As we continue recapping our HTN Now 2021 series, our next talk topic surrounds electronic prescribing roll-outs.
Chandni Khanderia, Lead Electronic Prescribing Pharmacist at Whittington Health NHS Trust, and her colleague Joseph Grayson, Electronic Prescribing Pharmacy Technician, presented a helpful session on their processes, providing tips and learnings drawn from their own recent e-prescribing roll-out to outpatient clinics and emergency departments.
Since 2014, Whittington Health had been using an e-prescribing solution, making it an early adopter of the technology. But Joseph and Chandni explained that some areas of the Trust, mainly outpatients clinics and emergency departments, had remained on paper. So from March 2020, Chandni, Joseph and their team worked to overcome long-standing challenges and roll-out the system in these areas too.
Keen to encourage others to go “live”, Joseph outlined the benefits of electronic prescribing systems to us. He said: “It’s our bread and butter, really…the standard stuff is having a consistent record of allergies for patients – that’s lost every time the patients come in and out of the hospital. It’s a process that needs to be started again if you’re using paper charts or paper outpatient prescriptions.
“Legibility – things prescribed electronically are obviously a lot clearer than what you’d find on paper…[and] your electronic system will tell you if you’re prescribing two drugs that are interacting, so [you get] your clinical decision support.”
Speaking about how the COVID-19 pandemic had “brought to life” other benefits, Joseph continued: “Things that people could see were clear benefits after the first wave started to take hold…[included] significantly reducing the contact points for patients…facilitating prescriptions for those who were self-isolating…the ability for outpatients to call in advance of collecting their prescriptions.
“Those were some of the headline reasons, really, and that was the catalyst to our ability to kind of grab hold of people and say ‘there’s no sensible way that you can deny that electronic prescribing is really the way to move forward now’ – so those were our sell-points.”
The duo showed snapshots from their e-prescribing system to guide viewers around the outpatient programme and illustrate the benefits, as well as how simple the platform is to use. This included explaining briefly to the audience how to use it to prescribe and covering how they trained others.
Challenges highlighted were mainly topical issues, such as advice on how to deliver and support socially distanced and virtual training, and how advertising over multiple platforms helped to spread the word.
“I would definitely recommend to provide support, for maybe just the first one or two prescriptions”, said Joseph. “The reason for that…the first prescription that they do is probably the most likely time that they’re going to revert to the old way, or to decide that it’s too difficult and that they can’t do it. That’s something that we think really paid off.”
“We advertise our training over multiple platforms and really the final nail in the coffin for the old paper process was that we got approval from our chief pharmacist and quite a few of the other key stakeholders, that we would stop supplying the blue outpatient prescriptions…once we started to advertise that we saw a big surge of people coming down for training.”
It took the Whittington team roughly three months to go from 30% pre-COVID electronic prescribing levels to “pretty much all of the on-site outpatient clinics live”, doubling their rates to around 60%.
Joseph was also able to provide some stats on the success of the implementation, including the results of a survey sent out to consultants to retrieve feedback. He explained: “We had about 74% positive or neutral about the system. And the remaining was negative. So we took the negative comments and provided a newsletter to send back to them…we tried to incorporate that into something productive…and we also wanted to keep in touch.”
Covering outcomes, Chandni told us: “We found that there were a lot of changes…this did reduce waiting times, significantly. For shielding and vulnerable patients we organised medication deliveries via volunteers, which was extremely helpful…we also organised some drive-though and pick-up services…couriers for urgent medications where patients lived far away.”
Revealing the results of a patient survey, Chandni said that out of 100 patients, over 90% found the service “very good” or “good”.
While the lead electronic pharmacist also outlined the problems they faced in implementation in A&E in greater detail, as well as benefits including a reduction in fraudulent prescriptions.
Rounding up their overall learnings and take-aways, Chandni explained: “E-learning will significantly help any roll-out effort…it will save a lot of time [and] helps with social distancing as well.”
While she also advised that creating an end point for the paper process is important and suggested contacting other Trusts to find out advice and lessons learnt, adding that they were happy for people to get in touch to ask about theirs.
Watch the presentation in full below, to find out more about Chandni and Joseph’s experience of electronic prescribing rollouts at Whittington Health: