eMedicines Administration: Practical Implications

Chris Fokke RGN, BA Hons, MSc. ITChief Clinical Information Officer Hampshire Hospitals NHS Foundation Trust

Session overview

• Share experiences from HHFT regarding changing from paper-based to Emedicine administration

• Concentrate on practical approach on how roll out was achieved successfully

• Lessons learnt and opportunities

Professional context to introduce Emediciness administration

• Include operational & senior staff in preparing for Go Live and process changes

• Nursing had anxiety regarding professional accountability (NMC code of conduct)

Section 4

Standard 8

Accurate and immediate recording needs to include reasons for withholding or not administering medicines

(NMC, 2010)

http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf

Log on to JAC and access the Patient Record using CHART or

POE

Nurse checks: Patient NameDate of BirthNHS number

Allergies

Nurse checksAdmin chart or 24 PAC

for duplicates

Click Order Inquiry for prescription details (as per

NMC guidelines)

Collect drug, check or calculate dose check expiry date

Take drug, lap-top and a witness (if required) to the patient

Check wrist band Information against the chart

Observe Patient taking the medication

Sign for admin by double clicking the ‘Admin date column’

thenClick green CHART button

Read any note attached to the medication, take action if

applicableClose note page

Complete the PRN section of the CHART as the patient

requires

Once all medication given to a patient close their record and

continue to the next

When the medication round is completed close the JAC

records.

Log off the JAC using the Log off button.

Appendix B Medicines Policy

Process for Administering Medications using e-Prescribing system (JAC)

Training/Support when rolling out

• Training 3 weeks prior to go live – all shifts• Ward based Refresher session 1 week prior go live• Ward Based go live Support 24 x 7• Nurses – Group Dedicated Training• Doctors – One on One training• E-learning package• E-learning assessment

Practical deployment

• Avoid Mondays!• Accompany all nurses on first shift and floor walk• Attend Doctor ward rounds on rollout day and the next

day• Pharmacy start early transcribing- electronic stickers on

notes• Introduced Shift Work in project team.• Programme manager accessible and responsive

Practical deployment

• High visible presence during rollout• Introduce a 24/7 bleep for help/support • Mobile phones for the team• Keep issue log and respond immediately• Allow emergency pain relief paper charting in critical areas

or situations (Recovery/ED)• Set up user groups

Go live and day-to-day considerations

• Business continuity plan (BPC)– Communicate to staff to revert back to paper– Have local Disaster Recovery folder– Be clear about roles and responsibilities

• How do paper charts get to wards• How do patient profiles get to wards• How do you transcribe back into electronic system

– Documentation of plan and triggers in IT support team

Emedicines administration – Quality/Safety

• Design and develop front-end using clinical engagement• No information is lost, strong IG/security• E-discharge information• Pin-pointing to root causes much easier• Re-use e-information for different purposes (e-Drug

chart/Admission/Discharge)

Customize views in clinical practice

Next EPR release will make E-Drug chartUsable according to staff’s needs

Conclusion

Our experience of E-prescribing and administration• Fast track change in practice works and minimises risk to

patients (transition of electronic versus paper)– Kinder on users (many worry- unnecessarily- about change

in practice)– Robust control of project due to short timeline– Fast adaptation of new practice– Needs careful investment and preparation to succeed

Conclusion

Beyond the embedding phase• Flexible use of e-prescribing/medicine management

information– Golden source of info regarding e-discharge summaries– DR/BAU needs to be regularly monitored/managed.– True clinical business critical system– Initial change in practice is difficult, but the rewards from a

safety and efficiency perspective is worth it

Thank you

Chris FokkeChief Clinical Information OfficerHampshire Hospitals NHS Foundation TrustAldermaston RoadBasingstokeRG24 9NA

01256 31(4936) 078272 34134       Chris.Fokke@hhft.nhs.uk