Download Appendix A - Information about LOP

Appendix A:
Information about
“Drugs and patient safety – LOP”
for
Helse Vest
Table of content
1.
2.
3.
4.
5.
6.
Background ........................................................................................................................ 3
Objectives and strategic foundation ................................................................................... 3
Solution scenarios .............................................................................................................. 7
key aspects to consider when choosing solution components ............................................ 8
Preparedness solutions and non-conformity management ................................................. 9
Roadmap, LOP 2011-2020 ................................................................................................. 9
Appendix A - Information about LOP
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1.
BACKGROUND
The drugs and patient safety project LOP (LOP - Legemiddel Og Pasientsikkerhet) has
long-standing history in The Western Norway Regional Health Authority (Helse Vest). The
initial project mandate was approved in a meeting of Helse Vest executive officers in
March 2008, and the LOP1 report was approved by the same meeting in May 2009. The
LOP2 report was similarly approved in December 2009. On the basis of this report, it was
decided that certain key areas were to be continued in a new project, LOP3, which in turn
was continued in the work of the LOP4 project.
The overall objective is to reduce the number of preventable, undesired incidents
involving drugs. The LOP-project should also recommend solutions that would provide
easy access to data in the medical record, such as vital signs, clinical observations, test
results, orders, and data capture from medical devices.
The project group was assigned the task of investigating and recommending actions to
achieve the overall objectives. The project group comprised more than 40 members. It
was an interdisciplinary effort, with representatives from all health trusts, including the
hospital pharmacies, Helse Vest IKT AS, and Helse Vest’s user involvement
representatives.
The project report was completed in June 2011, and several short- and long-term actions
have since been started. The solution scenarios are described in chapter three and in
then roadmap in chapter six.
2.
OBJECTIVES AND STRATEGIC FOUNDATION
Helse Vest is to acquire solution(s) for
(1) an electronic medical record/chart system that will display, analyse and store clinical
information such as vital signs, observations, test results, orders, and automatic data
capture from medical devices. The solution should include a computerized provider order
entry system (CPOE). The solution should also facilitate preparation, administration and
documentation of drug treatment.
(2) drugs supply; ordering of drugs for a hospital unit from a hospital pharmacy/supplier, delivery of the drugs (preferably unit dose) to that unit and storage in the unit.
The electronic medical record system in request must be user friendly and should provide
solutions for integration with existing and future clinical information systems in the
organization and also with the requested drug supply system.
The future
(secondary
particularly
objective of
solution(s) must support integrated patient care, both within Helse Vest
and tertiary care) and in interaction with other health service providers,
the primary health care services. It must contribute to the overall project
reducing the number of preventable, undesired incidents involving drugs.
These objectives have been developed into operative targets, as follows:
Appendix A - Information about LOP
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•
Solutions should contribute to proper
distribution, handling and use of drugs
clinical
decisions,
correct
ordering,
•
Solutions should provide or support clinical decision support systems
•
Solutions should improve work-flow
•
Solutions should contribute to better cooperation and coordination (integrated
patient care) within and across the health trusts , the regional health authority
and the primary health care
•
Solutions should meet requirements for documentation and reporting.
•
Solutions should contribute to improved data gathering
•
Solutions should support interfaces with technical medical equipment such as
patient monitors, ventilators, infusion pumps etc. and existing information
systems such as laboratory systems, blood-management systems, and EHR
information solutions
•
Solutions should enhance and improve internal audit processes and support
validation of equipment and processes
•
Solutions should be user-friendly
•
Solutions should be able to facilitate for new technologies and/or procedures
LOP objectives:
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Appendix A - Information about LOP
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Drugs are substances, pharmaceuticals and solutions assigned for or administered to
•
prevent (e.g. anticoagulants)
•
treat (e.g. antibiotics)
•
alleviate (e.g. analgesics)
•
detect (e.g. radiocontrast agents)
disease, symptoms, pain and/or influence physiological functions.
Helse Vest purchased drugs in the amount of NOK 506 million in 2010.
Patient safety is protection from avoidable adverse patient events, caused by health care
services or lack off health care services. It does not cover injury as a consequence of
disease, foreseen complications or consequence of treatment that does not work.
(Kunnskapssenteret: Norwegian Knowledge Centre for the Health Services, Sep. 2010).
LOP has strong regional foundations, and contributes to objectives as laid down in the
Regional Health 2020 Strategy, quality improvement strategy, ICT strategy and the EHR
