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Benefits of EPMA at QEH, Birmingham Asif Sarwar History of PICS at QEHB • 1,200 bedded tertiary referral and University teaching hospital • £545million new development opened June 2010 • EPMA across all in-patient beds – Not yet in A&E, theatres, dialysis From this to this using these Description Information Hospital 1200+ beds PICS Specialties 17 PICS registered users Weekly logins Peak concurrency >5000 3900 - 960 doctors - 2470 nurses 500+ Weekly prescriptions Weekly administrations 32,000 137,000 OPD episodes 10,000 per week Support people who work with medicines – “A guide on the side” EPMA provides us with: – Legible instructions – Reviewing medications history – Access to further information – Clear guidance on what to do next • Expert error detection – Rules based surveillance with alerts outside order entry – → Reduce errors of omission or commission Rules-based clinical decision support Prescribing • defaults • dose validations • interactions • drug • clinical condition • serological state • duration of scripts • by specialty where necessary External/Internal links Lab results Cross-Referencing PICS – a developing Electronic Clinical Record Laboratory Flow Sheets Fluid Balance Urinalysis Charts Infection Control Clinical Flags Operation Noting Physiological Observations Electronic observations charts Recognising and Responding to the Deteriorating Patient • Automated text messaging /pager alerting • Evaluation of the recognition of deteriorating patients • Can be linked into medication rules However... • It still requires human interactions IT related errors • Look-alike drugs • Picklist choice/keystroke errors • Alert fatigue • Workarounds What about pharmacy? • Reduced missed doses • Intervention logging • Records of drug histories • Warfarin alerts • High-risk drug flag • Formulary enforcement Its greater than the sum of its parts • Bee aware • E-transfer of discharge letters to GPs • 100% compliance with thrombosis assessment • Compliance with dementia screens • Barcode scanning of patients to confirm identity So what.... • Every click is auditable • Improved patient safety • Juniors at weekends don’t have to re-write charts; more time on actual patient care Clinical Dashboard Turning data into information Antibiotic - % Missed Doses Date A 15 April 2009 Pause function for doctors B 04 August 2009 15 December 2009 24 February 2010 30 March 2010 Missed Doses go live on clinical dashboard C D * D * Step change in % missed doses when information shared with clinicians / managers Further highly significant change when CEO started RCA meetings Intervention Introduction of coloured indicators to show due / overdue drugs NPSA Rapid Response Alert Chief Executive Missed Dose Root Cause Analysis meetings Thank you – Any Questions?