1. ePMA Benefits Realisation The RBHT’s Approach… Elsa Ng Darzi Fellow/ Paediatric Cardiac Pharmacist September 2015

2. About RBHT Our Work & Hospitals Harefield HospitalRoyal Brompton Hospital The largest specialist heart and lung centre in the UK One of the largest heart and lung centres in Europe Total of 520 beds in the Trust, including level 1, 2 and 3 Around 30,000 inpatients every year

3. Digital Care Transformation Programme (DCTP) ePMA Respiratory RBH Harefield Hospital Continue rolling out in adult level one wards Paediatrics & OP EDM User workshop & testing Building EDMScanning records Records available on screen PAS Preparation & Initiation Building PAS & new processes Testing & Training New PAS 2015 2015 2016 Summer Winter

4. Five Principles of ePMA Benefits Realisation 1. Aligning ePMA benefits with organisational goals 2. Creating ePMA benefits profiles 3. Estimate benefits using ‘evidence-based approach’ 4. Linking ePMA benefits with QI initiatives 5. Establishing good data management

5. Principle 1 Aligning ePMA benefits with organisational goals

6. Vision and Values Trust vision: To be the UK’s leading specialist centre for heart and lung disease. The Trust will achieve this mission by: Improving patient safety and satisfaction. Providing world class specialist treatments that others cannot offer. Bringing innovation to clinical practice through our research partnerships. Attracting, developing and retaining world class clinical leaders. Investing in services, technologies and facilities to support new service models at both sites.

7. Driver Diagram

8. Benefits Safety Quality ↓ErrorsTranscription Omitted Doses Experience Patients Users/ Staff Governance Med Rec VTE Assessment Antimicrobial Stewardship EfficiencyWork DuplicationTranscribing Financial ePMA Benefits Driver Diagram Benefits Strategic Goals Benefit Category Benefit Details Measure

9. Principle 2 Creating ePMA benefit profiles

10. Benefit Profile

11. Benefit 1: Safety - Transcription Errors > 14 days Level 1 Inpatient Re-written Drug charts

12. Safety – Transcribing Errors Methods Identify patients stay > 14 days Estimate number of transcription Estimate number of transcribed medication orders Transcribing error rates

13. Safety – Transcription Errors Results Estimated between 1500 – 1800 drug charts required transcribing per annum Approx. 10 medicines/ chart Hence 15000 – 18000 transcribed prescriptions Literature search Transcription error rates = 16.8% (Doormaal et al., 2015)

14. Principle 3 Estimate benefits using ‘Evidence-Based Approach’

15. Estimating Number of Transcription Errors at RBHT using literature Transcribed Orders 15000 - 18000 items/ annum Transcription Error Rates 16.5% (Doormaal et al., 2015) Estimated Error 2500 – 3000 / annum

16. Transcription Error Categories A: an error occurred but error did not reach the patient B: An error occurred and reached patient, but did not cause harm C: An error occurred that reached that patient and required monitoring D: An error occurred and resulted in harm

17. Estimating number of transcription error by categories A (84.6%) 2115- 2540 B (13.9 %) 350- 420 C (0.4%) 10-12 D (1%) 25-30 Results estimated based on RBHT PAS data and Doormaal et al., 2015 A: An error occurred but error did not reach the patient B: An error occurred and reached to patient, but did not cause patient harm C: An error occurred that reached that patient and required monitoring D: D: An error occurred and resulted in harm

18. Benefit 2: Efficiency Gain Prescribers/ Pharmacists Assume each transcription task takes 5 mins Efficiency gained by EPMA (prescribers’ time) ~ 17 – 20 work days/annum Estimated value gained SHO £3300 + Pharm £3300 Value gain £6600 (per annum) Calculation based on SHO salary ~ £ 40K Pharmacist salary ~ £40K

19. Principle 4 Linking ePMA with Quality Improvement (QI) initiatives

20. Administration time of IV antimicrobials

21. ePMA & QI Analgesia Administration Time (ePMA) Length of Stay Patient Experience Process Measure Outcome Measures Pain Scores SMART Aim Baseline Measure

22. Principle 5 ePMA generates data. Data is an asset. Asset requires owners. Owners translate data into information. Information breeds behaviours. chrysalis

23. Who owns ePMA

24. Avoid My Baby Problem

26. Five Principles of ePMA Benefits Realisation 1. Aligning eP benefits with organisational goals 2. Creating eP benefits profiles 3. Estimate benefits using ‘evidence-based approach’ 4. Linking eP benefits with QI initiatives 5. Establishing good data management