• Process map patient pharmacy journey • How many times does a list of drugs get transcribed?
• 4,5,6,7 maybe more depending on your systems • Huge opportunity for error!
• 5 % at each transcription
Where do you start?
• Looked at existing systems across Wales and England • Commercial offerings • Didn't fit the model that we wanted • We couldn't afford to adapt them • There is NO standard drug file!!!!
• Complex beast…..
• Previous speakers have eluded to this • VTM, AMD, VMP • Large no of sites in Wales use a legacy pharmacy system • EDS • Drug files are very different • Decided to build our own
If you build it they will come!
The Issues
• We needed a common formulary • Look up tool • Information resource • Most sites use EDS • JAC: 1 site • Ascribe: 1 site • Massive differences between files • Worked with FDBE to map the files • Created a common file • Linked it to dm&d codes
The Solution......
• Medusa • Purchased UCHL “Inform” product • 2009 • Used dm&d codes • Mapped this to every item in Wales • Allows us to share info with GP systems • Community pharmacy • WCCG
2011
• Each site has it's own version of the master formulary • Locally and nationally maintained
SITE SPECIFIC LOGIN
MASTER FORMULARY
SITE 1 SITE 2 SITE 3
WELSH CLINICAL PORTAL
Benefits
• Guides selection for data input • Reduces selection options • eg: Paracetamol • 22 lines • Hundred + products • Provides point-of-care information • Links to e-BNF, SPC and IV guide
Lets have a look!
So What!
• Formulary now in operation • Medicines management system built around this • This in turn is built around the patient management software (WCP) • Developed and agreed a common dose syntax across Wales • ShareD this with the medical schools and SOP undergraduates • Iterative development • About to pilot across hospitals in Cardiff & Vale Health Board
Summary
• We are trying different things • We hope that we are moving in the right direction • Trying to link everything together • This is NOT an e-Prescribing system