“What’s wrong with a piece of paper?”

The Electronic Transfer of Care

Princess of Wales Hospital

Rowena Lewis

Electronic Transfer of Care (e-TOC)

Clinical information Medication information Sent electronically to GP

10 medical wards over two sites 2 mental health wards 2 orthopaedic wards

The situation that had to change

“Mind the gap!” Carbon copy paper take-home prescription Patient had to transfer information

Varying clinical summary sent or not sent at all

GPs asked for better communication

Aims of e-TOC project

Improve discharge communication from hospital to primary care.

Improve patient safety and reduce clinical risk by providing better medication information to GPs.

GPs to receive in a timely manner with a target of 80% discharge summaries within 5 working days.

Objectives

Carbon copy → typed medication list Transfer electronically to GP immediately Reasons why medicines are started and

stopped - NICE/NPSA medicines reconciliation

Provide GP with full clinical details in uniform format

Method

Designed by clinicians Produced by our IT

department Accessed via PIMS+ Hospital wide wireless

network

Ward Process

Junior doctor enters initial information Updated during patient stay Doctor marks “ready for discharge” Pharmacist verifies medication list Junior doctor completes clinical info Consultant approves it for GP

Implementation

One ward pilot Many improvements made initially

Dosage codes taken from the pharmacy system Colours and symbols distinguish between new,

changed and stopped medicines Format of printed list of medication to improve

clarity Screen icons to aid communication between staff Laminated crib sheets Helpful hints boxes

Key Success Factors

Gradual roll out Dedicated project manager Multidisciplinary training sessions Regular feedback from all users

Key Success Factors

Frequent updates to system Regular audits of doctors input On site IT support Determination to succeed

Training within Pharmacy

Pharmacist users Entering medication Verifying medication Signing off medication Trouble shooting Regular updates Listening to feedback

Ward Technicians Marking drug chart Dispensing from drug

chart

Dispensary staff New format of discharge

prescriptions Printing medication

orders

Benefits of e-TOC Patient Pharmacist Doctor Nurse GP

96% of patients have verified medication sections sent to their GP on day of discharge – includes diagnosis and follow up arrangements

Time taken and percentage of discharge summaries received by GPs

0%10%20%30%40%50%60%70%80%90%

100%

Paper system Average of eTOC w ards Best performing eTOCw ard

0

5

10

15

20

25

30

35

40

Percentage of discharge summaries received by GP

Time taken to receive summary (days)

5.7%

70%

89%

How much have we achieved?

Increased number of summaries sent to GPs Improved timeliness of communication to

primary care

Gradual implementation helped acceptance of system in hospital

Have targets been reached?

Not achieved on all wards yet! Average is 70% in 9 days Much better than 5.7% in 37 days

Changes to practice have been challenging Sharing workload has helped

Benefits to Pharmacists

Medication on e-TOC system prior to discharge

Order function linked to dispensary Access to previous e-TOCs Legible list to give patient at discharge

Lessons learned

Thorough training required

Need modern computers

Helpful IT staff available to assist

Regular updates to system

Enthusiasm and determination

The future

Finish implementation across hospital Electronic learning package for users Medication reminder cards Pharmaceutical care plan

Summary

Clear communication Greater detail of medication changes Transfer of information to GP is guaranteed