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e-Discharge Summary

Mark Pepperrell, Principal PharmacistNilesh Patel, eRecords Project Analyst

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Technology Partner

• Application provider– Our thanks to Ascribe Ltd– www.ascribe.com

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Introduction

• SUHT local hospital care– 500,000 people

• Regional Services ~3 million – Neurosciences– Cardiac– Children’s Intensive Care

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Introduction

• Pharmacy Service– 250 staff– 3 dispensaries (2 sites)– 35-40,000 items/month

• Clinical pharmacy service– Specialist pharmacists– Ward rounds

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Introduction

• Discharge summary• Carbonized A4 form

– Illegible, unclear– GP transfer via post or patient– Pharmacy unaware completed

• Local initiatives• New standards

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Historic Discharge summary

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Aim

• Design and deliver an IT application provide a complete legible and timely discharge summary– Multi-disciplinary– Electronic ordering direct to pharmacy– Improve discharge information received

by GP’s in clarity and time

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Method

• Project Team – Multi-disciplinary• Current document

– Informal discussions– Medical– Pharmacy – Nursing and admin staff

• Wish list

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Method

• Bespoke design– Data extract-drugs name,form,regimes– Drug package/order sentences– Controlled drugs– Pharmacy roles– Logic rules - pharmacy exceptions– Dispensary/Ward work lists– Security

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Method

• Version 1– Acute Medical Unit (AMU)pilot - 2007

• Version 2– AMU, Medicine and Elderly Care

• Design– e-Learning package: doctors induction

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Results

• Since pilot in 2007, e-Discharge trust widee-Discharge Summary Count

0

1000

2000

3000

4000

5000

6000

7000

Apr-0

7

Jul-0

7

Oct-0

7

Jan-

08

Apr-0

8

Jul-0

8

Oct-0

8

Jan-

09

Apr-0

9

Jul-0

9

Oct-0

9

Jan-

10

Apr-1

0

Jul-1

0

Month

Vo

lum

e

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e-Discharge summary

Interactive Demonstration © Ascribe Ltd

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Work list

• Dispensary specific– Pharmacist screened documents appear in any

one of three dispensaries

© Ascribe Ltd

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Security

• Role specific access– Doctors– Pharmacist, MM technicians– Nurses, administration staff

• Password• PIN

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Information transfer

• e-Discharge Summary transfer– Hampshire Health Record (HHR)– 24 hours post patient discharge

• Direct transfer to GP surgery– 30-40 surgeries

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Discussion

• e-Discharge system SUHT• e-learning training• Benefits

– Patient– Pharmacy– Medical– Nursing and administration staff – GP’s

• Financial/Clinical reporting and audit

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Discussion

Issues• Time consuming

– Order sentences, drug packages– Common diagnoses lists specific to the

clinical specialty

• Transfer issues– Hampshire Health Record (HHR)– GP direct

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Lessons learnt…

• Multi-disciplinary– Nursing staff

• Senior support– Big stick approach!

• Communication– Junior medical staff

• Hardware

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Conclusion

• e-Discharge Summary– Reduction in illegible discharge

summaries.– Improved work flow into pharmacy.– Transformed access throughout Trust to

information on discharge summaries.– Improved GP transfer of information.

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The future

• Work– Outpatient module– Medicines reconciliation– Anti-coagulation ~ warfarin– DVT prophylaxis recording– Repeat Prescriptions

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Acknowledgements

• ePR Projects Team• Pharmacy Department SUHT

– James Allen - Pharmacist

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• Questions?