Using an electronic prescribing and medicines administration system (EPMA) in high secure services
Following the National Patient Safety Agency’s (NPSA) publication of ‘Reducing harm from omitted and delayed medicines in hospital 2010’ alert, Mersey Care NHS Foundation Trust (Mersey Care) set out to improve patient experience and safety through the implementation of an electronic prescribing and medicines administration system (EPMA).
The move from paper-based pharmacy records to an electronic system was undertaken to enhance medication optimisation for patients, reduce the risk of medication errors, improve ordering and stock control and, ultimately, to facilitate increased automation (and therefore accuracy) in dispensing.
Aligning to the guidance within the NPSA 2010 alert, Mersey Care sought to address the issues related to timely delivery of medication in improving patient outcomes, through medication optimisation.
Solution and impact
As Mersey Care’s hosted IT provider, the Informatics Merseyside team was appointed based on its knowledge and availability. WellSky International Ltd (formerly JAC) was appointed as the EPMA system supplier. They were also able to utilise the lessons learned from previous EPMA implementations.
The Trust selected the High Secure Services team to roll out EPMA first. This was mainly because the team already had a patient administration system (PAS) operating.
Having a mature and stable PAS is beneficial as it can provide a real time feed for patient information. This was connected into the EPMA solution, ensuring that the system reflected the patient’s actual location and by extension, where their medications will be delivered and issued from.
The approach has many benefits and outcomes.
- The introduction of electronic prescribing removes the need for transcription and reduces manual errors
- Standardised protocols and decisions support consistency in prescribing practices
Reducing unwarranted variation
- Standardised medication protocols support the use of organisationally agreed medicines delivery
- Decision support provides a standard set of alternative medications
Quality and safety
- Implementation of electronic prescribing eliminates transcription errors
- Real-time recording of issuing medications ensures that there are no duplicated doses
- Control protocols support standardised, safe prescribing
- The implementation of EPMA has reduced medication waste
Certain technical prerequisites were in place for this work prior to implementation:
- an electronic patient record (EPR), providing patient administration as well as real-time bed management functionality
- a dedicated, secure Wi-Fi network
- secured, multi-user, infection prevention and control-approved laptops
- trolleys as a mobile surface for laptops
- additional power points on wards to charge/power laptops
- secure remote access to the Trust network
The solution is web-based and can be accessed off-site through remote access functionality.
Medicines management and optimisation
- Decision support for contraindicated drugs, configured at a local organisational level
- Reduction in medicines administration errors with a real-time medication issuing solution
- Improved standardised medication protocols reducing unwarranted variation
Remote and assistive care
- The EPMA system is available off-site through a remote access solution and enables specialist support to ward staff, particularly out-of-hours when the service may require support from an on-call medic
- The solution includes decision support both for contraindications and also for organisational protocols when prescribing
Clinical and business management
- Custom reports enable detailed analysis of medication use and waste to support business planning
The solution can be accessed anywhere through remote access. It is intended for clinical use.
Key learning points
The key learning about the ongoing development of a business case from the implementation of EPMA was that an understanding of the scope of the work is critical. As much prior knowledge that can be gained from research is valuable but equally, evaluation of the ‘as-is’ state of the organisation and the context that the change is taking place within can significantly impact requirements.
The project was entirely focused on the delivery of EPMA in High Secure Services. However, the strategic view has been to implement a single instance of EPMA across the Trust. Due to the variation in use and requirements across the Trust, teams from the wider organisation joined clinical reference groups and project board meetings. This oversight ensured that all requirements were captured and that as far as possible configuration was undertaken in a way that supported organisation-wide requirements.
It was important to have a shared plan. The detailed planning following the Full Spectrum Organisational Readiness Assessment (ORA) developed in collaboration with the supplier created a clear path from the beginning of the implementation through to completion.
Find out more
Dr Arun Chidambaram, chief clinical information officer, Mersey Care NHS Foundation Trust
Cathy Young, marketing manager, WellSky International
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