2020 strategy. Furthermore, the project supports national objectives, which in turn also
are regional objectives, defined in
•
Samhandlingsreformen (The Coordination Reform - regjeringen.no)
•
Nasjonalt meldingsløft (The Message Exchange Programme)
•
Pasientsikkerhetskampanjen (The Norwegian patient safety campaign)
•
eResept (Electronic prescription )
•
Medikasjonstjeneste i spesialisthelsetjenesten (the Medication Service for the
Specialist Health Care)
•
Prosjekt Nasjonal Sykehus-FEST (the
Administration Support Programme)
•
Kjernejournal (the National Electronic Health Record Programme)
•
Nasjonal Helseplan (the National Health Plan)(Nasjonal helseplan 2011 - 2015)
•
Nasjonal Helseportal (the National Health Portal)
•
Nasjonal IKT (National ICT)
National
Hospital
Prescription
and
Several studies have concluded that new measures in the drugs administration area are
necessary,
•
Medication errors in 20 percentage of treatment pathways
The Drugs Report (Report no. 18 to the Storting, 2005)
•
Costs of medication errors estimated at approx. NOK 5 billion per year in Norway
The Drugs Report (Report no. 18 to the Storting, 2005)
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•
27 percentage of all reported injuries involve drug use or drug handling
Norwegian Board of Health Supervision (Summary report, 2001-2007)
•
610 reports on medication errors over a four-year period at St. Olavs Hospital
The Medication Errors for Patients Admitted to Hospital Report (Teigen et al.,
Journal of the Norwegian Medical Association, no. 13/2009)
•
3,770 non-conformance reports involving drugs handling in Helse Vest between
2009 and August 2011
Section for Patient Safety, Bergen Hospital Trust (September 2011)
SOLUTION SCENARIOS
3.
LOP has opted to evaluate solution scenarios in three main processes:
-
documentation of and easy access to data in the medical record, such as vital
signs, clinical observations, test results, orders, and data capture from medical
devices
-
drugs to patients
-
drugs supply
These processes are described in more detail below, however the overall objective for a
future solution is that these main processes are well coordinated.
The chart is traditionally defined as a graphic presentation of patient-related information
and results along a timeline. The chart is part of the patient’s medical record and is an
interdisciplinary presentation of patient progress, containing information about the
patient’s health and completed on-going and scheduled treatment. It acts as a channel of
communication between doctors and nurses and between various teams and units.
The current charts and medical documentation solutions are primarily paper-based,
with a few exceptions. LOP recommends that existing paper-based chart solutions are
replaced with electronic solution(s) meeting current and future user needs, as well as
requirements regarding documentation and reporting. A future electronic charts and
medical documentation solution is expected to meet all relevant needs throughout the
patient pathway, including any needs related to the drugs to patient process.
The drugs to patient process is defined as the process of drugs documentation and
handling, from the time the patient becomes the responsibility of the hospital (including
prehospital services/ambulance))and until the patient leaves, including support functions
pertaining to this process. Furthermore, this process also includes the exchange of
information regarding the patient’s medication when he or she is transferred between
units/levels of care.
The current drugs to patient process are highly complex, involving many different actors
and various chart systems (the majority of which are paper-based). The process requires
manual registration and transfer of critical information throughout the patient pathway.
LOP recommends an electronic solution with standardized processes, facilitating the use
Appendix A - Information about LOP
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of clinical decision support systems. New electronic processes should contribute to
integrated care, increased patient safety, increased safety for staff and better
documentation procedures. New solutions should also facilitate reports for the use of
quality improvement purposes, research and management purposes and the process of
submitting reports to central authorities. Quality requirements issued by supervisory
authorities etc. should also be met more easily.
The drugs supply process is defined as the process of ordering drugs for a hospital unit
from a hospital pharmacy/supplier, and delivery of the drugs to that unit.
The current drugs supply process is characterized by labour-intensive manual
procedures. The main recommendations from LOP are to introduce electronic solutions
for ordering and stock management, increase the supply and use of unit-dose drugs,
use automated dispensing cabinets for safer storage where suitable, implement ”top-up”
pharmacy-managed stock, including expanded process support to contribute to a more
efficient supply and proper use of drugs.
4.
KEY ASPECTS TO CONSIDER WHEN CHOOSING
SOLUTION COMPONENTS
The main focus of LOP is the user situation. A critical element for success for any future
solution is that the user situation is perceived to be
–
intuitive
–
quick
–
simple
–
informative
–
motivating
–
flexible
Throughout the LOP project, user groups have actively participated in designing solution
scenarios, describing what needs to be changed. To increase the awareness of
opportunities and challenges, the project has carried out study visits. Before deciding on
any solutions or suppliers, several reference visits will be carried out.
Below is a non-prioritized list of aspects to be considered when choosing solutions:






