epma benefits realisation the rbht’s approach… · elsa ng darzi fellow/ paediatric cardiac...
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ePMA Benefits RealisationThe RBHT’s Approach…
Elsa Ng
Darzi Fellow/ Paediatric Cardiac Pharmacist
September 2015
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About RBHTOur Work & Hospitals
Harefield Hospital Royal Brompton Hospital
• The largest specialist heart and lung centre in the UK • One of the largest heart and lung centres in Europe• Total of 520 beds in the Trust, including level 1, 2 and 3• Around 30,000 inpatients every year
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Digital Care Transformation Programme (DCTP)
ePMA Respiratory
RBH
Harefield
Hospital
Continue rolling out in adult level
one wards
Paediatrics & OP
EDM User workshop & testing
Building EDM Scanning records
Records available on screen
PASPreparation
&
Initiation
Building PAS &
new processes
Testing
&
Training
New PAS
2015 2015 2016Summer Winter
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Five Principles of ePMA Benefits Realisation
1. Aligning ePMA benefits with organisational goals
2. Creating ePMA benefits profiles
3. Estimate benefits using ‘evidence-based approach’
4. Linking ePMA benefits with QI initiatives
5. Establishing good data management
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Principle 1
Aligning ePMA benefits with
organisational goals
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Vision and Values
Trust vision: To be the UK’s leading specialist centre for heart and lung disease.
The Trust will achieve this mission by:
• Improving patient safety and satisfaction.
• Providing world class specialist treatments that others cannot offer.
• Bringing innovation to clinical practice through our research partnerships.
• Attracting, developing and retaining world class clinical leaders.
• Investing in services, technologies and facilities to support new service models at both sites.
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Driver Diagram
Decrease fuel
costs 1
Reduce price per
litre 2
Reduce miles
driven 3
Increase
mpg 4
Improve car
efficiency 5
Improve driving
patterns 6
Limit speed7
Use appropriate
gear 8
Drive
smoothly 9
AimPrimary
drivers
Secondary
drivers
Tertiary
drivers
Actions/
Interventions
Buy a diesel car
next time
Stick to 70 mph on
motorway
Get into highest gear
more quickly
Accelerate more
slowly
Book onto AA
course
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Benefits
Safety
Quality
↓Errors Transcription
Omitted Doses
Experience
Patients
Users/ Staff
Governance
Med Rec
VTE Assessment
Antimicrobial Stewardship
Efficiency Work Duplication Transcribing
Financial
ePMA Benefits Driver Diagram
Benefits Strategic Goals Benefit Category Benefit Details Measure
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Principle 2
Creating ePMA benefit profiles
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Benefit Profile
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Benefit 1: Safety - Transcription Errors
Level 1
Inpatient
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Safety – Transcribing Errors
Methods
• Identify patients stay > 14 days
• Estimate number of transcription
• Estimate number of transcribed medication orders
• Transcribing error rates
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Safety – Transcription Errors
Results
• Estimated between 1500 – 1800 drug charts required transcribing per annum
• Approx. 10 medicines/ chart
• Hence 15000 – 18000 transcribed prescriptions
Literature search
• Transcription error rates = 16.8% (Doormaal et al., 2015)
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Principle 3
Estimate benefits using ‘Evidence-Based Approach’
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Estimating Number of Transcription Errors at RBHT using literature
Transcribed Orders
• 15000 - 18000 items/ annum
Transcription Error Rates
• 16.5% (Doormaalet al., 2015)
Estimated Error
• 2500 –3000 / annum
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Transcription Error Categories
A: an error occurred but error did not reach the patient
B: An error occurred and reached
patient, but did not cause harm
C: An error occurred that reached that
patient and required monitoring
D: An error occurred and resulted in harm
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Estimating number of transcription error by categories
A (84.6%)
•2115-2540
B (13.9 %)
•350-420
C (0.4%)
•10-12
D (1%)
•25-30
Results estimated based on RBHT PAS data and Doormaal et al., 2015A: An error occurred but error did not reach the patientB: An error occurred and reached to patient, but did not cause patient harmC: An error occurred that reached that patient and required monitoring D: D: An error occurred and resulted in harm
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Benefit 2: Efficiency Gain
Prescribers/ Pharmacists
• Assume each transcription task takes 5 mins
• Efficiency gained by EPMA (prescribers’ time) ~ 17 – 20 work days/annum
Estimated value gained
SHO £3300
+ Pharm £3300
Value gain £6600 (per annum)
Calculation based on SHO salary ~ £ 40KPharmacist salary ~ £40K
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Principle 4
Linking ePMA with Quality Improvement (QI) initiatives
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Administration time of IV antimicrobials
-180
-120
-60
0
60
120
180
240
300
360
0 4 8 12 16 20 24
Tim
e d
iffe
ren
ce (
min
s)
Time (24hrs)
Administration time of IV Antimicrobials
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ePMA & QI
Analgesia Administration Time (ePMA)
Length of Stay
Patient Experience
Process Measure
Outcome Measures
Pain Scores
SMART Aim
BaselineMeasure
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Principle 5ePMA generates data.
Data is an asset. Asset requires owners.
Owners translate data into information. Information breeds behaviours.
chrysalis
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Who owns ePMA
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Avoid My Baby Problem
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Five Principles of ePMA Benefits Realisation
1. Aligning eP benefits with organisational goals
2. Creating eP benefits profiles
3. Estimate benefits using ‘evidence-based approach’
4. Linking eP benefits with QI initiatives
5. Establishing good data management