Implementation of a Medication
Management Module Within an
Existing Clinical and Patient
Administration System
3rd Annual ...
Claire Holt: Chief Health Information
Manager, Portland District
Health (PDH) - CHIA
Mary Rowe: Application Enhancement an...
5 hours
6 hours
TrakCare at PDH
• ED functionality in use for 10 years
• Clinicals – implemented over time
• PAS – March 2013
Essentials for success: SWARH
• PDH Executive commitment and leadership
• Regional support – SWARH hospitals/services
• EH...
Implementation on a shoestring
Essentials for success: PDH
• Culture
• Strong clinical educators
• Pharmacy
• Doctors
• Nurses
• Hardware
Go-live preparation
• Pre-implementation data gathering
• Preparation of medication charts one day
prior
• Staff support –...
Go-live preparation (continued)
• Communication –
– Strategy including flyers and screen savers
– Christmas support!
• NUM...
Training
• Super Users
• Nurses
• Doctors
• Test environment
Scope of eMM at Portland
Go-live 10th December 2013
• Prescribing
• Dispensing (in Pharmacy system)
• Administering
• Revi...
Security and Access
• Users allocated to Security Groups to provide
appropriate access –
– Doctor
– Nurse – Div 1, Enrolle...
Prescribing
• Access anywhere within
network
• Convert history into live orders
• Repeat orders
• Saving prescribing setti...
Administering
• Nurses’ Worklist
• EPR > visual overview
• Multiple administrations
• Single or dual signatures
• Administ...
Nurses’ Administration List
EPR > Medication Chart
Pharmacy
• Medication History
• Orders workbench
• Formulary workbench
• Communication with Doctors
• Medication Review
• ...
Medication Reconciliation
Tools for clinicians
• MIMS links everywhere
• Clinical educator
• TEST environment
• MIMS instructions for administering
...
Immediate Wins
• Decision support during Prescribing
• Doctors can prescribe and view
medication charts from anywhere
• In...
Immediate Wins (continued)
• Total elimination of time wasting in
deciphering hand-writing for Nurses and
Pharmacy – every...
• No purple pen!
• Formulary issues at go-live
• Not all doctors were trained
• Shift of burden to doctors – accurate
pres...
Longer term Wins
• Wealth of data available
• Frequent flyers
• Pharmacy reconciliation and auditing
• Reduction in incide...
Pre and Post-implementation Data
• Survey results
• Adverse events
How long does it take to write up a
medication chart for a new patient on
admission?
DOCTORS
Paper Medication charts
DOCTORS
Paper Medication charts
AFTER: Electronic Medication charts
DOCTORS
How often do you refer to
the Hospital Formulary?
DOCTORS
Paper Medication charts DOCTORS
Electronic Medication charts
Paper Medication charts DOCTORS
How often do you need to clarify the
orders with the doctors due to
illegible handwriting?
NURSES
Paper Medication charts NURSES
Paper Medication charts
Electronic Medication charts
NURSES
How often do you need to clarify the
orders with the doctors?
NURSES
Paper Medication charts NURSES
Paper Medication charts
Electronic Medication charts
NURSES
Medication errors
Spike: January 2014.
• Expiring doses – medications missed (3)
• PRN management on system – training (2)
• Patient self ad...
Realities
• No system can replace good clinical
judgement
• Medication charts still need to be reviewed
• Shift of account...
Realities (continued)
• HR issues – doctors
• Reflection – bring theatre on board at same
time
• Statistical Discharges
• ...
Realities (continued)
• System down!!
The Future
• Theatre
• IV fluids
• Antimicrobial stewardship
• Discharge PBS Scripts
• iPharmacy interface
• Configuration...
Questions?
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support A...
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Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support Analyst, SWARH - Implementation of a Medication Management Module within an Existing Clinical & Patient Administration System

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Claire Holt and Mary Rowe delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems.

For more information, please visit http://www.healthcareconferences.com.au/emed14

Published in: Health & Medicine
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Claire Holt, Chief Health Information Manager, Portland District Health & Mary Rowe, Application Enhancement and Support Analyst, SWARH - Implementation of a Medication Management Module within an Existing Clinical & Patient Administration System

