1. IV Prescribing and administration – the LHCH solution
Mrs Pamela Gardner (Senior Pharmacist)
Dr Johan Waktare (Chief Clinical Information Officer)
with
Dr Gillian Gow (Chief Pharmacist)
Caroline Waine (Senior Pharmacy Technician)
Lyndsey Waktare (Clinical Systems Manager)
December 2014

2. Overview Where we started from – JAC EPMA How did Allscripts differ?
Benefits of Allscripts EPMA
Issues raised with EPMA IV prescribing
The future

3. JAC EPMA
209 bedded (including 50 critical care beds) cardiothoracic hospital
Implemented May- Nov 2010 Version 4.47 – no IV solution
Paper charts – IVs prescribed on EPMA e.g ‘Glucose 5% infusion - see paper chart’
Risk if not prescribed on EPMA but mitigated by intense training of staff

4. Allscripts Full EPR –implemented June 2013
American system – IV Rx and admin established
Drugs built on series of forms- required reworking to meet Trust requirements
Discussion with consultants to determine options for individual drugs and hence build format

5. Build format Simple fluids e.g. Glucose 5% Once only
e.g. Cefuroxime – Once (stat – care US interpretation is different)
Drug – choose diluent
e.g. Flucloxacillin
Pre-built formulations
e.g. Magnesium infusions; Noradrenaline infusions (variable rate)
Complex Infusions
e.g. Amiodarone, Insulin sliding scale; Dopamine

6. Build format
Simple fluids e.g Glucose 5%

7. Build format
Once only
e.g. Cefuroxime - Once

8. Build format
Drug – choose diluent
e.g. Flucloxacillin

9. Build format
Pre-built formulations e.g. Magnesium infusions

10. Build format
Pre-built formulations e.g Noradrenaline infusions (variable rate)

11. Build format
Complex Infusions e.g. Amiodarone

12. Build format
Complex Infusions
e.g. Insulin sliding scale

13. Build format
Complex Infusions
e.g. Dopamine

14. Electronic Medicines Administration Record

15. Electronic Medicines Administration Record

16. Benefits of IV build All IV drugs visible on EPMA
Easy selection of IVs commonly used
Ability to pre-formulate a complicated regimen for prescribers thereby reducing error on manual input

17. Issues raised
Cannot avoid mistakes if doses not set as no dose range checking
IV continuous start and stop time not clear to admin staff
Critical care still using paper charts for recording IV drugs, flow rates etc – causing duplicates to sometimes occur
Dual signature workflow not matching UK workflow

18. The Future?
Work with Allscripts to improve view of prescribed and administered medication e.g. continuous infusions – to make duration more visible
Critical care – new format for recording flowsheets and obs required
Dual signature workflow enhancement built but not implemented yet.

19. Thank you