Electronic prescribing and medicines administration in mental health inpatient wards

Berkshire Health NHS Foundation Trust implemented ePMA (electronic prescribing and medicines administration), a solution which digitises the process of prescribing and recording medication administered to inpatients within the Trust.

All of Berkshire Healthcare’s inpatient mental health wards are now live with ePMA, which provides clinicians with 24/7 access to the patient’s medication record from anywhere, with built-in decision support, increasing safety and time efficiency. This saves an estimated 1,000 to 1,500 hours every year across all wards for medicine administration.

The ePMA system sits on the same platform as the Trust’s pharmacy system, dispensing robot and primary clinical record, providing a fully closed loop solution with additional benefits to clinicians with context launch from the clinical record into a patient’s record in ePMA and medications contained within the discharge summary.

Situation

Prescriptions and medicine administration documents were handwritten and recorded on a paper drug chart within inpatient mental health wards. Access to the resulting record was often limited and difficult to audit so the Trust decided to digitalise the process to increase efficiency.

Aspiration

The objective of the project was to create a clinical system that contained a full record of all medicines activities, including prescribing and administration, during an inpatient stay, and where medicines information could be accessed 24/7 from any location.

Solution and impact

By integrating the electronic medicines management (eMM) and electronic prescribing and medicine administration (EMIS ePMA) modules into the Trust’s core clinical information system (RiO) and the Trust’s hospital pharmacy system, a complete end-to-end medicines management solution was developed.

The solution provides an electronic patient record that includes a summary of medicines a patient is taking when discharged while enhancing functionality for clinicians at the point of patient care, increasing safety for patients and making more efficient use of clinician time.

Benefits and outcomes include:

• the ability to access the digital record by more than one person at the same time, which has improved the visibility of medication during multidisciplinary team meetings on the wards. Nursing staff, prescribers and pharmacy staff have reported a unanimous opinion that EMIS ePMA has saved a significant amount of time due to the availability of the system, from anywhere, 24/7
• improved patient safety through reduction of prescribing/administration/dispensing errors, alerting clinicians to drug allergies and prescribing contraindications
• improved medicines reconciliation processes
• increased efficiency through digitising the paper prescription and administration record to allow prescribing, dispensing and administration to be completed concurrently without the restriction of a physical 'chart'. Nursing staff have reported that 100% of nurses felt that EMIS ePMA saves staff time when starting the drug round
• removing the need for a single chart to be manually transferred between pharmacy, medical and clinical staff, supporting remote prescribing and reducing the need for physical attendance by a clinician
• increased efficiency in discharging patients and ordering medication supplies. Fifty percent of nursing staff felt that EMIS ePMA saved them time when ordering medication
• enabling an electronic discharge process through digitising the medication/prescription information and auto-populating discharge information generated by the core clinical information system (electronic patient record). This is then sent to GPs, increasing person-centered, coordinated care
• increased effectiveness and safety in transfers of care through prescribing information being available in a structured format for electronic delivery to receiving systems

Certain technical prerequisites were in place for this work prior to implementation:

• a core electronic clinical information system
• digital pharmacy system with which eMM and EMIS ePMA can integrate
• WiFi on wards
• printers for business continuity purposes in the event of a business continuity and disaster recovery (BCDR) event

Functionality

• Private Cloud-based service that can be accessed via desktop or mobile

Capabilities

• Automating the generation of demographic, episodic and relevant admission, discharge and transfer information as recorded in RiO
• Contextual launch between RiO and EMIS ePMA for medicines prescribing, supporting seamless patient selection and user log in (patient context launch without the need for duplication of entry and patient search)
• Sending one discharge summary to GPs containing clinical information as well as prescribed discharged medicines and other relevant medications
• All medication charts for patients on the mental health wards are accessible digitally and can be reviewed and updated 24/7 from anywhere
• The interface between EMIS ePMA and RiO results in all demographic, episodic, admission, discharge and transfer information to be messaged from the main clinical information system to the EMIS ePMA system, ensuring that all information is up to date, without the need for a manual intervention in EMIS ePMA

Scope

For use in the mental health inpatient setting.

Key learning points

• Undertake user acceptance testing - this facilitated the understanding of the clinicians’ ways of working and how they could work differently. It also enabled the team to work with users to agree the new processes and workarounds where required
• Include clinicians when process mapping - they should be involved early on to address poor practices before mapping work can commence for EMIS ePMA implementation
• Nursing staff felt supported and very quickly became confident using the system, knowing that project support staff were on hand to answer questions
• Floor walking was crucial to providing encouragement and supporting staff to carry out the required processes
• Dedicated time from prescribers and pharmacy was essential to complete preparation activities of transferring prescriptions on EMIS ePMA before go-live

Find out more

Read more about the Berkshire case study (requires login)

Key contact

Dr Guy Northover, consultant child and adolescent psychiatrist, lead clinical director, chief clinical information officer, GIRFT national clinical lead CYPMH

Guy.northover@berkshire.nhs.uk