1. Workstream 1: Project Management – System Configuration and Business as normal Andrew Heed Kathy Wallis 17 June 2013

2. Agenda Some background to us – Trust and ePrescribing Project Workshop structure –Pre-Go Live planning –Roll-out considerations –Maintenance and Support Any questions??

3. University Hospital Southampton 1100 beds Provides services for 1.3M people in Southampton and south Hampshire specialist services such as neurosciences, cardiac services and children's intensive care to more than 3 million people in central southern England and the Channel Islands major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust treat around 140,000 inpatients and day patients, including about 50,000 emergency admissions

4. Project timeline

5. Newcastle upon Tyne Hospitals Freeman Hospital Transplantation, Cancer Centre, Cardiothoracic Surgery, ENT, Vascular…… Royal Victoria Infirmary Neurosciences, Emergency care, Children’s Services, Plastic Surgery, Ophthalmology, Dermatology, Maternity Beds – 1792 (Inpatient) & 205 (Day case) Activity –Inpatients – 192,000 –Outpatients – 870,000 –Lab/ Rad requests – 3 million –ePrescriptions – 1.7 million –eAdministration – 7.2 million

6. ePx Project Cerner Millennium system –ePx, electronic orders, A+E, Theatre scheduling, PAS, documentation. Project timelines: –Work started April 2008 –Go-live November 2009 –Adult In-patient rollout completed March 2011 –Paediatric ward Feb 2013 (ongoing) –Starting 2 nd system upgrade. –Documentation ongoing. –Never-ending story

7. Workshop Session 1 Pre-Go Live Planning Design Considerations Testing Hardware Roll-out plan Training ….

8. Workshop Session 1 Feedback / Discussion

9. Design Considerations The drug catalogue –VTM, AMP, AMPP Terminology –Routes, forms, frequencies. Decision support. –Dosing sentences. –Alerts (interaction / dose checking / allergy others) –Order sets Future -proofing

10. Scope What can you actually do? –System limitations –Do you need documentation Where can you do it? –Other systems? What can you afford / support.

11. Hardware Can you ever have enough? What kind? Dispensing trolley? Security / cleanliness / durability. People will have better hardware at home –Or even in their pocket. –But what can an App actually do?

12. Training Who to train? When to train? What to train on? How many people? How to get bums on seats? What about the night shift? Who will do this in the long term? Should we even bother?

13. Workshop Session 2 Roll-Out Considerations Support Mixed Media Prescribing Bank and Agency Staff Real time PAS / ADT issues ….

14. Workshop Session 2 Feedback / Discussion

15. Roll Out planning Start upstream or downstream? Time between wards go lives – transfer of patients and outliers Dual systems – paper and electronic

16. Roll Out planning Big Bang vs staggered rollout. –What can you support? Staggered: –Arranged by directorate, patient flow –How does geography affect things –What is your transfer mechanism –Is it realistic –Too fast or too slow.

17. Dedicated ePrescribing support 24/7 ePrescribing team manager (Pharmacist) plus 5 full-time team members (Nurses or Pharmacy Technicians) On-site 24 hour support for 7 days post go live; otherwise 0730 – 2300 on site and on-call over night Used extra support for Theatres when surgical wards first went live (anaesthetists and recovery staff) Bank staff to support staff shortages Moving to be able to provide less on-site support over weekends Key success area for the project: awarded ‘Hospital Heroes’ team prize of Education and Support

18. Agency nurses and locum doctor access Use NHS professionals and multiple other agencies High agency usage – wards could not operate if agency staff not able to use the system Agreed process where agency nurses (and locum doctors) access and complete training before starting their first shift Agencies responsible for completing System Access Forms Built into the performance metrics for the agencies Difficult for first few wards, but easier as more wards are live

19. Real-time ADT Was an on-going issue for the Trust to have a accurate electronic bed-state – not a clinical task With ePrescribing: –Patient must be admitted to be able to administer medications (can prescribe if pre-admitted) –If patient not admitted or transferred to the correct ward, they do not appear on the list of patients due medication –If patient not discharged, they will continue to appear on list of patients due medications – each ward needs to clear all non-administered medications overnight to be able to administer medications the next day Nursing staff now complete ADT when ward clerk not on duty (also have a central ADT team to support) ADT available on the drug trolleys – therefore can complete transfers etc ‘on the fly’ Also supports the use of other systems (e.g. Doctors Worklist; Bed Management tools

20. Workshop Session 3 Maintenance and Support Responding to incidents Handling prescription errors On-going maintenance of the system Training Managing Expectations Reporting Data for audit Upgrades Downtime

21. Workshop Session 3 Feedback / Discussion

22. Responding to Incidents We now have something to blame! Who does this now? Who does this after go-live? System fault? or user fault? But what is the system? –software, user, computer, Wi-Fi, power cable, the workmen digging the road up 3 miles away? Trend monitoring. Feedback to users / training central team or department.

23. Consultant review of the drug chart / Drug Chart Viewer surgical consultant ward rounds anaesthetist review pre procedure (Demo)

24. On-going modification of build Link to stock control system limits naming of prescribable items: –Inclusion of strength and formulation Modification of existing protocols – general prescribing practice is more open Increasing list of protocols – standardise care and ease of prescribing

25. On-going maintenance Everything goes through the system –New policies –Clinical trials –Who designs or build this –Can the system / team become a bottleneck? How do we handle changes to the system? –En masse change vs drip feed. –How does the system handle change? –Change control Do we need a down-time.

26. Future Proofing Try to plan for every area you will be going to….. Or you potentially have a large rebuild / renaming process Try to take the long view and avoid short cuts. ???

27. Benefits: Error rates

28. Benefits: Drug Round times Drug Round pre / post eprescribing Avg time / patient (Mins) Avg difference (mins / patient Ward 1Ward 2Ward 3Ward 4Ward 5Ward 6Ward 7Ward 8 am pre11.4977.956.456.917.318.68.15 post6.476.177.576.187.076.886.79.470.92 lunch pre8.683.754.713.433.824.08104.12 post3.152.734.113.114.474.193.723.71.67 Eve pre9.2156.054.533.966.63 5.85 post5.214.533.454.365.53.253.3741.68 Night pre10.4754.264.814.55.4712.658.71 post5.786.424.95.435.396.459.3810.570.19

33. Questions?