NHS England Powerpoint Template - ePrescribing …Next Masterclass, 7th March 2018 Agenda 1pm Introduction Ann Slee, NHS England 1.05pm Managing medication risks with ePMA systems

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6th February 2018

ePrescribing

Masterclass

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Masterclass 6th February

Agenda

1pm Introduction Ann Slee, NHS England

1.05pm Is Three Enough? The Challenge of Selecting the Right Medicine.. Christine Dodd, Principal Pharmacist, Medication Safety and

Governance. Dorset County Hospital

1.30pm Using ePMA to Support Infusion Prescribing and Administration

Emma Ritchie, ePrescribing Pharmacist, Guys and St Thomas NHS Foundation Trust

1.55pm Summary, next steps and close Ann Slee

Is three enough for

medicines selection?

Christine Dodd

Medication Safety &

Governance

Pharmacist

February 2018

Prior to EPMA

wrong medication incidents included:

• Wrong medication prescribed

• Wrong medication dispensed

• Wrong medication administered

Reported wrong medication

prescribing incidents (Oct’16 to Feb ‘17):

Intended Medication Prescribed Medication

Metronidazole Metformin

Bisacodyl Bisoprolol

Quinine Quetiapine

Wrong medication RCA578

• “MET” was documented in the medical

notes by FY1 for treatment of Clostridium

difficile as instructed by Microbiology

Root Cause RCA578

• FY1 typed “met” into EPMA selection box

• Metronidazole intended

• Metformin wrongly selected by FY1

• Wrong medication prescribed

Contributory Factor RCA578

• Abbreviation of “met” in medical notes

• New treatment metformin administered

(unverified) by nursing staff

• Missing Clostridium difficile treatment not

recognised by nursing staff

• Surgical team subsequently commenced

vancomycin

• Prescribing incident identified by pharmacist,

during verification

• Prevented harm

Wrong medication RCA661

• Bisoprolol 20mg prescribed

• Bisacodyl 20mg intended

• Wrong treatment not administered

• No patient harm

Wrong medication RCA661

• 61 year old female admitted with a 6 day

history or intermittent left fronto-temporal

headache and slurred speech

• CTB - no evidence of infarction or

haemorrhage

• Patient experiencing migraines

Wrong medication RCA661

• Stat dose of aspirin 300mg given

• Consideration given to starting

prophylactic beta-blockade

• Not furthered due to concurrent use of

diltiazem (increased AV block and

bradycardia)

Chronology RCA661

• Bisacodyl 20mg ON omitted from regular

medication

• Pharmacy team requested prescriber to

review

• FY1 confirmed usual treatment with

patient

• FY1 confirmed usual dose of bisacodyl as

20mg ON

Root Cause RCA661

• FY1 typed “bis” into EPMA selection box

• Bisacodyl intended

• Bisoprolol wrongly selected by FY1

• Wrong medication prescribed

Contributory Factor RCA661

• ‘Three’star (***) alert: Tildiem retard and

bisoprolol: increased AV block and

bradycardia

• Overidden by FY1: benefits>risks

Lessons learnt

Lessons learnt

• Prescribers need to enter first 4 letters:

• “bisa” would have presented bisacodyl only

• “metr” would have presented metronidazole

only

• Re-read the prescription: ensure the drug name,

dose and frequency are correct and appear

within EPMA as actually intended

Interaction alert suppression

•One star* - initally

•Following RCAs and recognition of alert fatigue, decision

to suppress two star** agreed by Medicines Committee

•Three star *** - generally to be avoided

•Four star **** - always avoid

EPMA has introduced medication

miss-selection:

• Prescriber intention is to prescribe the

right medication, but the wrong

medication is selected in error on EPMA

Beating miss-selection

•Education and training

– FY1 induction training

– FY1 medication incident feedback

– Share the medication incident learning newsletter

EPMA – Right medication selection

•If you spell the medication incorrectly – you won’t find it

•Best practice is to use the first four letters of approved name

•This reduces the medication selection list = less likely to select the wrong

medication

•Wrong medication incident examples:

– Metronidazole intended - metformin prescribed

– Bisacodyl intended - bisoprolol prescribed

– Quinine intended – quetiapine prescribed

• Re-read prescription – is it the right patient, right medication, right dose right

route, right frequency?

Safe Medication Practice August 2017

The 5 R’s These apply to prescribing,dispensing & administering medication

1.Right Patient

2.Right Medication

3.Right Dose

4.Right Route

5.Right Time

Plus

Right Documentation Right to Challenge

Systems support to beat miss-selection

•Enhancement request submitted to mandate the need for the prescriber to

enter the first 4 letters of the medication name

•How do we get Systems to engage with our requests?

?Thank you

[email protected]

Going live with complex infusions at Guy’s and St Thomas’ Hospital

Emma Ritchie

Highly Specialist Pharmacist EPMA

Overview

• EPMA at Guy’s and St Thomas’

• Life before the infusion module

• What happened next?

• Life after the infusion module

• What we learnt

• What next?

• Questions

EPMA at Guys and St Thomas’

• MedChart is the mostly widely used system across the Trust and is made

by DXC

• Other EPMA systems used in the Trust- CareVue in ITU, Mosaiq for

chemotherapy

• Live with EPMA across nearly all areas of Evelina, Guy’s and St Thomas’

• We use a standalone prescribing system rather than an eHR solution

Before the infusion module• Infusions were written on a paper

drug chart

• Had to enter a ‘flag item’ into

MedChart

• Fluids were prescribed on

MedChart as STAT items

What happened next?

• Work with DXC to develop and infusion module

• Discussion with other MedChart Trusts

• Several rounds of testing

• New infusion tab and prescription template developed

• Discussion around what functionality to take

• Deciding what should be on the infusion tab

Time to go live

• Go live date set

• Training of super users

• Development of a prescriber and nursing e-learning

• Count down on all the wards

• Requirement gathering

• Meeting with Pharmacists

• More pre built prescriptions (QuickLists) developed

• Deployed on the 7th March 2017

After the infusion module

What we learnt

• Set a date and stick to it

• Training

• Requirement gathering

• Support

• Trouble shooting

• Transfer of patients between

physical locations and electronic

systems

• Administration of bolus

• Using a non home built catalogue

• Downtime with infusions in progress

What next?

• Make all infusion prescribing electronic

• Roll out into Evelina

• Review the impact

Thank you for listening.

Any questions?

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• Please let me have any ideas for future topics (or please do volunteer)

Next Masterclass, 7th March 2018Agenda

1pm Introduction Ann Slee, NHS England

1.05pm Managing medication risks with ePMA systems Caroline Anderson, Principal Pharmacist Electronic Prescribing

1.30pm How to avoid ePMA system choice pitfalls? Letitia Selby, ePMA Project Nurse, Royal Stoke University Hospital

1.55pm Summary, next steps and close Ann Slee