high availability of solutions
back-up solutions that automatically take over in the event of errors, scheduled
and un-scheduled stops, ensuring uninterrupted access to updated critical
information and other services
user-friendly interface
easy and quick access to information and services
compatibility with both mobile and stationary electronic equipment
compatibility with workflow processes and patient pathways across professions,
functions, organizational units and levels of care to ensure continuity in the flow
of information, e.g. about drugs
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






technical solutions applicable to standards for the health sector
flexibility in terms of integration with existing solutions and adapting of future
needs and requirements
technical solutions based on recommendations and guidelines for the health care
service, e.g. service-oriented ICT-architecture
possibility of clinical decision support, e.g.
regarding drug handling and
administration
possibility of logging changes in information and execution of the various data
and processes
possibility for solutions for reporting data for analytical purposes
possibility of regional solutions, which are flexible enough to handle variations
when this is necessary, based on actual differences in treatment and other
critical activities
PREPAREDNESS SOLUTIONS AND NON-CONFORMITY
MANAGEMENT
5.
Provisions in the Comprehensive National Health and Social Preparedness Plan require
specialist health care services to establish and maintain emergency preparedness plans.
The intention behind this plan is to prevent crisis and breakdown of critical functions, and
to ensure efficient crisis management and organization of the preparedness plans. ICT is
a key element in the hospital infrastructure, and the availability of all ICT services must
be secured. Preparedness plans must be implemented in case the ICT-services should no
longer be available.
Availability is crucial for all solutions, especially for those related to the drugs-to-patient
process and charts and medical notes process. Information provided by these solutions is
critical for patient safety. Solutions must therefore be secured with back-up solutions
that take over; with updated information about patient status and treatment from the
instant major service interruptions occur. Solutions must be monitored in such a way
that any irregularities are detected and the operator is notified. Whenever possible,
solutions must offer automatic back-up solutions in the event of service interruption.
ROADMAP, LOP 2011-2020
6.
A roadmap has been developed for the 2011-2020 period, see below. This roadmap
describes short- and long-term measures, the objectives of the project, and which
national measures the LOP project supports. Some short-term measures will be
implemented as soon as possible

because they add value without new investments or major changes

because of expectations or requirements laid down by national authorities
Appendix A - Information about LOP
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At the same time, a procurement process is initiated for future solutions that will meet
the project recommendations regarding charts and medical notes, drugs-to-patient and
- the drugs-supply processes. This procurement process aims to procure a
comprehensive solution, however we must

look for solution components for the future, however making sure it is a proven
record of the components promised results

consider the sequence the solution components should be introduced

consider which components each of the hospital trusts unit should have (and in
which order they should be introduced)

o
as it is not given that all units will receive all components of the
comprehensive solution
o
as there could be versions of each individual component, where volume
and cost/effect must be considered for each unit
pilot all new solution components before introducing them
The LOP activities are summarized in the following roadmap:
Appendix A - Information about LOP
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2011-12
• T1: Increase use of unit dose drug
packages
• T2: Increase use of Top-Up service
of drug delivery from pharmacy to drug
storage rooms in hospital wards
Local and regional solutions
• T3: Increase use of pharmaceutical
advisory services
• T4: Consider introducing a temporary
electronic ordering system for drug
ordering from hospital ward to
pharmacy
•T5: Consider carrying forward the use
of electronic patient records(EPR`s),
currently in use in W estern Norway
Regional Health Authority(EPR)
• T6: Piloting and introduce a shortterm solution for ePrescription
• T7: Introduce short-time solutions for
improving medication history taking,
medication reconciliation and
medication information for patient
coming from /returning to primary care
2013-17
2018-20
• T9: Piloting and introduce electronic drug
stocking management and ordering system for
hospital wards
• Continue
• T10: Piloting and implement Automated
dispensing cabinet for drugs in hospital wards
T10, T11, T12,
• T11: Piloting and implement electronic system,
supporting prescribing, administration and
dispensing of medication(EMR), electronic patient
identification and electronic information transfer
to/communication with primary care
T13 and T14
• High achievement of
gains and benefits
• T12: Piloting and implement electronic support
system for all other use of medical charts and
notes
• T13: Piloting and implement long-term
solution for e-Prescription
• Continue T1, T2 and T3,
T4 continues in T9, T5 in
T11/T12 T6 in T13
and T7 in T11
Escalation of gains and
benefits
• T8: Prepare and implement
procurement-process
Partial achievement of gains and benefits:
• Fewer avoidable, medication errors/drug adverse events
• Improved patient safety and quality
• Improved patient pathway and interaction
• Reduced costs related to use and stockholding of drugs and of personnel
• Improved and easier follow up of regulatory demands- and programs
• Improved and easier reports for change management and research
• Improved patient satisfaction and employees satisfaction
• Improved system support for a safe and good working environment
Gains / Benefits
Appendix A - Information about LOP
LOP
T3, T4, T5,
 National Quality indicators
 National patient record
 Patient portal
 Patient Safety Campaign
 The Coordination Reform
 National e-communication in health
and social service
 Electronic registry of drug information
for prescribing and expeditions/dispensing
(FEST)
 e-Prescription
 Medication IT services
 Patient Safety Campaign
 The Coordination Reform
 National e-communication in health and social service
 Electronic registry of drug information for prescribing and
expeditions/dispensing (FEST)
 e-Prescription
 Medication IT services
National programs
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