1. The Challenges of Having Multiple ePrescribing Systems Nick Hubbard SafeMeds (EPMA) Pharmacist WAHT

2. What is the Issue? Separate EPMA solutions for core and chemotherapy prescribing: Core prescribing on Noemalife solution. Chemotherapy on Elekta Impac Mosaiq. But relevant to most combinations. Systems not interfaced or integrated.

3. Research Nothing Literature search Almost nothing (One EPR) Colleagues within West Midlands Nothing (but concerned) Trusts outside West Midlands Nothing on eprescribing toolkit NHS England Same National Conferences

4. High Risk Patients High risk patients Immunosuppressed Other significant pathologies Other significant treatment High risk drugs Toxicity Interactions Need for adjunct therapy

5. Technology Problems Different drug catalogues: Core uses DM+D. Chemotherapy uses in house. Different DSS support systems: Core uses FDB (currently allergies, duplicates and interactions at WAHT). Chemotherapy uses in house for allergies only. Data source for discharges.

6. Clinical Problems Missed allergies, duplicates and interactions. Identification and management of ADRs. Split administration records. Adjunct therapy on both system - risk of duplicates. Hard to keep overall picture as no single record. Prescribing by junior doctor out of hours.

7. Practical Problems Maintaining and updating separate drug catalogues. Some drugs may also be on paper systems eg INR charts. Links with relevant lab results. Keeping track of what has been given/taken. Junior staff prescribing out of hours. Prescribing of EoL/palliative care drugs.

8. Potential Solutions or Work Arounds Single EPR – (the fortunate few!). Interface or integrate systems. View on multiple screens. Print off one chart for cross checking. Place holder for all drugs on core system. Place holder for chemo only on core system. Place holder for adjunct only on core system.

9. Summary – Moving Forward Sorry No solutions offered. Just points you may need to consider.