ePMA - Benefits Realisation at Harrogate

Paul GolightlyActing ePMA Lead Pharmacist

Harrogate District NHS Foundation Trust

Objectives

• Describe implementation of ePMA solution at HDFT

• Describe the approach to determine benefits at HDFT– Projected benefits– Baseline data

• Key Messages

Implementation

• ePMA solution (MedChart) implemented at HDFT during 2012

• Initial ward went live April 2012• Rapid roll-out– Go-live on a new ward approx. every two weeks– Most wards/departments live by Nov 2012– Only ED and Outpatients not live

• Baseline data collected prior to initial go-live• Simple approach to measuring benefits

Planned Benefits

• Avoidance of harm (inc. Cost)– Clarity of prescribing etc.

• Reduction in missed doses• Increased Staff Productivity• Allergy documentation• Prescribing Quality Benefits– Antibiotic Stewardship– Decision Support etc.

Baseline Data

• Incident reports– Prescribing incidents– Administration incidents– Particularly allergy incidents

• Productivity– Time taken for charts to go to pharmacy– Time taken for charts to be re-written– Time for ‘lost’ charts

• Baseline Audits– Missed doses– Allergy documentation– Antibiotic Prescribing

Incident Reports

• How many incidents reported on DATIX?– Classified by actual/potential harm

• Look for a reduction in incidents. Aimed for:– Zero incidents of Fatal potential harm– Zero incidents of Major actual harm– 50% reduction in potentially harmful admin errors– 20% reduction in potentially harmful prescribing errors

• Specifically monitor Allergy Incidents– Aim for zero allergy incidents (of known allergies)

Staff Productivity• Problems with paper drugs charts

– ‘Lost’ on the ward– In pharmacy– Only last 2 weeks

• Time and motion studies carried out to assess the time taken up with activities related to the above– 912 hours/year doctor time rewriting drug charts– 2190 hours/year nursing time looking for ‘lost’ drug charts– 1460 hours/year nursing time taking charts to/from pharmacy

• £45,000 per year• Further benefits to pharmacy around productivity

– Activity on wards– Charts, discharge prescriptions etc.

Audits

• Missed doses– 80% reduction in missed doses– 16,600 pre-ePMA, 3,300 post-ePMA

• Allergy Documentation– Paper charts audit – 95% completed– ePMA – 100% completed

• Antibiotic Stewardship– Trust standards are for Indication & Duration to be

documented on the prescription for all antibiotics• Paper charts – 35% (Indication) & 40% (Duration)• ePMA – 95% (Indication) & 80% (Duration)

Future Developments

• Significant benefits in reporting from the system– Audits– Investigations– Performance monitoring– Targeting activity

• Currently working with information services to develop reports from the system

Summary/Key Messages• Benefits of ePMA solutions are readily apparent– Safety, clarity of prescribing, full unambiguous

medication record• Simple approach to measuring benefits– Choose easily measurable benefits– Simple approach to measure benefits– Simple approach helps ‘buy-in’ from consultants etc.

• Easily understand the benefits

• Focus on the positive– Remember - it will NOT be worse than pen & paper!

ANY QUESTIONS?