Implementation of a Medication Management Module …vha.org.au/docs/christine-giles-facilitators-of-change--ict--july... · •Orders workbench •Formulary workbench •Communication

Chris Giles – Chief Executive Officer • Clinical Practitioner Background

• Rural –Regional – Remote Health Experience

• Rx- Implementing Clinical Information Systems

– Clinical System at Northeast Health Wangaratta

– GP – Hospital System in the Torres Straits

– Integrated Clinical EHR at Portland DH

5 hours

6 hours

Portland District Health • Acute Services – 3000 WIES

– Obstetrics, Medical and Surgical

• Urgent Care Centre - 8000 presentations

• Sub Acute – Rehab – Aged Care

• Primary – Community Health

• GP Super clinic – Active Health Portland

PDH – Staffing snapshot • Employees 265FTE – 400 full and part time

• Salaried Medical Staff -12 FTE

• Credentialed Medical Staff – 92

• Nursing Staff – 137 FTE

• Allied Health 10 FTE

• Pharmacist 2FTE

What You Don’t Know

• The Patient

– Arrives with a bag of tablets

– Mixed History of Doctors and jumble of who said to take what

– Leaves with a bag of tablets – are they wiser than when they arrived?

What Don’t You Know Hospital Staff – Doctors

– Medication Reconciliation

– Decision Support

– Discharge Handover

Pharmacy – Medication Reconciliation

– Monitoring inpatient orders

– Discharge medication information

Nurses – Comprehensive discharge summary with medication plan

What Don’t You Know Primary Health Staff– Doctors

– My patient is in Hospital ? – What Happened in Hospital – Medications on discharge

Pharmacy – Legible discharge scripts – patient information – Discharge medication information

Nurses – Compliance to the National Medication Chart – Legible – Decision Support – Alerts – Reminders - Prompts

Implementation on a shoestring $10.000

Essentials for success: PDH • Technical Playground – SWARH Network

• Playground Instructors – SWARH Personnel

• Capable Integrated Clinical Software System

• Leadership in the Know

• Passion – for patient centred care

• Plan of engagement

eMM Go-live • Leadership Team – No other option but to

succeed

• Implement from start to finish in 6 months – Re tasking existing staff

– Expert Users

– Champions

– Technical support

Scope of eMM at Portland Go-live 10th December 2013

• Prescribing

• Dispensing (isoft - ipharmacy)

• Administering

• Reviewing Medication Charts

• Medication Reconciliation

• Business Continuity

Prescribing • Access anywhere within

network

• Convert history into live orders

• Repeat orders

• Saving prescribing settings

• Decision support

• Varying the Dosing Plan

• Ceasing medication orders

Administering • Nurses’ Worklist • 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

Nurses’ Administration List

EPR > Medication Chart

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

Medication Reconciliation

Tools for clinicians

• MIMS links everywhere

• MIMS instructions for administering

• Drug interactions, therapeutic duplications

• On-screen, context-specific help

• Manuals and quick reference guides

• Warnings when nearing end of orders

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

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

• 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

Longer term Wins

• Wealth of data available

• Frequent flyers

• Pharmacy reconciliation and auditing

• Complaint to National Standards

• Safety and quality benefits

• Transferring patients – Medication Reports

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

Realities (continued)

• Reflection – bring theatre on board at same time

• Statistical Discharges

• Maintaining momentum/commitment – when key staff depart

• Remove as many clicks as possible

Does the Gain remove the Pain Yes

But – it is not easy to implement – Bribing the leadership team maybe needed

The focus must always be the patient

As the leader you must be able to on the spot counter any barrier so know why you are doing it exceptionally well

The Future • Observations

• IV fluids

• Antimicrobial stewardship

• Discharge PBS Scripts

• i-Pharmacy interface

• Configuration for mobile devices

• Personal Handheld EHR links