Three healthcare professionals from NHS Greater Glasgow and Clyde recently delivered a live webinar for HTN, to share their learnings from a WellSky Hospital Electronic Prescribing and Medicines Administration (HEPMA) implementation.
Dr Alastair Bishop, eHealth SDPM for Safer Medicines, Robert Puckett, Lead HEPMA Pharmacist, and Dr Fiona Leung, Clinical Teaching Fellow with the HEPMA team, were on hand to discuss their experiences and take part in a Q&A session with the audience.
Alastair kicked-off the talk by making sure viewers from both sides of the border were clear on what HEPMA is used for, explaining it is “prescribing medicines and recording the administration of medicines to patients in a hospital setting.” Often known as EPMA in England, Scotland uses the term “HEPMA”.
Topics covered in the presentation included an overview of the implementation of WellSky and an update on their progress – as well opinions from pharmacy, clinician and e-health perspectives.
Starting with a brief introduction to the Board, Alastair said, “NHS Greater Glasgow and Clyde is a Health Board in the West of Scotland. Health Boards are the equivalent of Trusts in England. We are a large Board…our largest hospital is the Queen Elizabeth Hospital, just south of the [River] Clyde.”
The Board, he explained, serves over 1 million people and has 38,000 staff members, as well as encompassing 330 wards, 120 theatres and 300 GP practices.
“To paint a picture of our current landscape,” he continued, “we have a number of ‘cornerstone’ clinical systems that are used very widely across the Board.” These include InterSystems TrakCare, the Orion Clinical Portal and EMIS Web.
Giving us a virtual tour of “what HEPMA is all about”, Alastair explained why the Board is keen to move away from the limitations of paper prescriptions and medicines administration – namely time constraints, limitations in terms of capacity and scope, lack of flexibility and risk of human error.
“Hospital medicines is a missing piece of the jigsaw, in terms of the electronic patient record (EPR)”, he added.
Addressing what will change as HEPMA is introduced, Alastair cited the removal of the paper drug chart, electronic prescribing that can provide warnings about drug interactions and allergies, and assistance with templates and protocols. In addition, he described more detailed recording of information and links to admission and discharge medicines processes. Further benefits highlighted included an improved audit trail, better legibility, increased accessibility and the ability for multiple people to view the electronic record at the same time.
HEPMA at NHS Greater Glasgow and Clyde will be implemented wherever the standard paper drug chart is currently used – inpatient wards, including mental health and paediatrics, and also in theatres. Chemotherapy, day cases and outpatients are not currently in scope.
On what else the Board hopes to achieve through the implementation, he added: “There are new opportunities to assess and analyse how we’re using medication, and look at how we standardise, improve and optimise that, as we go forward.”
Alastair went on to guide the audience through the HEPMA home screen and drug chart, highlighting how users can navigate and understand it.
On user feedback from the pilot so far he stated: “What do users think? Well, nurses, doctors and pharmacy staff like the system. They get to grips with it really quickly – within two or three days people are comfortable using the system for prescribing and administering medicines.
“We’re collecting top tips from actual user experiences that we’re building back into our training and support materials and we continue to work closely with WellSky to further improve the system.”
Speaking from the pharmacy perspective, Rob took over to take us through his team’s roll-out experience, explaining some of the issues they faced. “Resistance to the paper [printouts from HEPMA] has been quite high,” he said, “…we’re again working with the supplier to alter things slightly.”
“One of the key things I’m sick of saying,” he added, “is that HEPMA doesn’t stop bad prescribing. It’s just a tool. Bad prescribing is still bad prescribing.”
However, on the success side, he said: “It worked in a very complicated area. The feedback was very positive – we had very little negative feedback.”
Fiona then stepped in to conclude the talk, providing her opinions on the system through the lens of a medic. After talking us through the challenges of transcribing and training, she said: “Medical staff took on HEPMA very well, they were very comfortable to check the medications themselves…they did not require much support. I shadowed them for multiple ward rounds, they didn’t require much assistance, really.
“Some of them, by day three, were asking if there was a better or quicker way to do things – instead of how to do things.”
Concluding with general feedback from doctors, she added: “One common thing they did ask for was a training environment where they could practice prescribing on HEPMA after doing their e-learning module. This has been taken up by the team and now is nearly ready to be used.”
Find out more about doctor feedback from the pilot, as well as more successes and challenges, by watching the full video session below: