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Claire Holt and Mary Rowe delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems. For more information, please visit http://www.healthcareconferences.com.au/emed14
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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?