This document describes the SPACER study which aims to identify the benefits and disadvantages of electronic prescribing and medication administration (EPMA) compared to paper-based systems. The SPACER study will consist of 3 strands conducted over 3 years: 1) An ethnographic study to observe organizational changes and staff perspectives with EPMA implementation. 2) A data envelopment analysis study to assess the impact of EPMA on healthcare service efficiency. 3) A Drugs, Data, Decisions study to identify changes to key performance measures, processes, reporting and decision making regarding the medication process before, during and after EPMA implementation.

1. David RP Terry
SPACER
Dr David Terry
david.terry@bch.nhs.uk

2. David RP Terry
Study into Paediatric
Advanced Clinical
Electronics - Prescribing
Dr David Terry
david.terry@bch.nhs.uk

3. David RP Terry
Background to
BCH & EPMA

4. David RP Terry
Over 270,600 patient
visits every year
361 beds
43,151 inpatient
admissions each year

5. David RP Terry
£10M annual drug
spend
200,000 drug
transactions per
year.

6. David RP Terry
Hand written
drug-charts!

7. David RP Terry
Developing eRx’ing
EPMA – 5yrs
PICs
… built at UHB, but
excludes children.

8. David RP Terry
Prescribing
Information and
Communications
System
Safety
Quality
Resources

9. David RP Terry
Prescribe Supply Administer
Medication Process

10. David RP Terry
Medication errors up to
13%?
2/3 IV’s not given
according to guidance.
Prescribe Supply Administer

11. David RP Terry
SPACER
Aims: To identify the benefits and
disbenefits of EPMA compared to
paper-based system

12. David RP Terry
SPACER
• Before, during and after study
• 3 years
• 3 strands

13. David RP Terry
SPACER
Ethnographic
Data
Envelopment
Analysis
Drugs Data
Decisions (3D)

14. David RP Terry
Ethnographic
Data
Envelopment
Analysis
Drugs Data
Decisions (3D)
• Safety
• Quality
• Resources
• Culture
• Technology
• Processes
• Organisation structure

15. David RP Terry
Ethnographic
Data
Envelopment
Analysis
Drugs Data
Decisions (3D)
• Safety
• Quality
• Resources
• Culture
• Technology
• Processes
• Organisation structure

16. David RP Terry
Safety
Quality
Resources
Strand A
Ethnographic strand
Mixed method –
Qualitative and
Quantitative study
Observe the organisational
change, explore staff
perspectives of doctors,
nurses and pharmacists as e-
prescribing is implemented
Strand B Efficiency
– “DEA model”
strand
DEA – Data Envelopment
Analysis
What is the impact of e-
prescribing on the
efficiency of the services?
Strand C – 3D study –
Drugs, Data, Decisions
What Key Performance
Measures does the hospital
measure before implementation
of e-prescribing, how much
resources are used to generate
it?
What will be measured during
and after implementation?
Culture
Technology
Processes
Structure
Pre-
implementation
(year 1)
Peri-
implementation
(year 2)
Post-
implementation
(year 3)

17. David RP Terry
SPACER 3D – Drugs, Data, Decisions
Background
• BCH uses currently available data - define and
measure progress towards organisational goals
• Surveillance and audits are used to support
medication governance … via an organisational
structure.
• Enables decision making.

18. David RP Terry
SPACER 3D – Drugs, Data, Decisions
Questions:
What data / metrics are used?
How are they used?
How will EPMA change this?

19. David RP Terry
SPACER 3D
Aims and objectives
-To observe the relevant metrics before, during and
after implementation of electronic prescribing.
-To identify changes to metrics, processes, reporting
systems and decision making, in relation to the
medication process.

20. David RP Terry
SPACER 3D
Aims and objectives
-Capture metrics … catalogue being assembled
-By analysing the documentation and reports in
circulation during the three periods of transition
DATA - Identify the medication related changes that
occur.
PROCESSES - Identify process (report) changes
due to EPMA
REPORTS - Observe committee oversight &
responses to reports.

21. David RP Terry
BCH Medicines Governance Structure
Trust Board
CRAC
DTC
Medicines Safety Committee
Antimicrobials
Non-medical prescribing
Data - KPIs and Metrics

22. David RP Terry
SPACER 3D – Drugs, Data, Decisions
Pre- implementation Peri- implementation Post
implementation
KPI manager
Interview – document
field notes + record
resources required
Selection
Gathering
Processed
Reported
Catalogue of
KPIs with X
domains
monitored
Catalogue of KPIs
with X domains
monitored – X
obsolete + Y
domains
incorporated (in
anticipation to
implementation)
Method
KPI manager
Interview – document
field notes + record
resources required
Selection
Gathering
Processed
Reported
KPI manager
Interview – document
field notes + record
resources required
Selection
Gathering
Processed
Reported
Catalogue of KPIs
with X domains
monitored –
(Xobsolete + Y
obsolete) + Y
domains + Z
domains

23. David RP Terry
SPACER 3D
Expected outputs
• An increase in clarity in how data is used.
• Reduction in the time and resources recorded to produce the
audits.
• Develop metrics not available in paper system.
• The quality and depth of information from the reports may
improve.
• Identification of novel underlying problems within the system
that cannot be measured under the current paper system.

24. David RP Terry
No Domain/KPI
1 Nursing quality indicators
2a Drug Chart audits
2b Jeff Martin exercise
3
Medication (not Patient) Safety
thermometer
4 Incident reporting IR1 / SUI
5 Antibiotics usage
6 Surgical Prophylaxis
7a Antibiotics TDM Audit
7b Respiratory TDM Audit
8
Restricted antibiotic usage (BCH
Formulary)
9
Point prevalence surveys,
comparators.
10 PAU / MAU antibiotic prescribing
11 PN usage
12 Dispensaries activity
13
Dispensary errors, both internal
and external
14 Medicines Information - activity.
15
Pharmacist interventions -
frequency
16 Nurse interventions
17
Pharmacy Technician
interventions (administration of
drugs).
18 Pharmacy end of month reports
No. Domain/KPI
(NB Check if official title)
a Contact
b Selection – What
c Population scope/subset
d Gathering: Who/how/technology
e Frequency & Duration
f Location
g Processed (by):
h Reported (To)
i Who uses it
j Follow up – what is done as a result
k Does it relate to procedures?
l General Comment
m Type
Overlays to consider
Healthcare Service Measures
Safety
Quality
Resources
Organisation Change/Business Measures
Culture Changes
Technology
Processes
Structure
Also
Costs
Example output obtained?