ePMA Benefits RealisationThe RBHT’s Approach…

Elsa NgDarzi Fellow/ Paediatric Cardiac Pharmacist

September 2015

About RBHTOur Work & Hospitals

Harefield Hospital Royal Brompton Hospital

• The largest specialist heart and lung centre in the UK • One of the largest heart and lung centres in Europe• Total of 520 beds in the Trust, including level 1, 2 and 3• Around 30,000 inpatients every year

Digital Care Transformation Programme (DCTP)

ePMA Respiratory RBH

HarefieldHospital

Continue rolling out in adult level

one wards

Paediatrics & OP

EDM User workshop & testing Building EDM Scanning records

Records available on screen

PASPreparation

&Initiation

Building PAS &new processes

Testing &

TrainingNew PAS

2015 2015 2016 Summer Winter

Five Principles of ePMA Benefits Realisation

1. Aligning ePMA benefits with organisational goals2. Creating ePMA benefits profiles3. Estimate benefits using ‘evidence-based approach’4. Linking ePMA benefits with QI initiatives5. Establishing good data management

Principle 1

Aligning ePMA benefits with organisational goals

Vision and Values

Trust vision: To be the UK’s leading specialist centre for heart and lung disease.

The Trust will achieve this mission by:• Improving patient safety and satisfaction. • Providing world class specialist treatments that others cannot offer. • Bringing innovation to clinical practice through our research partnerships. • Attracting, developing and retaining world class clinical leaders. • Investing in services, technologies and facilities to support new service

models at both sites.

Driver Diagram

Decrease fuelcosts 1

Reduce price per litre 2

Reduce miles driven 3

Increase mpg 4

Improve car efficiency 5

Improve driving patterns 6

Limit speed7

Use appropriategear 8

Drive smoothly 9

AimPrimary drivers

Secondary drivers

Tertiary drivers

Actions/ Interventions

Buy a diesel car next time

Stick to 70 mph on motorway

Get into highest gear more quickly

Accelerate more slowly

Book onto AA course

Benefits

Safety

Quality

↓Errors Transcription

Omitted Doses

Experience

Patients

Users/ Staff

Governance

Med Rec

VTE Assessment

Antimicrobial Stewardship

Efficiency Work Duplication Transcribing

Financial

ePMA Benefits Driver Diagram

Benefits Strategic Goals Benefit Category Benefit Details Measure

Principle 2

Creating ePMA benefit profiles

Benefit Profile

Benefit 1: Safety - Transcription Errors

> 14 days

Level 1Inpatient Re-written

Drug charts

Safety – Transcribing Errors

Methods• Identify patients stay > 14 days• Estimate number of transcription • Estimate number of transcribed medication orders• Transcribing error rates

Safety – Transcription Errors

Results• Estimated between 1500 – 1800 drug charts required

transcribing per annum • Approx. 10 medicines/ chart• Hence 15000 – 18000 transcribed prescriptionsLiterature search• Transcription error rates = 16.8% (Doormaal et al., 2015)

Principle 3

Estimate benefits using ‘Evidence-Based Approach’

Estimating Number of Transcription Errors at RBHT using literature

Transcribed Orders

• 15000 - 18000 items/ annum

Transcription Error Rates

• 16.5% (Doormaal et al., 2015)

Estimated Error

• 2500 – 3000 / annum

Transcription Error Categories

A: an error occurred but error did not reach the patient

B: An error occurred and reached

patient, but did not cause harm

C: An error occurred that reached that

patient and required monitoring

D: An error occurred and resulted in harm

Estimating number of transcription error by categories

A (84.6%)

• 2115-2540

B (13.9 %)

• 350-420

C (0.4%)

• 10-12

D (1%)

• 25-30

Results estimated based on RBHT PAS data and Doormaal et al., 2015A: An error occurred but error did not reach the patientB: An error occurred and reached to patient, but did not cause patient harmC: An error occurred that reached that patient and required monitoring D: D: An error occurred and resulted in harm

Benefit 2: Efficiency Gain

Prescribers/ Pharmacists• Assume each transcription task takes 5

mins• Efficiency gained by EPMA (prescribers’

time) ~ 17 – 20 work days/annum

Estimated value gainedSHO £3300

+ Pharm £3300Value gain £6600 (per annum)

Calculation based on SHO salary ~ £ 40KPharmacist salary ~ £40K

Principle 4

Linking ePMA with Quality Improvement (QI) initiatives

Administration time of IV antimicrobials

0 4 8 12 16 20 24

-180

-120

-60

0

60

120

180

240

300

360

Administration time of IV Antimicrobials

Time (24hrs)

Tim

e di

ffere

nce

(min

s)

ePMA & QI

Analgesia Administration

Time (ePMA)

Length of Stay

Patient Experience

Process Measure

Outcome Measures

Pain Scores

SMART Aim

BaselineMeasure

Principle 5ePMA generates data.

Data is an asset. Asset requires owners.

Owners translate data into information. Information breeds behaviours.

chrysalis

Who owns ePMA

Avoid My Baby Problem

Five Principles of ePMA Benefits Realisation

1. Aligning eP benefits with organisational goals2. Creating eP benefits profiles3. Estimate benefits using ‘evidence-based approach’4. Linking eP benefits with QI initiatives5. Establishing good data management