June 17 2013 workshop AH SLIDES

Workshop Session 1 Pre-Go Live Planning... • Time between wards go lives – transfer of patients and outliers • Dual systems – paper and electronic... – What can you support?... Dedicated

Workstream 1: Project Management – System Configuration

and Business as

normal

Andrew Heed Kathy Wallis

17 June 2013

University Hospital Southampton

• major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust

• treat around 140,000 inpatients and day patients, including about 50,000 emergency admissions

Project timeline

Newcastle upon Tyne Hospitals

• Freeman Hospital

• Transplantation, Cancer Centre, Cardiothoracic Surgery, ENT, Vascular……

• Royal Victoria Infirmary

• Neurosciences, Emergency care, Children’s Services, Plastic Surgery, Ophthalmology, Dermatology, Maternity

• Beds – 1792 (Inpatient) & 205 (Day case)

ePx Project

• Cerner Millennium system

– ePx, electronic orders, A+E, Theatre scheduling, PAS, documentation.

Workshop Session 1 Pre-Go Live Planning

Workshop Session 1 Feedback / Discussion

• What can you actually do?

– System limitations

– Do you need documentation

• Where can you do it?

– Other systems?

• What can you afford / support.

• Can you ever have enough?

• What kind?

• Dispensing trolley?

• Security / cleanliness / durability.

• People will have better hardware at home

– Or even in their pocket.

– But what can an App actually do?

• Who to train?

• When to train?

• What to train on?

• How many people?

• How to get bums on seats?

• What about the night shift?

• Who will do this in the long term?

• Should we even bother?

Workshop Session 2 Roll-Out Considerations

• Support

• Mixed Media Prescribing

• Bank and Agency Staff

• Real time PAS / ADT issues

• ….

Workshop Session 2 Feedback / Discussion

Roll Out planning

• Start upstream or downstream?

• Time between wards go lives – transfer of patients and outliers

• Dual systems – paper and electronic

Roll Out planning

• Big Bang vs staggered rollout.

– What can you support?

Dedicated ePrescribing support 24/7

• ePrescribing team manager (Pharmacist) plus 5 full-time team members (Nurses or Pharmacy Technicians)

• On-site 24 hour support for 7 days post go live; otherwise 0730 – 2300 on site and on-call over night

• Used extra support for Theatres when surgical wards first went live (anaesthetists and recovery staff)

• Bank staff to support staff shortages

• Moving to be able to provide less on-site support over weekends

• Key success area for the project: awarded ‘Hospital Heroes’ team prize of Education and Support

Agency nurses and locum doctor access

• Use NHS professionals and multiple other agencies

• High agency usage – wards could not operate if agency staff not able to use the system

• Agreed process where agency nurses (and locum doctors) access and complete training before starting their first shift

• Agencies responsible for completing System Access Forms

• Built into the performance metrics for the agencies

• Difficult for first few wards, but easier as more wards are live

administer medications the next day

• Nursing staff now complete ADT when ward clerk not on duty (also have a central ADT team to support)

• ADT available on the drug trolleys – therefore can complete transfers etc

‘on the fly’

• Also supports the use of other systems (e.g Doctors Worklist; Bed

Management tools

Workshop Session 3 Maintenance and Support

• Responding to incidents

• Handling prescription errors

• On-going maintenance of the system

Workshop Session 3 Feedback / Discussion

Responding to Incidents

• We now have something to blame!

• Who does this now? Who does this after go-live?

• System fault? or user fault?

• But what is the system?

– software, user, computer, Wi-Fi, power cable, the workmen

digging the road up 3 miles away?

• Trend monitoring.

• Feedback to users / training central team or department.

Consultant review of the drug chart / Drug

On-going modification of build

• Link to stock control system limits naming of prescribable items:

– Inclusion of strength and formulation

• Modification of existing protocols – general prescribing practice is more open

• Increasing list of protocols – standardise care and ease of prescribing

On-going maintenance

• Everything goes through the system

– New policies

– Clinical trials

– Who designs or build this

– Can the system / team become a bottleneck?

• How do we handle changes to the system?

– En masse change vs drip feed.

– How does the system handle change?

– Change control

• Do we need a down-time.

Benefits: Error rates

Benefits: Drug Round times

Drug

Round eprescribing pre / post

Avg time / patient (Mins)

Avg difference (mins / patient Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Ward 8

Questions?