1. Use of the JAC electronic prescribing system to facilitate audit data collection Dr. Richard Hughes, Anaesthetic Research Fellow Dr. Nicola Edwards, Anaesthetic SHO Dr. Niall Poole, Pharmacist and EPS manager Birmingham Heartlands Hospital

2. Dr. Richard Hughes, BHH Nov 2003 Overview Two audits performed eight months apart One manual data collection One electronic data collection Methods of electronic data collection using electronic prescribing

3. Dr. Richard Hughes, BHH Nov 2003

4. Clinical Problem Thromboprophylaxis in high risk surgical patients

5. Dr. Richard Hughes, BHH Nov 2003 Audit 1 Routine audit of thromboprophylaxis amongst thoracic surgical patients completed January 2003. Data collected on paper forms by reviewing notes and drug charts.

6. Dr. Richard Hughes, BHH Nov 2003 Audit 1 - Manual data collection

7. Dr. Richard Hughes, BHH Nov 2003 Efficiency – Audit 1 Manual audit collection  20 minutes per patient  114 patients =38 hours i.e. SLOW

8. Dr. Richard Hughes, BHH Nov 2003 Interpretation problems

9. Dr. Richard Hughes, BHH Nov 2003 Results – Audit 1 N=114 Only 42% patients had full compliance with protocol Majority of failure due to prescription timing errors.

10. Dr. Richard Hughes, BHH Nov 2003 Completing the audit cycle Action taken: –Correspondence to all SHOs and Ward Nurses highlighting problem –Increased flexibility of drug dosing agreed Repeat audit planned. Electronic prescribing system introduced.

11. Dr. Richard Hughes, BHH Nov 2003

12. Data stored in caché Name PID Age Admission date Admission time TEDS Enoxaparin prescription time Prescriber Time of first dose If not before theatre why not? Date enoxaparin discontinued Manual data collection

13. Dr. Richard Hughes, BHH Nov 2003 Data stored in caché Name PID Age Admission date Admission time TEDS Enoxaparin prescription time Prescriber Time of first dose If not before theatre why not? Date enoxaparin discontinued Manual data collection

14. Dr. Richard Hughes, BHH Nov 2003 Outstanding Data 1.Operation date and time 2.Procedure Manual data collection

15. Dr. Richard Hughes, BHH Nov 2003 JAC prescribing system EPS to be mandatory in acute hospitals by 2005. JAC (John, Andy,?) Supplying pharmacy software for 20 years.

16. Dr. Richard Hughes, BHH Nov 2003 JAC prescribing system CACHÉ Post relational database 1. Drug File 2. Patient File 3. User File JAC electronic prescribing 1. Prescribing record 2. Administration record 3. Dispensing record

17. Dr. Richard Hughes, BHH Nov 2003 Outstanding Data 1.Operation date and time 2.Procedure Manual data collection

18. Dr. Richard Hughes, BHH Nov 2003 Operation Code Format Procedure Date Time. ABCD 131103 1130

19. Dr. Richard Hughes, BHH Nov 2003 Operation Codes OperationCode LobectomyLOBE PneumonectomyPNEU Wedge resectionWEDG Open BiopsyOPBI OesophagectomyOESO DecorticationDECOVATS MediastinoscopyMEDI Bronchoscopy onlyBRON OesophagoscopyOSCP Other majorOTMA Other minorOTMI

20. Dr. Richard Hughes, BHH Nov 2003

23. Manual data collection

24. Dr. Richard Hughes, BHH Nov 2003 JAC prescribing system CACHÉ Post relational database 1. Drug File 2. Patient File 3. User File Crystal reports JAC electronic prescribing 1. Prescribing record 2. Administration record 3. Dispensing record

25. Dr. Richard Hughes, BHH Nov 2003 Crystal reports READ ONLY access to caché Generates report of pre-selected values Enables full control over accessed data

26. Dr. Richard Hughes, BHH Nov 2003 Select required tables 1.Active patients 2.Patient basic 3.Clinical notes 4.General users

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28. LOBE 131103 1100

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31. Efficiency Manual data collection  20 minutes per patient  114 patients =38 hours Electronic data collection  2 minutes per patient  114 patients =4 hours

32. Dr. Richard Hughes, BHH Nov 2003 Results – Audit 2

33. Dr. Richard Hughes, BHH Nov 2003 Strengths of electronic audit Fast, efficient assimilation of data Benefit increases as size of audit increases Allows viewing of additional variables at a later date

34. Dr. Richard Hughes, BHH Nov 2003 Other potential uses Countless other uses in clinical audit Pain audit –Reviewing analgesic prescribing and administration

35. Dr. Richard Hughes, BHH Nov 2003 Weaknesses Only as accurate as the data already in caché Relies on accurate input of coded information Manually inputted reasons for non- administration not analysed

36. Dr. Richard Hughes, BHH Nov 2003 Summary Golden Ideal - universally compatible IT system throughout NHS Avoidance of duplication of data input Principle of utilising existing electronic data Doors open to a powerful tool for clinical audit

37. Dr. Richard Hughes, BHH Nov 2003 Questions?

38. Dr. Richard Hughes, BHH Nov 2003 Thank You!