E-Prescribing

E-PRESCRIBING@Imperial College Healthcare NHS Trust

Following from interviews taken with staff groups involved in the implementation of an electronic Prescribing system at Imperial NHS Trust, this website contains condensed lessons and key facts which aim to aid other NHS organisations considering implementing similar solutions.

This work was undertaken by the Technology Team at the Health Innovation Network in September 2018.

Please click below to learn more about the insights that were learnt from different professions and around different themes and to download further resources. Scroll down to find out more about the implementation plan undertaken by Imperial.

PROJECT OVERVIEW

Imperial College Healthcare NHS Trust is a trust of 10,000 staff who provide care for approximately one million patients each year. This care is provided out of their five hospitals or community centres in North West London.

They are a Global Digital Exemplar Trust that is internationally recognised for delivering exceptional and efficient care through the use of world-class digital technology and information. Exemplars share their learning and experiences to enable other trusts to follow in their footsteps as quickly and effectively as possible.

Following the implementation of an Electronic Health Record (EHR) system in 2013, funded in part by the NHS National Programme for IT (NPfIT), Imperial decided to implement electronic Prescribing and Medicines Administration (ePMA) in 2015.

The ePMA implementation was rolled out alongside an electronic Clinical Documentation software and was broken down into delivery tranches, which corresponded to the hospital sites across the Trust. Within each tranche there was an eight-week preparation stage followed by a four-week go-live cycle, where the clinical documentation software would go live first and be followed a week later by ePMA. Following two weeks of documentation software stabilisation, the associated outpatient areas would start going live. This left a further two-week period for stabilisation.

Preparation and deployment activities can be seen in greater detail below (click here).

The ePMA project was delivered by three teams working closely together, which were the ICT Project Team, the Change Team and the Pharmacy Team.

The ICT Team consisted of a Project Manager, 7 Project Leads and ~80 floorwalkers.

The Pharmacy Team consisted of six individuals with a mix of pharmacy and technical backgrounds. It was led by the Lead ePMA Pharmacist, who possessed previous knowledge of ePMA implementation.

The Change Team comprised several Project Leads assigned to various areas/tranches, who coordinated with the Clinical and Operational (Service) Leads. This team was led and organised by the Head of Transformation.

Compiled by the HIN’s Technology Team, this e-resource brings together the challenges faced and lessons learnt throughout Imperial College Healthcare NHS Trust’s (ICHT)implementation of an ePMA system. This resource aims to share knowlege in order to aid the successful implementation of e-Prescribing by other NHS Trusts in the UK and beyond.

The information found in this e-resource is based primarily on semi-structured interviews conducted by the HIN’s Technology Team with key staff members at St. Mary’s Hospital around their experiences with the planning and implementation of e-Prescribing at St. Mary’s, Charing Cross and Hammersmith hospitals (also part of ICHT).

For further information or to discuss commissioning similar e-resources please email us at hin.technology@nhs.net. More information about the HIN’s Technology Team can be found here.

Implementation Schedule

The ePMA implementation at Imperial was rolled out alongside the Clinical Documentation software, where the implementation was undertaken in eight tranches as outlined below.

Tranches
Tranch Preparation Start Date Deployment Start Date Deployment End Date
St Mary’s Hospital (1/2) 27/07/2015 21/09/2015 18/10/2015
St Mary’s Hospital (2/2) 24/08/2015 19/10/2015 15/11/2015
Hammersmith and Queen Charlotte’s & Chelsea (1/2) 24/09/2015 16/11/2015 13/12/2015
Hammersmith and Queen Charlotte’s & Chelsea (2/2) 16/11/2015 11/01/2016 07/02/2016
Charing Cross Hospital (1/2) 14/12/2015 08/02/2016 06/03/2016
Western Eye Hosptial 14/12/2015 08/02/2016 06/03/2016
Charing Cross Hospital (2/2) 11/01/2016 07/03/2016 03/04/2016
Paediatrics 29/03/2016 28/03/2016 24/04/2016

“From the physician perspective, the biggest change was to the discharge prescribing”



Consultant Geriatrician

Imperial College Healthcare NHS Trust


  • Connector.

    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


  • Connector.

    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


  • Connector.

    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


  • Connector.

    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.


  • Connector.

    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.


  • Connector.

    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.


  • Connector.

    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.



  • Connector.

    Week 9

    In-patient electronic Clinical Documentation Software Go-Live

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


  • Connector.

    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.


  • Connector.

    Week 11

    Outpatient electronic Clinical Documentation Software & ePMA system Go-Live

    Overnight floorwalker support was reduced as need decreased.


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    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.