Benefits of EPMA at QEH, Birmingham

Asif Sarwar

History of PICS at QEHB • 1,200 bedded tertiary referral and University teaching hospital • £545million new development opened June 2010 • EPMA across all in-patient beds – Not yet in A&E, theatres, dialysis

From this using t hese to this

Description

Hospital PICS Specialties

Information

1200+ beds 17 PICS registered users Weekly logins Peak concurrency Weekly prescriptions Weekly administrations >5000 3900 - 960 doctors - 2470 nurses 500+ 32,000 137,000 OPD episodes 10,000 per week

Support people who work with medicines – “A guide on the side” EPMA provides us with: – Legible instructions – Reviewing medications history – Access to further information – Clear guidance on what to do next

• Expert error detection – Rules based surveillance with alerts outside order entry – → Reduce errors of omission or commission

Rules-based clinical decision support

Prescribing • defaults • dose validations • interactions • drug • clinical condition • serological state • duration of scripts • by specialty where necessary

External/Internal links

Lab results Cross-Referencing

PICS – a developing Electronic Clinical Record

Laboratory Flow Sheets Fluid Balance Urinalysis Charts Infection Control Operation Noting Clinical Flags Physiological Observations

Electronic observations charts Recognising and Responding to the Deteriorating Patient • Automated text messaging /pager alerting • Evaluation of the recognition of deteriorating patients • Can be linked into medication rules

However...

• It still requires human interactions

IT related errors • Look-alike drugs • Picklist choice/keystroke errors • Alert fatigue • Workarounds

What about pharmacy?

• Reduced missed doses • Intervention logging • Records of drug histories • Warfarin alerts • High-risk drug flag • Formulary enforcement

Its greater than the sum of its parts • Bee aware • E-transfer of discharge letters to GPs • 100% compliance with thrombosis assessment • Compliance with dementia screens • Barcode scanning of patients to confirm identity

So what....

• Every click is auditable • Improved patient safety • Juniors at weekends don’t have to re-write charts; more time on actual patient care

Clinical Dashboard

Turning data into information

Antibiotic - % Missed Doses

A Date

15 April 2009

B C D * D *

04 August 2009 15 December 2009 24 February 2010 30 March 2010

Intervention Pause function for doctors Missed Doses go live on clinical dashboard Introduction of coloured indicators to show due / overdue drugs NPSA Rapid Response Alert Chief Executive Missed Dose Root Cause Analysis meetings Step change in % missed doses when information shared with clinicians / managers Further highly significant change when CEO started RCA meetings

Thank you – Any Questions?