implementation of a medication management module...
TRANSCRIPT
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
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
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
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
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