“Of all our digital projects, e-prescribing is the biggest step forward in patient safety. It reduces errors and ensures the right things get to the right place at the right time.”

St. Helens & Knowsley’s CCIO, Rowan Pritchard Jones

In April 2017 St. Helens & Knowsley Teaching Hospitals NHS Trust’s inpatient’s facility, Whiston Hospital, went live with JAC’s new web-based EPMA (Electronic Prescribing and Medicines Administration) system. Purchased under the NHS Safer Hospitals, Safer Wards technology funding scheme, EPMA works with St. Helens’ existing JAC Pharmacy stock control module to deliver end-to-end medicines management and is being interfaced with the Trust’s new PAS for order communications, discharge data and a range of other functionality.

Digital Maturity

JAC’s new EPMA is also a strategic step forward in digital maturity. Says Mike McKenna, the Trust’s EPMA Programme Manager: “It gives us a whole new interoperability environment to share data for things like A&E discharge, remote treatments for mental health facilities and secure patient records for clinicians on the road.”

In choosing JAC, the Trust opted for a solution with a broad, proven user base and specialist-designed set of tools. Says Christine Walters, CIO: “Since we don’t currently have an EPR we were free to choose the market leader. McKenna adds: “JAC EPMA gives us much richer functionality and whatever our future EPR plans turn out to be, JAC will remain the core of our medicines management strategy.

New Web Benefits

The team also wanted a modern web interface which would give remote users quick and easy access to information. Says Walters: “EPMA’s web technology makes the system easier to deploy, add upgrades and link to other applications as our digital environment evolves. Gone are local software reinstalls; now we can add updates at the centre and provide users with access via URLs to save time and ensure everyone is on the same version. And for remote users, internet data security is assured with firewalls and VPN access codes into the Trust server.” Rowan Pritchard Jones, CCIO and consultant plastic reconstructive surgeon, adds:

“In addition to being more intuitive than many systems, the web interface gives clinicians a much greater degree of agility for mobile use.”

The Digital Transition

Currently the JAC EPMA is in production in several key wards including stroke rehabilitation and haematology, with all of Whiston’s remaining 35 wards due to be live by Spring 2018. When it came to rolling out the new system to users, the web interface – designed in response to in-depth studies on how clinicians navigate screens – greatly simplified the training process. Says Dr. Francis Andrews, medical director and the project’s chair: “I was able to go from paper to working electronically in 15 minutes. As for the nursing staff, nothing would induce them go back now.”

The pharmacists are also won over. As EPMA project pharmacist, Sally Patrick explains: “We went through a programme of intensive hands-on training with each pharmacist, working with them to perform a wide range of complex tasks such as inputting medicine defaults and customised alerts. It’s a big change from what they were used to, but it didn’t take long for the dispensary pharmacists to get familiar with EPMA and now they are more than happy to leave paper behind.”

As Dr. Andrews points out, the speed with which the hospital’s cultural and technology barriers were overcome is particularly impressive considering e-prescribing’s complexity which makes it the most difficult environment to change. “To start with there’s a vast array of standard medicines protocols and dosage banding that has to be entered into the system – including thousands that come pre-loaded in the EPMA medicines library. Others need to be custom configured by the pharmacists along with alerts for an individual patient’s drug allergies and adverse interactions. A single error can be life threatening which explains why medicines management has one of the lowest tolerances to error: It has to be safe.”

Errors Reduced to Zero

This ‘safety first’ attitude is shared by everyone at St. Helens. Says Pritchard Jones: “Of all our digital projects e-prescribing is the biggest step forward in patient safety. It reduces errors and ensures the right things are getting to the right place at the right time.” According to Dr. Andrews, in just six months EPMA’s impact on prescription errors has already been dramatic: “We used to get a lot of error reports but in the last three months we haven’t had a single one.”

Among the safety enhancements of going paperless are the system’s many exception alerts, decision support tools and reduction of transcription errors (since drug cards are no longer written by hand). Prescription orders and cardexes no longer go astray and in cases when speed is care-critical, prescription data and dosage changes from A&E can be transmitted instantly to the wards five floors up.

Other benefits

EPMA also provides numerous other clinical benefits. One of these is the ability to see a patient’s complete medicines card on a single screen. Drug histories can be called up, test results viewed, patient files checked to see if they have been betablockers, free text messages left on the file, and decision support data accessed: all from a single logon.

The system’s ability to capture and retain all past and present medicines data means that on readmission a patient’s drug history is already there to meet them. And on discharge, prescription letters can be processed using data from the EPMA to save rekeying. For patients on 25 or more drugs, Patrick estimates this saves up to a half-hour per discharge. In addition, all prescription information can be shared with the GP through the hospital’s ICE interface. As to operational and financial efficiencies, since all medicines management data is automatically captured and continually updated in the JAC database, generating reports and analysing data is straightforward.

Working with JAC

Given the complexities of St. Helens’ EPMA project, with Whiston’s 37 wards and further rollouts planned for St. Helens outpatients’ and possible outreach into the community, a good supplier relationship is vital. Says Walters: “Since we already use JAC Pharmacy we knew we could count on JAC, but our relationship has been strengthened with the EPMA implementation. We appreciate the fact they didn’t just send us techies; the team also included an expert who was a former EPMA user with hospital experience and a pharmacy background. He understood immediately what we were trying to do which made a huge difference.”

For Dr. Andrews it was JAC’s confidence in the face of the size and complexity of the project that most impressed him: “With anything of this scope you’d expect a few hiccups, but with EPMA these have been far fewer than most other projects. The JAC team worked extremely hard, sincerely believes in the products and the company has a good roadmap. All of which makes JAC our trusted partner for the long term.”