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Implementation of a Medication Management Module Within an
Existing Clinical and Patient Administration System
3rd Annual Electronic Medication Management ConferenceMarch 2014
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Claire Holt: Chief Health Information Manager, Portland District Health (PDH) - CHIA
Mary Rowe: Application Enhancement and Support, South West Alliance of Rural Health (SWARH)
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5 hours
6 hours
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TrakCare at PDH
• ED functionality in use for 10 years• Clinicals – implemented over time • PAS – March 2013
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Essentials for success: SWARH
• PDH Executive commitment and leadership• Regional support – SWARH hospitals/services• EHRAG• InterSystems
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Implementation on a shoestring
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Essentials for success: PDH
• Culture • Strong clinical educators• Pharmacy• Doctors• Nurses• Hardware
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Go-live preparation
• Pre-implementation data gathering• Preparation of medication charts one day
prior• Staff support – around the clock• Support escalation strategy
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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
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Training
• Super Users• Nurses • Doctors • Test environment
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Scope of eMM at Portland
Go-live 10th December 2013• Prescribing • Dispensing (in Pharmacy system)• Administering • Reviewing Medication Charts• Medication Reconciliation• Business Continuity
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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
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Prescribing
• Access anywhere within network
• Convert history into live orders • Repeat orders • Saving prescribing settings• Decision support • Varying the Dosing Plan• Ceasing medication orders
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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
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Nurses’ Administration List
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EPR > Medication Chart
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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
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Medication Reconciliation
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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
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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
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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
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• 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
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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
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Pre and Post-implementation Data
• Survey results• Adverse events
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How long does it take to write up a medication chart for a new patient on admission?
DOCTORS
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Paper Medication charts DOCTORS
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Paper Medication charts
AFTER: Electronic Medication charts
DOCTORS
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How often do you refer to the Hospital Formulary?
DOCTORS
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Paper Medication charts DOCTORS
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Electronic Medication charts
Paper Medication charts DOCTORS
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How often do you need to clarify the orders with the doctors due to
illegible handwriting?
NURSES
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Paper Medication charts NURSES
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Paper Medication charts
Electronic Medication charts
NURSES
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How often do you need to clarify the orders with the doctors?
NURSES
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Paper Medication charts NURSES
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Paper Medication charts
Electronic Medication charts
NURSES
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Medication errors
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Spike: January 2014. • Expiring doses – medications missed (3)• PRN management on system – training (2)• Patient self administering (1)• Insulin dose missed
Medication errors
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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
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Realities (continued)
• HR issues – doctors• Reflection – bring theatre on board at same
time• Statistical Discharges• Maintaining momentum/commitment –
when key staff depart
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Realities (continued)
• System down!!
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The Future
• Theatre• IV fluids• Antimicrobial stewardship• Discharge PBS Scripts• iPharmacy interface• Configuration for mobile devices
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Questions?