1. MedChart is live at SCDHB Helen Sharples

2. In May, South Canterbury DHB introduced MedChart for the electronic prescribing and administration of medicines at Timaru Hospital. Timaru Hospital staff are pushing 30 new COWs around the wards, but instead of distributing milk these technical bovines are used for medication. Relying on paper and pen attached to a clipboard at the end of the bed will eventually be over-ridden, now that MedChart is here.

3. Affectionately called COWs (Computers on Wheels) the trolleys have been individually named with the quintessential Daisy and Blossom monikers. They were installed for all adult inpatient wards in May. Children's medication dosage relies on a weight formula and that aspect of the computer programme is being developed in Dunedin.

4. The system was trialled in two of Dunedin Public Hospital's medical wards in 2010 and has since been rolled out there, Invercargill and some parts of the Canterbury District Health Board. It is hoped all hospitals in New Zealand will use the system eventually as well as General Practitioners and rest homes.

5. We know that paper-based prescribing, both in NZ and overseas, is associated with a high rate of medication errors. Electronic prescribing helps with prescribing safely, staff with access can log on to MedChart from anywhere in the hospital, there are checks for errors and duplications, automatic warnings show up if a higher-than-usual dose is prescribed, and it is very clear when changes are made. Administration of medicines is easier, because prescriptions are clear and there is an overview of when medication is due.
Nursing staff at Timaru Hospital give dietary supplements as prescribed on Medchart.
When meds are due an alarm clock icon appears on the screen against the patient's name. An alert also shows when medications are late or if not given.
There is increased compliance with nursing staff giving dietary supplements with good documentation if supplements are declined of with held.

6. Nursing staff at Timaru Hospital give dietary supplements as prescribed on Medchart.
When meds are due an alarm clock icon appears on the screen against the patient's name. An alert also shows when medications/supplements are late or if not given.
There is increased compliance with nursing staff giving dietary supplements with good documentation if supplements are declined or with held.

7. Drug chart errors due to illegible hand writing a thing of the past.

8. The Dietitians, Clinical and Nursing staff have responded really positively to the significant changes imposed by the move from paper charts to the new system. The new system is easy to use and clear.
If a patients chart is open then there is read only access until the other staff member has logged out.

9. Multiple back ups are in place in case of computer malfunction and staff could revert to paper again as a last resort. The introduction of the $300,000 programme over three years was a big task with 400 staff members undergoing training for it. The system will have ongoing costs of about $50,000 a year for the licensing software, maintenance and replacements.

10. Support was provided by the Southern DHB team who were onsite to help with the implementation and training once the Dietitian’s formulary was provided by our team.
Only supplements/sip feeds/vitamins or minerals/enzymes on the dietitian’s formulary can be prescribed by the Dietitians but of caution all meds can be ceased.
To cease a medication you need to enter your pass word and the reason is asked for.

11. South Canterbury DHB Dietitian Formulary
Special Foods
 For up to date information go to
Vitamin products
Vitamin A  with vitamin D and C
Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops
Pyridoxine hydrochloride
Tab 25 mg or Tab 50 mg
Thiamine hydrochloride
Tab 50 mg
Vitamin B complex
Tab, strong, BPC
Ascorbic acid
Tab 100 mg
Alpha tocopheryl acetate
Water solubilised soln 156 iu/ml, with calibrated dropper
Multivitamins
Tab or Powder or Oral liq
Vitamins
Tab (BPC cap strength)  or Cap (fat soluble vitamins A, D, E, K)
Folic acid
Tab 0.8 mg
Mineral products
Calcium carbonate
Tab 1.25 g (500 mg elemental) or Tab 1.5 g (600 mg elemental) or Tab 1.75 g (1 g elemental)
Sodium fluoride
Tab 1.1 mg (0.5 mg elemental)
Ferrous fumarate
Tab 200 mg (65 mg elemental)
Ferrous fumarate with folic acid
Tab 310 mg (100 mg elemental) with folic acid 350 μg
Ferrous sulphate
Tab long-acting 325 mg (105 mg elemental) or Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml)
Ferrous sulphate with folic acid
Tab long-acting 325 mg (105 mg elemental) with folic acid 350 μg
Potassium iodate (iodine)
Tab 268 mg

12. Oral electrolyte replacement products Pancreatic enzymes
Oral electrolyte replacement products
Compound electrolytes
Powder for soln for oral use 5 g
Dextrose with electrolytes
Soln with electrolytes
Potassium bicarbonate
Tab eff 315 mg with sodium acid phosphate g and sodium bicarbonate 350 mg
Potassium chloride
Tab eff 584 mg (14 m eq) with chloride 385 mg (8 m eq) or Tab long-acting 600 mg
Sodium chloride
Oral liquid
Pancreatic enzymes
Cap 10,000 units
Oral electrolyte replacement products
Compound electrolytes
Powder for soln for oral use 5 g
Dextrose with electrolytes
Soln with electrolytes
Potassium bicarbonate
Tab eff 315 mg with sodium acid phosphate g and sodium bicarbonate 350 mg
Potassium chloride
Tab eff 584 mg (14 m eq) with chloride 385 mg (8 m eq) or Tab long- acting 600 mg
Sodium chloride
Oral liquid
Pancreatic enzymes
Cap 10,000 units

13. Sip feeds and food modules
Ensure Plus
Fortisip
Fortisip Muilti Fibre
Glucerna Select
Diasip
Fortijuce
Two Cal HN
Pulmocare
Suplena
Nepro
Renilon
Calogen
MCT oil

14. The formulary can include special foods and supplements not on the Hospital Medicines List ( HML ) however prescribing these will come with a warning and you need to select override to continue. This could be used to include supplements provided by the patient which can then be prescribed.
A note can be entered in the qualifier box, such as “continuation use patient’s own supply”

15. Fluids are still prescribed on fluid balance charts.
Enteral feeding regimes are written on enteral feeding charts by the Dietitians. MedChart is then updated that an “Infusion Chart Exists”

16. MedChart in summary
Pros
Improved patient safety
Access to prescribing records easier eg. audits possible
Can easily check administration of supplements
Automatic alerts
Can include protocols
Rapid access to hospital formulary
Reference viewers eg. MIMS, Auckland Guidelines,
Medication resources etc.
Cons
Cost to set up and administer
Human error still possible