IMPLEMENTING EPMA Experience at Kings College Hospital Caroline Anderson Principal Pharmacist EPMA November 2009

King’s - Overview EPMA system = iSOFT iCM EPMA integral to EPR system Joint pharmacy & ICT project Multidisciplinary Project Board Pilot started November 08 Roll-out completed on 6 wards Expansion of the EPMA team to meet roll-out demands Integral to EPR so all health records in once place BUT does not interface with pharmacy systems Now have 9 members of EPMA team (1 x Pharmacist, 8 x Clinical Analysts) and one vacant post (business analyst)

Choosing a Pilot Area Key considerations Range of users & process Diversity of prescribing User ‘buy-in’ & enthusiasm Rate of patient turnover Complete patient journey Practical considerations USERS & PROCESS– Important so see if the system suits everyone e.g. prescribing, drug history taking administration etc PRESCRIBING – Important to get a feel for different types of items e.g. fluids, warfarin, reducing regimens etc – try it and see ENTHUSIASM – can not be under-estimated. Involve divisional managers, consultants, matrons and ward staff. Aim to get a ‘champion’ in each area TURNOVER – balance between having enough patients to test the system against length of stay to make it worthwhile for all involved COMPLETE JOURNEY – important to tests process from admission, temporary visits (e.g. angio) through to discharge PRACTICAL – wireless networks, using IT for other things, any other projects happening on the ward, staffing location etc

King’s Choice GENERAL MEDICINE

Pre-pilot Assessment Types of drug charts used Commonly prescribed items & particulars Identify ward staff and visiting teams Timings of shifts, visits and drug rounds Identify regular ward or team meetings Drug trolleys, POD lockers or both Hardware, network and software Gauge what users want & expect Once an area has been chosen, there are many things to do in the run-up to pilot: Important to assess individual ward set-up Different wards function in different ways

Hardware ? Hardware can be one of the most difficult things to decide upon Space – places to store and charge Users – ward based and / or visiting teams, numbers during peak times Drug rounds – do they use drug trolleys or pod lockers? COWs or integrated drug trolleys?

Pre-pilot Audits RISK PROCESS Prescribing standards Error rates Missed doses Allergy recording PROCESS Time taken to prescribe Length of drug rounds Finding drug charts RISK Matched to Trust prescribing standards Included ‘legibility’ of prescriptions Missed doses including WHY missed PROCESS Team followed ward and drug rounds trying to collect data Very difficult to get accurate records and very time consuming to collect information ASSISTANCE WITH AUDIT We have started to recruit some external help. Pre-reg pharmacist did risk audit Year 5 medical student will re-designing and repeating risk audit and repeat on EPMA. Excellent opportunity to get other people involved. Benefits both parties

Training **Maintenance** Identify different user-groups Design and compile different lesson plans Training documentation and user guides Dedicated training rooms Pre-training training (e.g. Computer skills) Scheduling staff ‘Ad hoc’ and emergency training Video scripts and intranet links **Maintenance** Appropriate to dedicate a slide to training issues as training burden should not be underestimated Paperwork – design and plan training and supporting documentation. Regular updates to keep on top of new configurations etc Planning – on-going booking of training rooms, obtaining staff rotas, being flexible around working patterns Additional training resources – videos etc Rotations – need to be aware of staff rotations and intake of new staff - communication is key

Getting to and past ‘Go-live’ Go-live on a Tuesday to avoid post weekend ‘catch-up’ Morning drug-round on paper EPMA team transcribe charts Everything double checked by a pharmacist 1st e-drug round at lunchtime (fewer drugs, staff more prepared, EPMA Team able to support) Support 24 hours on-site for first week Weekend days 8am-3pm Extended hours on-site for 2nd week 24 hour ongoing on-call Consolidation Usually about a month after go-live. Provides opportunity to assess how the project is running and address any issues. Also indicates reduced EPMA presence on the ward from that time onwards.

‘Go-Live’ People focus on go-live day but it is such a small part of the process. Really, if everything else is in place then go-live should be a ‘mild transition’ rather than a bit of a shock! = GO-LIVE

King’s roll-out plan ON TARGET! 18 month Trust roll-out plan Aiming for 2 wards per month Additional time allowance for complex areas (e.g. A&E, Critical Care, Specialist Medicine) Current plan excludes Paediatrics ON TARGET!

Continuing Development DRUG CATALOGUE ENHANCEMENTS Review configuration of all items Additional items Drug-specific information Order-sets USING NEW FUNCTIONALITIES Allergy checking Duplicate checking Dose-calculation forms Reports Scoping new areas Working with specialist teams OTHER: Reports, audit, additional training documentation, super-users, sharing experiences

Any Questions? carolineanderson1@nhs.net