Following on from our deep dive last week in which we explored electronic patient records, today we’re turning our attention to electronic prescribing and medicines administration (EPMA).
Earlier this week, we published an interview with Gary Mooney, clinical solution executive at InterSystems. Gary shared his experiences implementing InterSystems’ EPMA solution with North Tees and Hartlepool NHS Foundation Trust, highlighting how the solution can help to “reduce well established medications risk relating to transitions of care” along with “tackling those siloes of medicines information that don’t get communicated in a timely way between care teams”.
In June, we shared how Nottingham University Hospitals launched Nervecentre’s EPMA solution across The City Hospital and Queen’s Medical Centre, with the latter involving the transcription of 14,100 prescriptions from drug charts over to the system.
March saw us cover the news that Digital Health and Care Wales launched a new framework with the aim of supporting organisations in procuring EPMA solutions. Specifically, the programme seeks to support hospitals in Wales to run smaller competition processes and call-off EPMA solutions on a local basis. Nervecentre, CareFlow Medicines Management and Better were all awarded the framework, with Digital Health and Care Wales’ chair Simon Jones calling the framework “a huge milestone in the development of digital transformation”. He added that “the outcome of this work will make a really positive difference in secondary care. This is a big step in the delivery of the digital medicines programme.”
Tips on EPMA roll-out from Barnsley Hospital NFT
In November, we heard from Barnsley Hospital NHS Foundation Trust on their EPMA project, including the timeline, rollout, engagement with staff and the planning and support that went into it.
The team shared how their project “EPMA in 80 days” as they went from introductions and project planning in October 2021 to “celebrating the success of electronic prescribing” in March 2022.
The team conducted a pilot across two wards to give them a chance to see how it was working and spot any potential issues, which Barmsley’s deputy director of IT Richard Billam said “definitely highlighted things that we could improve. We looked at how people used the system in the real world and that informed how we trained it, how we communicated. It helped us to build the tools for managing patients through the cutover process, so we made sure that we’re tracking it all the way through.”
He shared some lessons learned from the pilot, including the different practices between different wards which necessitate adaptions for training materials; and also that the system could be embedded “within three days”, which meant that the planned timeframe could be shortened to prevent clinicians becoming frustrated.
Barnsley’s clinical digital lead Bethany Pearson discussed the planning and support put in place for the EPMA implementation. She shared how the trust “worked closely with the University of Sheffield and Sheffield Hallam University; they provided student nurses and student medics and that was quite innovative. It was a two-way support system – we helped them with change management projects and being involved in digital healthcare, and they helped us with supporting staff and supporting the rollout.”
A wide range of staff also provided on-the-day support with transcription, with Bethany commenting how they “put an SOS out across the hospital” to garner support. “We got support from medics, from pharmacists, pharmacist techs, the patient safety team and the acute response team. They weren’t necessarily prescribers but that was fine, they had medical knowledge or clinical experience and they weren’t actually prescribing. They were just transcribing, and the medications are authorised afterwards.”
In addition, when a ward was in the process of going live, Bethany’s team and the IT team would visit each ward beforehand, providing the wards with an overview of what to expect and checking all IT equipment.
On the day, she added, her team would arrive on the ward for the handover at 7am and introduce themselves; this meant that staff knew who to approach for help, and also allowed Bethany and her tea to identify high-risk patients on critical medication for extra support.
“We provided elbow support for the staff throughout the day, up until the last medication had been given at night,” Bethany shared. “We identified those members of staff that might need a bit of extra support and sat down with them before we left, and then we came back again the next morning at 7am so that we knew everyone was OK.”
Find out more about Barnsley’s EPMA project here.
Insights from Nervecentre
“EPMA systems are complex,” Paul said. “There is an enormous amount of variation with drugs, and the modelling of this variation drives the complexity in order to provide the most granular clinical decision support possible.”
He highlighted how Nervecentre has sought to deliver an EPMA solution that is “both comprehensive and utilises innovative approaches to help to further improve safety and to make the system easier to use.”
To drive this innovation, he described how his team has worked closely “with a multi-disciplinary team of nurses, doctors and pharmacists to ensure the system meets all of the objectives of the people that use the system. This helped us to fully understand the variations and the complexities. It is important to take a broad approach to partnering, to develop ideas with a wide variety of people.”
Paul also raised the challenge of delivering a product into an existing market: “Even the first version of our EPMA had to handle the most complex scenarios and medications, and we took a collaborative approach to achieve that.”
He noted that medicine management “is one of the highest risk areas of acute care, and the opportunity for digital systems to reduce that risk is significant, but systems need be able to support the most complex medications and protocols, and flex to individual patient needs.” He shared how Nervecentre looked at “why, for instance, some hospitals with mature EPMA systems retained paper records for complex medicines such as insulins. We were able to ensure that results and vital signs, as well as clinical information known about a patient, were tightly integrated into the user experience so they could be used to deliver a full picture to a clinician, or provide hide alerts that were not relevant based upon a patient’s pathway or condition.”
In addition, Paul said, Nervecentre worked to “link medicine information through to our Live Flow operational dashboards, that give actionable insights to clinician’s mobiles, as well as to the command and control room. This allows, for example, pharmacists to prioritise the review of a patient admitted with a high-risk medicine in their medication history, over the review of a patient with minimal medication history.”
Catch up with Paul’s interview in full here.
Learnings from Dorset
Looking further back, we heard about the joint EPMA implementation managed by Poole Hospital NHS Foundation Trust and Royal Bournemouth & Christchurch NHS Foundation Trust.
Nick Bolton, then interim chief pharmacist, now deputy associate director of pharmacy, said that the project started “against a backdrop of challenging IT deployments, with cynicism from some clinicians towards newer IT solutions”. Wanting the teams to have the “full support they needed”, Nick described how the trusts opted for a phased rollout approach. He added that a key success factor was that the project was “really well delivered and well managed.”
Nick acknowledged that there are positives and negatives with a phased rollout approach. “It can mean you’re using a mixture of paper and electronic processes but then there are risks associated with a big bang approach in getting it right.” He emphasised that each trust has its own “unique circumstances” and that the phased approach is what worked for them.
“It gave us the opportunity to work with our nursing, clinical and pharmacy teams to really understand their processes. You might think the methodology is right beforehand but in practice we gained valuable feedback from the teams. This feedback loop helped us to hone and refine the system, we had some really good ideas come back that we were able to implement.”
Tips from the trust include having the deployment team on the wards providing on-hand support throughout shifts, and identifying advocates within wards to help embed working patterns.
James Young, then EPMA project lead pharmacist, noted: “We decided to start the proof of concept in a downstream ward that had slower patient turnover. However this was not an admitting ward, so we had to transcribe new patients from paper to digital. The better place to start is an admission ward, because although it’s busy with a higher turnover, it’s safer going from digital to paper (by printing) than the other way around.
He added that “engagement is really key to ensure an effective rollout of a system and to have passionate people around you.”