Bedford Hospital NHS Trust is transforming chemotherapy medicines management with a highly specialised clinician-designed CMS system designed to digitise the end-to-end workflow from electronic prescribing to drug administration, in-pharmacy production and the integrated patient record.
A desire for increased patient safety and an enhanced experience for both patients and clinicians led Bedford Hospital NHS Trust on an extensive search for an electronic chemotherapy management system. The mission was to create a data sharing environment for oncology services on just for inpatients but that would encompass home care and community facilities, as well as links to Addenbrooke’s (its tertiary hospital partner in Cambridge), as well as cancer service providers in Luton and Milton Keynes.
Finally in 2016 Bedford chose a European-designed CMS system from JAC. Says Kandarp Thakkar, Chief Pharmacist, Divisional Clinical Director and project co-sponsor: “When I first arrived at Bedford, the Trust was on the verge of purchasing a long-established US-based chemotherapy system. I suggested that instead we throw it open to tender for a wider selection of alternatives. We then scored them against a comprehensive list of requirements that included, besides specific functionality, ease of implementation and long-term support reliability.”
The fact that the CMS system Bedford selected was designed by oncologists ticked the box in terms of functionality, however the project team was initially unsure whether a European system could handle NHS requirements like SACT reporting. “As Thakkar explains: While the tools needed for oncology care may be universal, the processes obviously differ across geographies.” But after an onsite visit to The Hague they were reassured as to the system’s cross-regional configurability.
In the event the CMS rollout was completed within eight months with minimal disruption, including interfacing the system with the Trust’s PAS and pathology applications. In the next phase of its end-to-end programme, Bedford plans are to integrate the CMS with its Pharmacy system (also JAC) which will incorporate the additional advantages of medicines stock control, ordering, inventory management and financial oversight.
A key part of Bedford’s CMS strategy was adapting the new digital workflow to replicate existing clinical procedures rather than forcing staff to learn new methodologies forced upon them by the technology. Towards this end, the JAC system’s browser-based front end was easily configured to present information in a way both familiar and easy to navigate – a fact that simplified training and encouraged adoption by staff who were previously reluctant to work within a computerised environment. Oncology Nurse Wendy Cox, a quick convert says: “Now I don’t have to carry around bits of paper all the time.”
By centralising all patient-related chemotherapy treatment data – including items like dose adjustments and lab results – nurses and doctors can leave each other free text notes on the system rather than clipping pieces of paper to charts and files which can easily detach. Digitisation also minimises patient risk by reducing errors arising from lost patient records, mislaid prescriptions, transcription mistakes resulting and poor handwriting, And when issues do arise, the system’s secure clinical audit capability can immediately identify the source of an error so it can be corrected. As Thakkar points out: “One of the single most important benefits of a digital workflow is that it provides full traceability and auditability.”
For the busy clinician, at-a-glance access to oncology patients’ information at the point of care – wherever and whenever that may be – is crucial. The Bedford system captures data across all touchpoints on the treatment journey from diagnosis through prescribing, aseptic production, appointment scheduling and administering and on an integrated medicines chart visible on a single screen. No longer do clinicians find themselves having to cut between screens and different systems in order to piece the picture together.
Says Athar Ahmad, Consultant Oncologist and Medical Lead on the CMS project: “I can bring patient records for a real-time view of what regimens they are receiving, any dose reductions or omissions and dates of previous and upcoming treatments. I can also access their previous recorded toxicities and see any notes that other healthcare professionals have left as well as data on previous treatments without searching through historical paper records. Chemotherapy can be prescribed and received immediately by Pharmacy with all the doses calculated and dose-banded. They system also provides a range of other decision support tools to speed the prescribing process and ensure best practice is followed.”
When it comes to generating ad hoc or routine clinical and management reports, access to a central repository timely digital data, along with customised analytics capabilities, streamlines previously time consuming tasks. Take the Trust’s monthly SACT reports. Traditionally a laborious task that required input from multiple pharmacists and frequently took up to a day to compile, the system can now generate a report with a single click.
Easing the patient experience
During a course of chemotherapy it is the quality of a patient’s experience that is front of mind for Bedford’s oncology clinicians. When a patient arrives at the hospital for the next stage of their treatment they can be confident there will be no delays and their session will not have to be rescheduled due to a missing medical file.
Given the ever-increasing pressures on resources within the NHS, this complete, accurate and up to the minute visibility on chemotherapy patients, whether on the ward, at home or in a community clinic, enables caregivers to do more in less time with higher rates of patient safety and greater peace of mind.