The Impact of EPMA on Day to Day Working for Clinical Staff By Jane Coleborn, Chief Pharmacist Richard Musk, EPMA Pharmacist Great Western Hospitals NHS Foundation Trust

Doctors What we thought Clinical decision support aid less experienced staff Mobile IT improved bedside care What actually happens Currently being over ridden without discussion with EPMA team Lack of mobile devices for Dr’s, leading them not to review medication charts on rounds, systems too slow

Doctors (2) What we thought What actually happens Robust audit trail Improved communication Internal External Transcription error reduction No re-writes There but training required to pull/interpret information Need an understanding of the system (int) External - working but need to audit suitability of information No transcription required No re-writes required

Nurses What we thought What actually happens Visual aide for when medicines are required Electronic prescriptions always available Status of order sent to pharmacy Communication improved Happens, however constraint by limited window of opportunity – 2hrs Happens, but records can be locked, but not hidden Happens, but delivery not specified Happens, however no substitute for face to face contact

Nurses (2) What we thought What actually happens Legible prescriptions Robust audit trail Ordering named pt medication Happens There but training required to pull/interpret information Safer and more efficient ordering process

Pharmacy What we thought What actually happens Medication charts always available Populating discharge letter Instantaneous receipt of medication orders Legible prescriptions Robust audit trail Happens, but records can be locked, but not hidden Happens Happens, but need to be clinically checked by pharmacy Happens, safer system There but training required to pull/interpret information

Pharmacy (2) What we thought What actually happens Audit KPI reporting Paper light Happens, but skill required in writing reports/extracting data Happens, but as above Supplementary chart still required, print out for transfer to non-EPMA wards, print out paper copy of TTA & I/P orders

Organisation What we thought What actually happens Better governance Reduced risk Data for service line reporting Enhanced reputation for Trust Happens but high lighting previous poor practices that can no longer be ignored Happens but introduces own set Trust is not able to utilise as other systems need to be in place Potentially but………….

Patient What we thought What actually happens Patient allergies recorded Improved turn around times for TTA’s Medication history stored centrally Right medication, to right pt at right time Happens but users still have to enter data first time round Not currently obvious Happens but increasing benefit over time Not closed loop system e.g no pt positive identification functionality at present

Summary We have been live since May 2015 – still embedding, some people love system and some don’t Majority of EPMA benefits medium to long term A lot of time still spent by pharmacy convincing trust and driving agenda, not optimising system Prescribing was not perfect before EPMA but often overlooked – short memories

CQC visit Oct 2015 Raised as an issue during CQC visit Transfer of information between paper based and electronic systems Visibility of EPMA risk/issue log Response to concerns Training uptake