1. The Health Roundtable Electronic Medication Management Presenter: Dr Melissa Baysari UNSW Innovation Poster Session HRT1215 – Innovation Awards Sydney 11 th and 12 th Oct 2012 1 4-4d_ HRT1215-Session_BAYSARI_UNSW_NSW

2. The Health Roundtable KEY PROBLEM  Medication errors are the single greatest source of preventable harm to patients 2

3. The Health Roundtable AIM OF THIS INNOVATION  A reduction in medication errors  Clinical errors (e.g. wrong doses)  Procedural errors (e.g. incomplete orders) 3

4. The Health Roundtable BASELINE DATA  Daily chart review to identify prescribing errors (878 admissions)  3.62 prescribing errors/admission  2.66 procedural errors/admission  0.96 clinical errors/admission  26 serious prescribing errors per 100 admissions  Severity ≥ 3 SAC rating Westbrook et al, 2012 4

5. The Health Roundtable KEY CHANGES IMPLEMENTED  Electronic medication management system (eMMS) = MedChart  MedChart – end to end medication management including prescribing, monitoring, dispensing & administration  Includes some decision support: computerised alerts, pre- written orders, reference sources  Gradual roll-out commencing in April 2005  By August 2010, every inpatient ward of SVH had eMMS including high dependency and ICU 5

6. The Health Roundtable 6

7. OUTCOMES SO FAR  MedChart associated with 60% reduction in prescribing errors  3.62  1.46 prescribing errors/admission  Driven by a large reduction in procedural errors  2.66  0.17 prescribing errors/admission  44% reduction in serious errors  No change in clinical errors – limited decision support  Designing effective decision support a real challenge  Alerts frequently ignored and overridden  Doctors irritated & frustrated Westbrook et al, 2012; Baysari et al, 2011 7

8. The Health Roundtable LESSONS LEARNT  Success for eMMS depends on  A positive workplace (leadership, teamwork and clinician ownership)  Acceptance of the major impact on work practices by all staff  Timely response to user feedback  Training and support for clinicians  A usable system  Limited decision support  Ongoing evaluation is critical (including process evaluations) 8

9. The Health Roundtable LESSONS LEARNT  ‘Process’ evaluations have shown:  Decision support (DS) is more effective in some situations (junior doctors prescribing after-hours) than others (ward-rounds)  Poorly designed DS results in alert fatigue  Sub-optimal use of the eMMS can result in additional unnecessary computerised alerts Baysari et al, 2011; 2012 9