1. ePMA implementation in ED Lessons Learnt Atiyah Maroof ePMA Pharmacist Luton and Dunstable University Hospital

2. Agenda L&D ePMA Project Plan Options for ED Go Live ED IT interface Patient Pathways L&D ePMA Go-Live in ED Problems faced & Solutions implemented

3. L&D ePMA Project Outline

4. Options to go live in ED Speciality teams review patients in ED If a Decision To Admit (DTA) is made subsequent medication is prescribing in ED Option 1: The whole ED Department Complete prescribing/administration profile on ePMA All ED admissions on ePMA system LDUH ED department due to be rebuilt next year Current ED infrastructure does not support for ePMA go live in whole ED department ePMA not yet implemented in Maternity and Paeds so will not support patient flow.

5. Options to go live in ED Option 2: Patients being admitted into hospital only Speciality teams to transcribe patients onto ePMA at point of a DTA a patient Will help reduce current transcription burden on ePMA live areas Incomplete prescribing/administration profile on ePMA as ED will use paper ED admissions on paper and cannot be referred to easily

6. Options to go live in ED LDUH Preferred Option: To Go Live with DTA to reduce current transcription burden Followed by Option 1 once Maternity and Paediatrics live with ePMA and ED department has been re-built.

7. ED Interface This is not a simple step! Allow for plenty of time to liaise with all parties Vigorous testing is required Patient presents in ED ED attendance documented in Symphony Episode opens on ePMA Patient admitted into hospital PAS episode takes over ED attendanc e

8. Patient Pathways Ensure that all patient pathways from ED are well mapped out Surgical/Medical/Contingency areas/Gynae/Critical Care/Paeds/Outliers Very complex pathways were identified Maintain a close working relationship with the ED teams Regular meetings were held with ED matron and lead ED consultant All process maps were approved and signed off by the relevant staff

9. EPMA Go-Live in ED ED went live with DTA 7 th July 2015 IT interface issues caused the delay in rolling out Timing is everything! Best time for go live was identified as 7am Quietest time in ED & before all handovers and safety briefings ePMA attended ED and speciality team handovers during implementation

10. EPMA Go-Live in ED ePMA floor walking support 24 hours/day for 7 days Further 14 days 6am-11pm to encourage and help support speciality teams At this point paper prescription charts were not removed as not all adult base areas were live with ePMA Gynaecology ward was outstanding Maternity and Paeds emergency patients treated in separate areas

11. Problems Faced Paper prescription charts were started by ED team, but were not being transcribed by speciality teams despite encouragement ePMA transcription service ceased at the point of ED go live Number of prescription charts increased on ePMA base wards Increased risk of dual process Not enough hardware in ED for speciality teams Hardware not fast enough in ED to help facilitate process

12. Problems Faced Gynaecology ward was not live with ePMA Adult ED was live for DTA but could not include gynaecology patients Caused confusion amongst staff Surgical/medicals outliers placed on this ward Some senior clinicians required more support at this point as they had not used ePMA as much as junior doctors prior to ED ePMA implementation

13. Solutions implemented ED STAT chart introduced All paper prescription charts removed from ED and base wards Gynaecology ward go-live bought forward Additional desktop PCs with Virtual Desktop Infrastructure (VDI) deployed to ED to help facilitate process Further support given to speciality teams

14. What is next? Maternity and Paeds ePMA Go-live Jan/Feb 2016 Implementation of ED in whole ED department planned for March 2016 To purchase bespoke handheld devices

15. Question Time