  1. 1. Implementation of a Medication Management Module Within an Existing Clinical and Patient Administration System 3rd Annual Electronic Medication Management Conference March 2014
  2. 2. Claire Holt: Chief Health Information Manager, Portland District Health (PDH) - CHIA Mary Rowe: Application Enhancement and Support, South West Alliance of Rural Health (SWARH)
  3. 3. 5 hours 6 hours
  4. 4. TrakCare at PDH • ED functionality in use for 10 years • Clinicals – implemented over time • PAS – March 2013
  5. 5. Essentials for success: SWARH • PDH Executive commitment and leadership • Regional support – SWARH hospitals/services • EHRAG • InterSystems
  6. 6. Implementation on a shoestring
  7. 7. Essentials for success: PDH • Culture • Strong clinical educators • Pharmacy • Doctors • Nurses • Hardware
  8. 8. Go-live preparation • Pre-implementation data gathering • Preparation of medication charts one day prior • Staff support – around the clock • Support escalation strategy
  9. 9. Go-live preparation (continued) • Communication – – Strategy including flyers and screen savers – Christmas support! • NUM support – no expectations of perfection on day one • Transferring patients – Medication Charts to go • Treats for staff
  10. 10. Training • Super Users • Nurses • Doctors • Test environment
  11. 11. Scope of eMM at Portland Go-live 10th December 2013 • Prescribing • Dispensing (in Pharmacy system) • Administering • Reviewing Medication Charts • Medication Reconciliation • Business Continuity
  12. 12. Security and Access • Users allocated to Security Groups to provide appropriate access – – Doctor – Nurse – Div 1, Enrolled Nurse, no medication endorsement – Pharmacist – Health Info / Management • Biometrics
  13. 13. Prescribing • Access anywhere within network • Convert history into live orders • Repeat orders • Saving prescribing settings • Decision support • Varying the Dosing Plan • Ceasing medication orders
  14. 14. Administering • Nurses’ Worklist • EPR > visual overview • Multiple administrations • Single or dual signatures • Administration statuses – changing, reversing • Audit trails • “Not Administered” – across ward • Changing planned admin times • Variable doses, order instructions, PRN meds
  15. 15. Nurses’ Administration List
  16. 16. EPR > Medication Chart
  17. 17. Pharmacy • Medication History • Orders workbench • Formulary workbench • Communication with Doctors • Medication Review • Instant access to entire patient history and episode details • National Medication Management Plan - reconciliation
  18. 18. Medication Reconciliation
  19. 19. Tools for clinicians • MIMS links everywhere • Clinical educator • TEST environment • MIMS instructions for administering • Drug interactions, therapeutic duplications • On-screen, context-specific help • Manuals and quick reference guides • Warnings when nearing end of orders
  20. 20. Immediate Wins • Decision support during Prescribing • Doctors can prescribe and view medication charts from anywhere • Instant win for Pharmacy – – No more leaving Pharmacy to access medication charts – All patient details available in Trak
  21. 21. Immediate Wins (continued) • Total elimination of time wasting in deciphering hand-writing for Nurses and Pharmacy – everyone can read everything • Ability to record attempts to administer and change administration status – full audit trail • Ability to review an entire ward’s medications • Time savings when re-ordering medications
  22. 22. • No purple pen! • Formulary issues at go-live • Not all doctors were trained • Shift of burden to doctors – accurate prescribing is the key • Expectations of time required vs reality • Don’t under-estimate the significance of the change • Business continuity – what happens before the plan is activated
  23. 23. Longer term Wins • Wealth of data available • Frequent flyers • Pharmacy reconciliation and auditing • Reduction in incidents related to mis-reading • Conformity with regulations • Safety and quality benefits • Transferring patients – Medication Reports • Hidden education
  24. 24. Pre and Post-implementation Data • Survey results • Adverse events
  25. 25. How long does it take to write up a medication chart for a new patient on admission? DOCTORS
  26. 26. Paper Medication charts DOCTORS
  27. 27. Paper Medication charts AFTER: Electronic Medication charts DOCTORS
  28. 28. How often do you refer to the Hospital Formulary? DOCTORS
  29. 29. Paper Medication charts DOCTORS
  30. 30. Electronic Medication charts Paper Medication charts DOCTORS
  31. 31. How often do you need to clarify the orders with the doctors due to illegible handwriting? NURSES
  32. 32. Paper Medication charts NURSES
  33. 33. Paper Medication charts Electronic Medication charts NURSES
  34. 34. How often do you need to clarify the orders with the doctors? NURSES
  35. 35. Paper Medication charts NURSES
  36. 36. Paper Medication charts Electronic Medication charts NURSES
  37. 37. Medication errors
  38. 38. Spike: January 2014. • Expiring doses – medications missed (3) • PRN management on system – training (2) • Patient self administering (1) • Insulin dose missed Medication errors
  39. 39. Realities • No system can replace good clinical judgement • Medication charts still need to be reviewed • Shift of accountability – system enforces good practice • Second signatory not always available
  40. 40. Realities (continued) • HR issues – doctors • Reflection – bring theatre on board at same time • Statistical Discharges • Maintaining momentum/commitment – when key staff depart
  41. 41. Realities (continued) • System down!!
  42. 42. The Future • Theatre • IV fluids • Antimicrobial stewardship • Discharge PBS Scripts • iPharmacy interface • Configuration for mobile devices
  43. 43. Questions?
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