Digital, drive and diversity

Imagine you are Shirley. Shirley has hypertension, diabetes and rheumatoid arthritis. She was admitted to A&E this morning following a fall and is due her regular medication of metformin and linagliptin but this has not been administered yet as initially the paper prescription chart could not be found. Following it’s discovery, the nurse noted the prescribed medicines were illegible and unsigned. Read further to hear from Digital Pioneer Fellow, Ramandeep Kaur, on Barking, Havering and Redbridge University Hospital NHS Trust’s (BHRUT’s) transition to digitalisation for prescribing and administration.

Currently, activities associated to prescribing and administration are paper based and BHRUT is embarking on a huge transformational journey to digitalise these processes by 2024 as per the national target. I have been at the Trust for just over a year and in my role as Lead Electronic Prescribing and Medicines Administration (EPMA) Pharmacist and Interim EPMA Project Manager I have responsibility for multiple workstreams including procurement, design, build, configuration and testing of the chosen EPMA solution, clinical engagement, training, benefits realisation and re-designing the processes related to medicines management.

The challenge

Shirley’s experience is unfortunately not uncommon. Problems with the current paper-based systems include:

• Illegible handwriting on prescription charts and consequent impact on patient care
• Incomplete information being recorded
• Inappropriate ordering
• Transcription errors due to the re-boarding of prescription charts
• Lost or misplaced prescription charts and time wasted in looking for these
• Errors in calculations for specific medicine doses

On average over 2000 medication incidents are reported annually at BHRUT, however this is a conservative estimate as it is clear from observational studies and ad hoc intensive monitoring exercises that medication incidents are under-reported. Some medication incidents are of moderate or severe harm level and could be averted through use of an EPMA system e.g. incorrect medication supply or administration due to illegible handwriting in the case of Shirley.

Creating digital change

At present, the organisation is in a procurement phase for an EPMA and this was the key focus for my project during the year’s fellowship. The DigitalHealth.London Digital Pioneer Fellowship programme has empowered me to take the lead on this transformational change in the Trust as a digital leader and clinician. The support through the action learning sets, my mentor and other pioneers has enabled me to discuss difficult concepts and then apply the skills and knowledge gained from the programme and transfer this learning into practice whilst progressing the procurement workstream including understanding contract schedules and writing a business case.

I strongly believe, digital change is everyone’s responsibility and the implementation of an EPMA solution would have negated the problems experienced by Shirley. The success of this project would be a huge milestone for the organisation as it would improve patient safety and workflow by:

• Reducing prescribing and administration errors
• Eliminate time spent looking for charts
• Avoid unnecessary readmissions
• Improve legibility and compliance with legality

The EPMA project encompasses the Trust’s PRIDE values of Passion, Responsbility, Innovation, Drive and Empowerment. The positivity with which the workforce has embraced an array of digital solutions over the past year is heartwarming and the drive to adopt EPMA and prevent Shirley’s experience from reoccurring again is long awaited.

The implementation of EPMA at BHRUT is pivotal to replace the adversity experienced by Shirley. The drive to switch from paper to digital is key to realising the diverse benefits associated with an EPMA system, however the journey to implementation is yet to kickstart in BHRUT as we are undergoing procurement. Will we be fully implemented and paperless by 2024 in all clinical areas? Watch this space!

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