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

2. 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)

3. 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

4. King’s Choice
GENERAL MEDICINE

5. 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

6. 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?

7. 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

8. 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

9. 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.

10. ‘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

11. 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!

12. 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

13. Any Questions?