Trusts
Trusts have varying perceptions of the objectives they want to achieve. Project management and specialties differ from trust to trust and its essential that the product is configured accordingly to match the users needs. As a result thorough planning and the review of hospital processes and procedures are essential to make the software work for the trust. Rather then computer systems dictating new processes and procedures its important that god working practices remain.
Case Study: Gateshead Health NHS Trust & Nottinghamshire Healthcare NHS Trust
M.Horsely, mentioned earlier has been involved with recent implementations of e-prescribing. He has been involved with Janet Bass, Pharmacy Services Manager at Gateshead Health NHS Trust, and Steve Mayers, Pharmacy Services Manager at Nottinghamshire Healthcare NHS Trust. Mark comments, “ The two projects are interesting to compare because they have been set-up in completely different areas. The latter is a mental health trust, whereas the Queen Elizabeth Hospital at Gateshead chose their coronary care unit and an adjoining cardiology ward for their EP pilot project.”
Trust-wide commitment
‘Both agree that a key factor of success of an electronic prescribing project is trust wide commitment. Mayers says, “For other trusts I would recommend gaining trust board commitment to establish principles of operation to be adhered to by all and to fund the full extent of the project, including robust IT systems, comprehensive technical support and commitment to using the system.”
Bass, “believes doctors, nurses and pharmacy staff have differing views of how medicines should be prescribed and that there needs to be clear understanding that electronic prescribing is a trust wide venture and not purely a pharmacy project.
Nottinghamshire demonstrates Stakeholder involvement where the project board is made up of relevant consultants, nurse managers from involved directorates from the Trusts IT department, as well as project managers. Such groups make all major decisions.
Pilot Site
It is important to select an appropriate pilot site for phasing an electronic prescribing project. This seen as an important critical success factor required ensuring a successful roll-out. The project board at Nottinghamshire for instance, selected an acute psychiatry ward and a community health outpatient’s clinic. They believed such would cover a variety of experience, prescription type and prescriber.
Another example at Gateshead is where the decision to use a ‘true medical ward' was taken. As a result the coronary care unit was selected because it was compact in nature and only three consultant cardiologists largely managed it.
When selecting a pilot ward, Mark believes the flow of patients should be analysed. The ward should take admissions directly, not from another ward that is not included in the pilot, else extra workload is created by transcribing the paper drugs charts on the prescribing system.
Project Management
Any project regardless of nature needs to be managed effectively. Structured project plans should be drawn up from the outset. Planning is essential and the project should be broken down into small stages so that all parties involved can view progress as it occurs. Often project boards fail to achieve too much in one particular stage or plan or fail resource critical stages.
Training
Any electronic prescribing system will require a training plan to be adhered to. Many staff are reluctant to change their working patterns, as the fear of the unknown is often a problem, particularly when it involves new technology. New procedures should be written down to alleviate such problems. An iterative approach to training for key staff is a key required. This allows staff more time to accept new principles at their own pace. Final training for end-user should be achieved nearer the end. It’s imperative that that doctors and nursing staff have the necessary induction training. It would be dangerous for doctors to prescribe electronically without proper understanding of the system.
Technical Set-up
Technical set-up differs dependant on trust, scope of the project and the hospitals existing infrastructure. For instance, in Gateshead a handheld radio device was deployed for bedside prescribing, enabling real time transfer of information. The system is integrated with the hospital network on a Windows NT server.
At Nottinghamshire, mobile terminals are not required, as they do not suit the needs of the company. However, the same software as Gateshead is used but based on thin client technology.
These two instances show:
Hardware must suit the organisation and its processes.
The software should be flexible to allow many different types of device.
Benefits as a result of e-prescribing
Once a successful e-prescribing project has been realised numerous benefits will be achieved as a result.
The main priority as a result of e-prescribing is to improve the clarity of prescriptions and speed up communications between prescriber, nurse and pharmacist.
For instance, at Burton hospital the value of e-prescribing has been realised. At ward level the drug administration and electronic prescribing is paperless as a result of information technology. Mobile workstations with access to the entire hospital information are available. The use of these technologies throughout the whole hospital has revolutionised the use of EPRs for the direct clinical care of patients. As the system is comprehensive most of the data pertaining to patients care is entered on to the system, and is a valuable tool in supporting the care of patients. For instance it is possible to display the patients temperature chart and relate that to antibiotic treatment.
Access to nursing notes and clear, complete administration records also make a valuable source of information available to the prescriber.
Summary of key benefits according to the British Journal of Healthcare Computing
Key benefits of e-prescribing
- Improved clarity, completeness and lack of ambiguity allow nurses to administer
- Non-ward stock drug supplies are ordered automatically without the need for manual intervention by the nurse
- Pharmacists have been able to improve effectiveness through ready access to patients clinical details
- Dispensing services can be more timely as it possible to inform pharmacy in real-time about prescriptions
- Medical staff are able to prescribe remotely (in theatres) so patients receive medication without delay
- Medicines arrive in good time
- Medicines information is available which is readily referenced by medical and nursing staff and also facilitates patients education
- Allows for efficient records and audit trails, which are available as evidence if required. As a result clear and ambiguous records should ensure that errors are less likely, which will reduce the risk of litigation and fast efficient clinical audit.
Bibliography
The use of electronic prescribing as part of a system to provide medicines management in secondary care
Nick Ford, Petula Paul, Chris Curtis
The British Journal of Healthcare and Computing and & Information Management October 2002 Volume 17 Number 8
How to achieve success in electronic prescribing
Suzanne Walton
The British Journal of Healthcare and Computing and & Information Management May 2002 Volume 19 Number 4
Barriers to the successful and timely implementation of electronic prescribing and medicines administrations
The British Journal of Healthcare and Computing and & Information Management October 2000 Volume 17 Number 8
