In this interview we speak with Chandni Khanderia, Lead Electronic Prescribing Pharmacist and Joseph Grayson, Lead Electronic Prescribing Pharmacy Technician at the Whittington Health NHS Trust.
Chandni and Joseph take us through the full rollout of the WellSky system in outpatient clinics and A&E and their efforts in the removal of paper prescriptions accelerated by the Covid-19 pandemic.
Both Chandni and Joseph begin by summarising their careers over the past few years.
Can you tell me about yourself and your role?
Joseph: In terms of getting into the role, I was a clinical medicine management technician where I had developed to the point I could go no further in that career path. I branched out to digital through applying for a job that was for implementing a system I was already familiar with into a hospital; there’s a well know electronic prescribing product from WellSky which I had used through my years as a clinical technician. At that point of applying for the job, I genuinely thought I had extensive knowledge of that system.
I was given the job and ended up in the project team and soon realised how much I had to learn about the system, and how mistaken I was thinking that I had known it all before – the next few months turned out to be a very steep learning curve; I realised just how much technology and IT works in the background. I spent 3 years rolling the system out at the Princess Alexandra Hospital, I then came back to the Whittington and continued that work here with Chandni.
Chandni: I have been working at the Whittington for seven years and like Joe, I thought I knew the system quite well. When I was working in my clinical role I used to ask the electronic prescribing team to give me access to more of the back office features but as I came into my current role in February this year, I realised there is so much more to the system and I’m still learning features now.
We used electronic prescribing in our in-patient setting, but in our out-patient setting prescribing here was predominantly on paper. When Covid-19 happened, we decided to stop supplying all paper prescriptions and began to transition staff onto electronic prescribing. We then trained around 200 staff members to start using the electronic prescribing system.
What are the benefits of the electronic prescribing system?
Joseph: We used the system for patients which are in hospital beds and for the administration of medications, but one aspect we have often been behind on is when a patient comes in for an out-patient clinic appointment and we need to prescribe them medications; the movement to change to digital has been historically quite difficult until Covid-19 happened – we ended up training consultants who have traditionally never been heavily involved in IT and this has gained traction due to the savings involved in electronic prescribing over paper prescribing.
Electronic prescribing is also safer, for example allergy recordings are permanent in an electronic system and not in a paper system. In terms of Covid-19, the benefits of electronic prescribing have seen staff who are self-isolating being able to prescribe from home, and patients being able to quickly pick up medicines or delivery arranged from the Whittington Pharmacy. This means patients’ risk of exposure to Covid-19 is lessened.
What have been the challenges in the implementation of the electronic prescribing system?
Chandni: There were a few different challenges, one was having the space to train staff members on the system; we have a room in the pharmacy that we usually use but we had to reduce the numbers of staff in that room at any one time from 12 to five. This increased the amount of training sessions required. Face to face support was also an issue – staff would have to call us as opposed to in-person training. Staff who needed training on other sites was also an issue and so we quickly learned how to use MS Teams and other virtual training software.
Joseph: At the time we had 2.5 people in our team and over the course of eight weeks we had to train 200 members of staff. In retrospect, the amount of effort it would have saved if the trust had an e-learning platform would have been immense; we could have sent out the package to staff and this would have saved a lot of our team’s resources. Also, there were some intricate details that we just simply couldn’t build into the system. One such example was the clinician’s contact number, where all other details are legible, the clinicians contact number was missing which is something that the paper system always included. We therefore had to re-train staff to write in their number manually.
Chandni: Joe started at the end of February, and I started at the beginning of February and we had to manage our day-to-day jobs as well as rolling out the system – that was probably one of the biggest challenges we had.
Can you share any learnings you’ve acquired?
Chandni: Covid-19 has a silver lining, we were able to use it to drive the digital agenda of the Trust. Also, one piece of advice would be to not be afraid to make hard stop decisions; we made a conscious decision to stop supplying paper prescriptions and advertised a date for the cessation of these paper prescriptions. This forced staff members to book into training sessions. Those staff members who were resistant to change therefore had no choice in engaging digitally. Other staff members were enthusiastic about being trained; however, the problem was as described earlier being the limited training places available in each session.
Joseph: Historically, the NHS has been slow at adopting change; part of it is a safety mechanism, but now everyone has a freshness to adapt quickly and have the door open for change in practice. This eagerness of staff should be utilised to push the digital agenda of the Trust.
We wanted to ensure that users knew we were available to contact should they need, therefore we sent out a questionnaire to receive feedback from the out-patient consultants on how they felt regarding the system. Overall feedback was positive but there were some frustrations with the system, thus we sent out a ‘you said, we did’ document in response, providing some tips and tricks to work around some of those frustrations. It is about keeping the engagement from implementing such a big change so as when the next change comes, those users will not feel discouraged from adapting again.
What advice would you give to those implementing system change?
Joseph: In the NHS we are really good at identifying a problem and firefighting it, but we always tend to forget to capture some baseline audit data; doing this can allow you to build up a really good use case of proving what you are doing is beneficial rather than detrimental, and to show precisely where those benefits are – once the change is implemented. It is very difficult to go back and look through the process to identify where the positives occurred.
Chandni: If healthcare providers did want to go live with a new system, don’t be afraid to contact other Trusts/providers to obtain their lessons learned. We are constantly contacting other hospitals to find these just so we can develop a really effective electronic prescribing system. Encouraging healthcare workers to talk to each other makes a world of difference.
