Next up, as we run the rule over our fantastic finalists in the Health Tech Awards 2021, we take a look at those who have excelled in the world of Electronic Prescribing and Medicines Administration (EPMA) and Care Co-ordination.
Entrants into the ‘Excellence in EPMA and Care Co-ordination’ category include Wye Valley NHS Trust, Better Care, Nervecentre Software, System C, and St Helens and Knowsley Teaching Hospitals NHS Trust.
Our awards, which are back for their fifth year, will take place on 7 October 2021, when we’ll announce the winners. You can peruse information about the entrants and their work, across all categories, through our dedicated channel.
For now, however, we explore some of the related ideas and achievements from the past year.
Wye Valley NHS Trust and Better Care
Wye Valley NSH Trust (WVT) and Better Care’s submission to this award focuses on the challenges navigated when implementing an EPMA, at pace, during the COVID-19 pandemic.
The trust switched to electronic prescribing and medicine administration to make efficiency savings and improve patient safety and – despite COVID-related delays – went live on its pilot ward within six months. In just nine months, the Better Meds EPMA system was live across 95 per cent of the trust, including three community hospitals.
WVT provides community services and hospital care in Herefordshire, and urgent and elective care in mid-Powys, Wales. It was previously relying on out-dated paper-based prescribing processes, involving extensive use of hand-written drug charts and requisitions which were delivered to pharmacies by hand, air tube or, in the case of the three community hospitals, by fax.
Recognising the serious risks, such as illegibility, lost charts, and prescription and transcription errors, EPMA was made a priority and – following a competitive tender – Better Meds was selected.
WVT put in extensive pre-planning to ensure the success of the implementation, starting with gaining buy-in at board level, navigating pandemic challenges, and engaging with end-users early to understand pain points and concerns and achieve a rollout by consent. The latter included knocking on doors, joining ward rounds, giving end-users a laptop to trial the system, organising a stand in the canteen where people could ask questions, and standing at the staff entrance from 7am to speak with workers as they arrived.
With in-person training not possible due to COVID, the team moved training online and incentivised engagement by getting the nurse training course accredited with the Royal College of Nursing. During each ward implementation, the team was available from 7am-10.30pm for extra training or troubleshooting and outside these hours through an on-call system.
Kate Leonardo, Critical Care Lead Pharmacist said: “[The team were] very supportive of initially providing one-on-one training on multiple sessions to get me up to speed with the new EPMA system…The roll-out went so well, with four weeks of face-to-face support for the whole team of doctors, nurses, allied healthcare professionals, in an area of the trust where we were more concerned with the many critical care infusions.”
Now that the roll-out is at 95 per cent, the trust estimates that 210 working hours will be saved each quarter from pharmacists no longer having to look for charts. Doctors are estimated to save 60 hours a week as a result of no longer having to transcribe medicines in discharge letters and a further 12 hours a week will be saved from no longer rewriting medication charts. The trust also estimates that between £13-16,000 will be saved per year in local prescription chart printing costs.
Nervecentre Software
Our next entrant, Nervecentre Software Mobile, highlights the success of its closed-loop EPMA, which includes integrated real-time vital signs data and pathology data.
The aim of the Nervecentre EPMA is to provide a safe and efficient closed-loop mobile solution for clinicians, to help reduce medication errors and enable clinical decision support. Using mobile barcode scanning of patient medication at the bedside via mobile devices, the solution is built natively upon FHIR dose syntax to simplify interoperability and interacts with real-time vital signs and pathology data to show optimum drug chart views and ensure safe delivery of drugs.
Other features of note include that complex protocols can be configured with enhanced clinical decision support; including variable dose and sliding scale protocols. Bespoke questions can be defined in the protocol, to be presented to the prescriber to ensure safe prescribing and decision support, and full drug history can be viewed on the mobile device, with options for omitting doses or requiring a clinical review.
Alerts can also be configured and generated based upon certain triggers for specific medicines, including alerts to pharmacy for toxic or high-cost medicines, infection control when medicines are prescribed to treat contagious diseases, and alerts to the nurse if medicine administration becomes overdue for medicines that have tight timing requirements.
Nervecentre’s customers this year include Leicester’s Hospitals, which successfully ran a pilot which included bespoke models specific to the trust. This progressed onto the full trust-wide roll-out and Nervecentre EPMA is currently live across two of its hospitals – with the third hospital due to complete its roll-out in the summer of 2021.
Sherwood Forest Hospitals and Bedfordshire Hospitals NHS Foundation are also in the process of deploying Nervecentre EPMA, while Nottingham University Hospitals NHS Trust is currently scoping the project for roll-out towards the end of the year.
Andy Carruthers, Chief Information Officer, Leicester’s Hospitals, said: “The rollout of our brand new e-prescribing module is a really exciting step forward in our EPR journey with Nervecentre. It is great to see it in use out on the wards, and the fact that our teams have made a significant and enthusiastic contribution to the development process is great to see. Key benefits of the new e-prescribing system are the ease of use and enhanced capabilities including barcode scanning from mobile devices, particularly helpful for nursing staff when doing the drugs round and we have had some really positive feedback about this from our teams.”
St Helens and Knowsley Teaching Hospitals NHS Trust and System C
Our final award hopeful in this category is St Helens and Knowsley Teaching Hospitals NHS Trust (STHK), which chose modules from System C’s CareFlow Electronic Patient Record (EPR) to help its clinical teams go digital with a care co-ordination platform.
Clinicians St Helens and Knowsley are now benefiting from access to mobile, real-time patient information on the new platform, and paper-based clinical processes have been replaced with digital workflows to maximise efficiencies and standardise formats for safer care.
System C’s CareFlow Connect, a secure and mobile clinical communications and collaboration system, is designed to facilitate faster and safer care co-ordination for clinical teams within a hospital and across a care community. It optimises key clinical workflows through a range of features such as shared patient lists, electronic handover, clinical tagging, task management and referrals, and is improving access of patient information by providing clinicians with a fuller, secure, and up-to-date view of patient information on their mobile phones.
STHK is using Connect’s electronic handover functionality, for safer transfer of care between teams to improve outcomes. The system both streamlines the process and standardises the format, complete with notes that are dynamically updated by multi-professional teams and date/time stamped to create a robust audit trail. When patients move between departments, the handover information moves with them. The system also monitors and analyses a patient’s vital signs to identify deteriorating conditions and provides risk scores to trigger further necessary care.
At St Helens and Knowsley, the system has been rolled out across the majority of medical, surgical, obstetrics, gynaecology, paediatrics, community and therapy wards. It is embedded in the clinical workflows across each of these areas and is also used by around 1,600 clinical staff. Many of the wards were onboarded during the pandemic to support the trust’s response and to capitalise on the alerting functionality for observations and COVID-19 positive results.
As an intuitive secure mobile phone app, clinical staff can access and begin using it with minimal training and disruption, as well as through their own devices. So far, the care of around 19,000 patients has been managed using Connect, with 252,000 handovers updated, of which 40,000 were carried out just in the last month, along with 15,000 referrals and 42,000 clinical tags. Early analysis estimates that areas of STHK’s digitisation programme has resulted in a saving of around 2.7 million sheets of paper a year, equating to £38,000 pa of savings.
Ragit Varia, Clinical Director and a consultant in acute medicine at STHK, said: “Not only has CareFlow standardised and streamlined patient referrals but it has enabled enhanced accessibility via clinician’s devices. This means the shift lead can have a helicopter view of all acute admissions, and resources can be maximised using the task management facility.”
