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

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

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

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

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

Build format Simple fluids e.g Glucose 5%

Build format Once only e.g. Cefuroxime - Once

Build format Drug – choose diluent e.g. Flucloxacillin

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

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

Build format Complex Infusions e.g. Amiodarone

Build format Complex Infusions e.g. Insulin sliding scale

Build format Complex Infusions e.g. Dopamine

Electronic Medicines Administration Record

Electronic Medicines Administration Record

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

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

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.

Thank you