Case study: e-Prescribing for Mental Health at Leicestershire Partnership NHS Trust
“The e-Prescribing system is excellent. It is easy to use and not only does it help practitioners feel more confident in their prescribing but also makes the dispensing quicker. This computerised method is a much better way to manage medicines and improve patient safety and I’m delighted this is being extended to all areas of the Trust.”
Dr Mangesh Marudkar, Consultant Psychiatrist
Customer needs met
- Enhanced patient experience through reduced prescribing and drug administration errors.
- Trust-wide roll-out of electronic prescribing across 34 inpatient wards and 45 outpatient units underway.
- Improved legibility of prescriptions delivering an overall reduction in medication errors.
- Replaced time-consuming manual paper-based systems.
- Improved control of ward medicine stocks.
- Routine use of electronic prescribing data for auditing & customised reporting.
Leicestershire Partnership NHS Trust has worked with JAC to successfully deploy Electronic Prescribing and Medicines Administration (EPMA) across its sites. EPMA is now active at 8 sites, with wider deployment extending to 34 inpatient wards and 45 outpatient units by early 2011.
JAC’s EPMA system has helped the Trust reduce prescribing and drug administration errors at its various sites by automating key processes, and has released clinicians’ time to provide care by reducing the amount of time they spend on issuing medication during drug rounds.
The Trust is also using auditing and reporting tools within EPMA to help key staff, such as doctors, nurses, and pharmacists, monitor prescribing protocols to help improve the overall service.
Furthermore, since there are no onsite pharmacies at the Trust’s hospital units, EPMA has also enhanced communications, allowing pharmacists to clearly see what drugs have been prescribed by the hospital and by which clinician. This streamlines the overall prescribing process, eliminating the need for hospital staff to clarify or re-issue prescriptions that may be illegible or incomplete.
Proving the case for prescribing
Leicestershire Partnership NHS Trust provides services for patients with mental health and learning disabilities mainly in the city of Leicester and the neighbouring counties of Leicestershire and Rutland. In 2007, the Trust decided to deploy a prescribing programme with EPMA senior specialist Andrew Moonesinghe heading up the project.
“The Trust wanted to upgrade from its paper based prescribing system primarily to reduce the risk of prescribing errors and to save medical and nursing staff time,” said Andrew. “Clinicians often found the paper based prescribing system very time consuming and a key drawback was that it was only accessible from a single location.”
“The Trust had been using JAC’s stock control module for a number of years, which meant the infrastructure for EPMA was already in place and staff were familiar with it. This made it easy to fully integrate EPMA into our existing infrastructure, as well as with our prescription tracking and patient administration systems.”
The system was initially piloted on four wards for six months, within older person’s mental health services. The EPMA solution enables clinicians to access and check prescriptions wherever they are in the Trust, saving them time and providing patients with a more efficient level of care.
“The reaction from staff has been very positive and this has helped prove the benefits of EPMA when prescribing medication. It was particularly beneficial to junior doctors working in psychiatric services for the first time, as the system uses the Multilex Drug Data File for decision support, which allows users to monitor drug-drug interaction, reducing the risk of prescribing errors.”
All ward staff including nurses, doctors, pharmacists and technicians welcomed the implementation of EPMA, The positive feedback strengthened the case for wider deployment of the solution across the Trust’s other sites.
Dr Mangesh Marudkar, Consultant Psychiatrist at the Trust, said: “The e-Prescribing system is excellent. It is easy to use and not only does it help practitioners feel more confident in their prescribing but also makes the dispensing quicker.
“This computerised method is a much better way to manage medicines and improve patient safety and I’m delighted this is being extended to all areas of the Trust.”
Realising the benefits – rolling out across 8 sites
The initial project started in 2007 and JAC’s EPMA solution was selected as the Trust was impressed by their stock control system, which had been in place since 2000. During the six month pilot scheme, the benefits of EPMA were apparent to the project team and to clinicians, and as a result JAC’s e-prescribing solution was rolled out across 8 sites.
