Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application...

Implementation of a Medication Management Module Within an

Existing Clinical and Patient Administration System

3rd Annual Electronic Medication Management ConferenceMarch 2014

Claire Holt: Chief Health Information Manager, Portland District Health (PDH) - CHIA

Mary Rowe: Application Enhancement and Support, South West Alliance of Rural Health (SWARH)

5 hours

6 hours

TrakCare at PDH

• ED functionality in use for 10 years• Clinicals – implemented over time • PAS – March 2013

Essentials for success: SWARH

• PDH Executive commitment and leadership• Regional support – SWARH hospitals/services• EHRAG• InterSystems

Implementation on a shoestring

Essentials for success: PDH

• Culture • Strong clinical educators• Pharmacy• Doctors• Nurses• Hardware

Go-live preparation

• Pre-implementation data gathering• Preparation of medication charts one day

prior• Staff support – around the clock• Support escalation strategy

Go-live preparation (continued)

• Communication – – Strategy including flyers and screen savers– Christmas support!

• NUM support – no expectations of perfection on day one

• Transferring patients – Medication Charts to go

• Treats for staff

Training

• Super Users• Nurses • Doctors • Test environment

Scope of eMM at Portland

Go-live 10th December 2013• Prescribing • Dispensing (in Pharmacy system)• Administering • Reviewing Medication Charts• Medication Reconciliation• Business Continuity

Security and Access

• Users allocated to Security Groups to provide appropriate access –– Doctor– Nurse – Div 1, Enrolled Nurse, no medication

endorsement– Pharmacist– Health Info / Management

• Biometrics

Prescribing

• Access anywhere within network

• Convert history into live orders • Repeat orders • Saving prescribing settings• Decision support • Varying the Dosing Plan• Ceasing medication orders

Administering

• Nurses’ Worklist • EPR > visual overview• Multiple administrations• Single or dual signatures• Administration statuses – changing, reversing• Audit trails• “Not Administered” – across ward• Changing planned admin times• Variable doses, order instructions, PRN meds

Nurses’ Administration List

EPR > Medication Chart

Pharmacy

• Medication History• Orders workbench• Formulary workbench• Communication with Doctors• Medication Review• Instant access to entire patient history and

episode details• National Medication Management Plan -

reconciliation

Medication Reconciliation

Tools for clinicians

• MIMS links everywhere• Clinical educator• TEST environment• MIMS instructions for administering• Drug interactions, therapeutic duplications• On-screen, context-specific help• Manuals and quick reference guides• Warnings when nearing end of orders

Immediate Wins• Decision support during Prescribing• Doctors can prescribe and view

medication charts from anywhere• Instant win for Pharmacy – – No more leaving Pharmacy to access

medication charts– All patient details available in Trak

Immediate Wins (continued)

• Total elimination of time wasting in deciphering hand-writing for Nurses and Pharmacy – everyone can read everything

• Ability to record attempts to administer and change administration status – full audit trail

• Ability to review an entire ward’s medications

• Time savings when re-ordering medications

• No purple pen!• Formulary issues at go-live• Not all doctors were trained• Shift of burden to doctors – accurate

prescribing is the key• Expectations of time required vs reality• Don’t under-estimate the significance of the

change• Business continuity – what happens before

the plan is activated

Longer term Wins

• Wealth of data available• Frequent flyers • Pharmacy reconciliation and auditing • Reduction in incidents related to mis-reading • Conformity with regulations• Safety and quality benefits• Transferring patients – Medication Reports• Hidden education

Pre and Post-implementation Data

• Survey results• Adverse events

How long does it take to write up a medication chart for a new patient on admission?

DOCTORS

Paper Medication charts DOCTORS

Paper Medication charts

AFTER: Electronic Medication charts

DOCTORS

How often do you refer to the Hospital Formulary?

DOCTORS

Paper Medication charts DOCTORS

Electronic Medication charts

Paper Medication charts DOCTORS

How often do you need to clarify the orders with the doctors due to

illegible handwriting?

NURSES

Paper Medication charts NURSES

Paper Medication charts

Electronic Medication charts

NURSES

How often do you need to clarify the orders with the doctors?

NURSES

Paper Medication charts NURSES

Paper Medication charts

Electronic Medication charts

NURSES

Medication errors

Spike: January 2014. • Expiring doses – medications missed (3)• PRN management on system – training (2)• Patient self administering (1)• Insulin dose missed

Medication errors

Realities

• No system can replace good clinical judgement

• Medication charts still need to be reviewed• Shift of accountability – system enforces

good practice • Second signatory not always available

Realities (continued)

• HR issues – doctors• Reflection – bring theatre on board at same

time• Statistical Discharges• Maintaining momentum/commitment –

when key staff depart

Realities (continued)

• System down!!

The Future

• Theatre• IV fluids• Antimicrobial stewardship• Discharge PBS Scripts• iPharmacy interface• Configuration for mobile devices

Questions?