E-Prescribing

PROJECT OVERVIEW

• Weeks 1 - 2

  Preparation Packs

  Gathering information to support project delivery and identifying risks and issues. Specifically ascertaining the following:
  – Bed numbers and level of care
  – Staffing levels
  – Existing infrastructure
  – Clinical workflows
  – Clinical team workflows
  – Prescribing and administration workflows



• Weeks 2 - 7

  Infrastructure

  To determine the hardware and infrastructure requirements across clinical areas (i.e. number of new computers needed), the following criteria were considered:

  – Maximum number of staff in the location
  – Acuity of patients
  – Existing equipment
  – Space

  For further information click here.

  The types of computers that were supplied were:

  – Powered carts for ward rounds
  – Laptop carts with drawers for drug rounds
  – Laptop carts –desktop PCs



• Weeks 3 - 8

  Smartcards

  For the testing of smartcard readers, the provision of staff access and the development of a custodian system for temporary staff, the following actions were required:

  – Completion of the designated training
  – Identification of secure locations to store cards
  – Development of local procedures for smartcard issuing and activation
  – Preparation of documentation for issuing temporary access



• Weeks 3 - 9+

  Change management

  This required working with the different clinical services to examine current processes for documenting patient records. This included both:
  – Generic documentation
  – Ward / department specific documentation

  Supporting teams to decide how to effectively use the electronic patient record was also necessary in moving forward:
  – Mapping paper processes and  forms to the ePMA  system
  – Future developments

  Identifying benefits with services and support realisation was also part of the change management process.



• Weeks 6 - 8

  Training

  ‘Champion’ users of the ePMA system were identified and their training consisted of classroom-based sessions (half day for doctors and a full day for nurses).

  The training for other users encompassed in situ familiarisation sessions, which were delivered by floorwalkers.

  Other resources and tools that were available to users included videos, quick reference guides and crib sheets.



• Weeks 7 - 9

  Business Continuity

  The Business Continuity plan was articulated around the following actions:

  – Real time local copy of clinical information for patients on selected wards
  – Machine identification
  – Embedding of testing in day-to-day activities

  A trust-wide ePMA system downtime plan was also put in place.



• End Week 8

  IP Clinical Documentation Cutover

  Go/No-Go Decisions for go-live to beginning on the following Monday were made on the preceding Friday.

• Week 9

  In-patient electronic Clinical Documentation Software Go-Live

  One IT Floorwalker was deployed to each clinical area from 7.30 am.



• Week 10

  In-patient ePMA system Go-Live

  Junior doctors would transcribe drug charts under the supervision of the Pharmacy Team.

  A dedicated floorwalker supported the documentation and ePMA systems on each ward and undertook the following activities:
  – Determining which patients required transcription
  – Removing paper notes from the end of the bed
  – Escalating issues as per defined criteria
  – Scheduling checkpoint calls to track issues / monitor progress

  Floorwalkers were present for drug rounds and during / after ward rounds. For every four locations, one floorwalker would be on site from 11 pm to 8 am and at weekends.

  Support was flexible and based on the intensity and complexity of each clinical area, which was generally determined by the:

  – Number of beds
  – Turnover of patients
  – Acuity
  – Complexity of drugs
  – IT skills of staff

  Second level support for ePMA was provided by the Pharmacy Team.



• Week 11

  Outpatient electronic Clinical Documentation Software & ePMA system Go-Live

  Overnight floorwalker support was reduced as need decreased.



• Week 12

  Stabilisation

  There were generally two tranches per hospital site, which ran sequentially. As a result, the first wave of tranches effectively received an additional two weeks of support, as floorwalkers were still on site overseeing the second wave deployments.