eMedicines Administration: Practical Implications Chris Fokke RGN, BA Hons, MSc. IT Chief Clinical Information Officer Hampshire Hospitals NHS Foundation Trust

Session overview Share experiences from HHFT regarding changing from paper-based to Emedicine administration Concentrate on practical approach on how roll out was achieved successfully Lessons learnt and opportunities

Professional context to introduce Emediciness administration Include operational & senior staff in preparing for Go Live and process changes Nursing had anxiety regarding professional accountability (NMC code of conduct)

Section 4 Standard 8 Accurate and immediate recording needs to include reasons for withholding or not administering medicines (NMC, 2010) Publications/NMC-Standards-for-medicines- management.pdf

Log on to JAC and access the Patient Record using CHART or POE Nurse checks: Patient Name Date of Birth NHS number Allergies Nurse checks Admin chart or 24 PAC for duplicates Click Order Inquiry for prescription details (as per NMC guidelines) Collect drug, check or calculate dose check expiry date Take drug, lap-top and a witness (if required) to the patient Check wrist band Information against the chart Observe Patient taking the medication Sign for admin by double clicking the ‘Admin date column’ then Click green CHART button Read any note attached to the medication, take action if applicable Close note page Complete the PRN section of the CHART as the patient requires Once all medication given to a patient close their record and continue to the next When the medication round is completed close the JAC records. Log off the JAC using the Log off button. Appendix B Medicines Policy Process for Administering Medications using e-Prescribing system (JAC)

Training/Support when rolling out Training 3 weeks prior to go live – all shifts Ward based Refresher session 1 week prior go live Ward Based go live Support 24 x 7 Nurses – Group Dedicated Training Doctors – One on One training E-learning package E-learning assessment

Practical deployment Avoid Mondays! Accompany all nurses on first shift and floor walk Attend Doctor ward rounds on rollout day and the next day Pharmacy start early transcribing- electronic stickers on notes Introduced Shift Work in project team. Programme manager accessible and responsive

Practical deployment High visible presence during rollout Introduce a 24/7 bleep for help/support Mobile phones for the team Keep issue log and respond immediately Allow emergency pain relief paper charting in critical areas or situations (Recovery/ED) Set up user groups

Go live and day-to-day considerations Business continuity plan (BPC) – Communicate to staff to revert back to paper – Have local Disaster Recovery folder – Be clear about roles and responsibilities How do paper charts get to wards How do patient profiles get to wards How do you transcribe back into electronic system – Documentation of plan and triggers in IT support team

Emedicines administration – Quality/Safety Design and develop front-end using clinical engagement No information is lost, strong IG/security E-discharge information Pin-pointing to root causes much easier Re-use e-information for different purposes (e-Drug chart/Admission/Discharge)

Customize views in clinical practice

Next EPR release will make E-Drug chart Usable according to staff’s needs

Conclusion Our experience of E-prescribing and administration Fast track change in practice works and minimises risk to patients (transition of electronic versus paper) – Kinder on users (many worry- unnecessarily- about change in practice) – Robust control of project due to short timeline – Fast adaptation of new practice – Needs careful investment and preparation to succeed

Conclusion Beyond the embedding phase Flexible use of e-prescribing/medicine management information – Golden source of info regarding e-discharge summaries – DR/BAU needs to be regularly monitored/managed. – True clinical business critical system – Initial change in practice is difficult, but the rewards from a safety and efficiency perspective is worth it

Thank you Chris Fokke Chief Clinical Information Officer Hampshire Hospitals NHS Foundation Trust Aldermaston Road Basingstoke RG24 9NA (4936)