Leicestershire Partnership NHS Trust is the biggest mental health organisation JAC has worked with. However, the strong case for widespread deployment of JAC’s EPMA system was based on witnessing five key benefits:
Reducing prescribing errors. The ability for e-prescribing to help minimise the chance of errors during the prescription process was a determining factor for EPMA rollout. It ensures the accurate dose is issued and enables staff to monitor drug-drug interactions. This is essential when prescribing psychiatric medication due to the potential for patients to suffer adverse effects if drugs conflict or are prescribed for longer than is necessary.
Clarity of prescription. EPMA leads to better clarity in prescribing, saving time in the process and enhancing patient experience. Since the Pharmacy Department is not on-site, prescriptions previously had to be faxed through, requiring pharmacists and technicians to travel to different sites to review prescriptions. There were also issues with prescriptions when handwriting was illegible or if parts of the prescription were missing. E-prescribing has now enabled pharmacists and technicians to review prescriptions clearly from the pharmacy itself, and has helped improve communications between pharmacies and hospital departments.
Control of ward stocks. EPMA has been integrated into the prescription tracking system. The system automatically books in prescriptions received electronically and records all information, enabling ward staff to see exactly what has been ordered and the process it is currently undergoing. The solution also integrates with the patient administration system, collating all patient information across to JAC’s EPMA. This frees-up staff time as they are no longer required to manually input data.
Efficient prescribing process. EPMA prompts staff about the medication needed during their rounds, meaning issuing of drugs is more efficient. Previously, ward staff would have to look through their whole medication card, which took considerable time and sometimes left room for error.
Audit. EPMA allows the Trust to review all aspects of medicine usage at the click of a button. From using EPMA on psychiatric wards, the team realised that the extensive amount of patient data and prescribing and administration records accumulating in the system could also be used to benefit other functions on the wards. They believed the EPMA data, which was previously available only on paper records, could help improve prescribing specifically for antibiotics and hypnotics by analysing drug dosages, the frequency in prescribing each drug, and whether the drug needed to be re-prescribed.
Although prescribing for psychiatric illnesses is complex, JAC worked hard to meet the needs of the Trust and implemented changes to the electronic system where necessary to accommodate their specific requirements. JAC is also developing a mental health module based on the Trust’s requirements as part of their overall development roadmap.
The project team – with advice from JAC – developed a reporting tool for clinicians treating patients with mental health problems. The tool could access and explore EPMA data in the JAC system and use it to conduct in-depth audits and further analysis.
Prior to EPMA deployment, an audit of this kind would have been a long and tedious process, involving extracting prescribing data from paper forms and carrying out further reviews on drug charts and notes.
With EPMA in place however, the project team were able to export and view data from EPMA to display results in a format that is easily manipulated. Therefore, audits that would previously have taken weeks to complete and may have been subject to interpretation errors, can now be done accurately in a matter of hours.
This enabled clinicians to use EPMA as an investigative tool, helping to identify historic prescribing issues and ultimately improve overall practice.
Anthony Oxley, Associate Director, Medicines Management for the Trust said: “EPMA moves medicines management firmly into the 21st century. All stages of prescriptions, administered and dispensed can be audited and this really benefits patient care. The hard work of the ePrescribing team has released spectacular benefits.”
The future for e-prescribing
The JAC EPMA solution will be fully rolled out across 34 inpatient wards and 45 outpatients units by early 2011, extending the benefits of EPMA across the Trust’s other sites. Andrew Moonesinghe said: “The wider deployment of JAC’s EPMA solution is ambitious, but the Trust has secured staff to help support the integration, and we expect rollout to run to time and budget.”
About JAC’s EPMA system
JAC has the largest installed base of Electronic Prescribing and Medicines Administration (EPMA) systems in UK hospitals. These systems improve patient safety by reducing prescribing and administration mistakes that could result in medication errors and adverse drug events.
EPMA also facilitates wider improvements in clinical practice, including: reductions in paperwork and transcriptions; improved audit trails for medication; performance monitoring and intelligence; enhanced reporting capability to review practice, improve future care and deliver management and financial information such as reporting for PbR; greater consistency and continuity of care between primary and secondary care settings; and more effective communication between hospital departments and pharmacies.
The system incorporates the UK’s leading drug database, to support safe and effective electronic prescribing through its clinical checking. This allows the system to check for drug-drug interactions, sensitivities, drug doubling and duplicate therapy, therefore reducing the risk of medication errors and increasing patient safety.
You can read more about JAC’s EPMA system here.Read More