Whats wrong with a piece of paper? The Electronic Transfer of Care Princess of Wales Hospital Rowena Lewis

Electronic Transfer of Care (e-TOC) Clinical information Medication information Sent electronically to GP 10 medical wards over two sites 2 mental health wards 2 orthopaedic wards

The situation that had to change Mind the gap! Carbon copy paper take-home prescription Patient had to transfer information Varying clinical summary sent or not sent at all GPs asked for better communication

Aims of e-TOC project Improve discharge communication from hospital to primary care. Improve patient safety and reduce clinical risk by providing better medication information to GPs. GPs to receive in a timely manner with a target of 80% discharge summaries within 5 working days.

Objectives Carbon copy typed medication list Transfer electronically to GP immediately Reasons why medicines are started and stopped - NICE/NPSA medicines reconciliation Provide GP with full clinical details in uniform format

Method Designed by clinicians Produced by our IT department Accessed via PIMS+ Hospital wide wireless network

Ward Process Junior doctor enters initial information Updated during patient stay Doctor marks ready for discharge Pharmacist verifies medication list Junior doctor completes clinical info Consultant approves it for GP

Implementation One ward pilot Many improvements made initially Dosage codes taken from the pharmacy system Colours and symbols distinguish between new, changed and stopped medicines Format of printed list of medication to improve clarity Screen icons to aid communication between staff Laminated crib sheets Helpful hints boxes

Key Success Factors Gradual roll out Dedicated project manager Multidisciplinary training sessions Regular feedback from all users

Key Success Factors Frequent updates to system Regular audits of doctors input On site IT support Determination to succeed

Training within Pharmacy Pharmacist users Entering medication Verifying medication Signing off medication Trouble shooting Regular updates Listening to feedback Ward Technicians Marking drug chart Dispensing from drug chart Dispensary staff New format of discharge prescriptions Printing medication orders

Benefits of e-TOC Patient Pharmacist Doctor Nurse GP 96% of patients have verified medication sections sent to their GP on day of discharge – includes diagnosis and follow up arrangements

5.7% 70% 89%

How much have we achieved? Increased number of summaries sent to GPs Improved timeliness of communication to primary care Gradual implementation helped acceptance of system in hospital

Have targets been reached? Not achieved on all wards yet! Average is 70% in 9 days Much better than 5.7% in 37 days Changes to practice have been challenging Sharing workload has helped

Benefits to Pharmacists Medication on e-TOC system prior to discharge Order function linked to dispensary Access to previous e-TOCs Legible list to give patient at discharge

Lessons learned Thorough training required Need modern computers Helpful IT staff available to assist Regular updates to system Enthusiasm and determination

The future Finish implementation across hospital Electronic learning package for users Medication reminder cards Pharmaceutical care plan

Summary Clear communication Greater detail of medication changes Transfer of information to GP is guaranteed