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Newcastle Hospitals Electronic Evolution

Newcastle Hospitals Electronic Evolution. Andrew Heed Lead Clinical Informatics Pharmacist. Topics of Discussion. Project overview Challenges Go-Live What now. What have you done?. Cerner Millenium System. PAS / A+E / ORDERS / SCHEDULING Electronic prescribing

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Newcastle Hospitals Electronic Evolution

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  1. Newcastle Hospitals Electronic Evolution Andrew Heed Lead Clinical Informatics Pharmacist

  2. Topics of Discussion • Project overview • Challenges • Go-Live • What now

  3. What have you done? • Cerner Millenium System. • PAS / A+E / ORDERS / SCHEDULING • Electronic prescribing • In-patient and discharge ordering • Pharmacy validation • Rolled out at Freeman Hospital + A+E. • 27 Adult In-patient wards • ITU last week

  4. When did we do it? • Apr. 08 - Start work with UPMC • 14th Nov 08: 1st Build deadline • A+E go-live 27th November 09 • Freeman Roll-out on 30th November 2009 • Stopped for 4 weeks over Christmas. • Restarted at 2-3 wards per week • Completed early April.

  5. Challenges -Build Deadlines • PAS were 6 months ahead. • Domain deadlines • BLD > PRP > PRD • Failure to meet deadline multiplies build by 3. • Not a good idea

  6. The Newcastle model

  7. Build it quick. • Prioritise the build + keep it simple. • Routes / Forms etc, Drug catalogue, some order sentences. • Test, tweak then churn. • 85% of core build done this way. • Several re-builds. • Abandoned some processes

  8. Mapping processes • How many processes (p)? • During engagement you will hear that this is governed by • Drugs (d), Routes (r), The ward (w), Staff grades (s) • P = D x R x W x S • P = 2500 x 60 x 30 x 5 • P = 22500000

  9. Refining processes • Deal with D and R first • 2 D types: Strength and volume • 2 R types: Medication and Continuous infusion • Then W and S • Actually represent prescribe and administer • P = 2 x 2 x 2 = 8

  10. The prescribing conundrum • On achieving the qualification of “prescriber,” the recipient will do their upmost ensure that the tedious act of prescribing is performed by some other person irrespective of their relative qualification to do so. • Does the system change or do they?

  11. The Pharmacy Factor • How many working methods do we have? • Do the wards understand them? • Do we understand their impact? • Are we all speaking the same language?

  12. The Challenge of language

  13. Language and the drug build • Docscrawl: • Mesalazine 1g PO BD. • Nursechatter • Mesalazine sachets 1g PO BD. • Pharmwitter • Mesalazine sachets MR 1g PO BD. Place the granules directly on the tongue and swallow with plenty of liquid without chewing.

  14. Language and the drug build • Electricity • Mesalazine 500mg gastro-resistant modified-release granules sachets (Dr. Falk Pharma UK Ltd) 100 sachet Salofalk. TWO SACHETS, TWICE A DAY. Place the granules directly on the tongue and swallow with plenty of liquid without chewing. • We need to compromise on clarity for clarity sake.

  15. Language • Don’t panic • CfH / DMD guidance • For orderables we used: • Drug name (oral prep) • Drug name and form (non-oral or MR) • Drug name form and strength. • Consolidated by order sentences

  16. Language • Order Sentences • Choose wisely • Less is more? • Data mining • Order sets • What do users really want? • Build based on usage?

  17. Challenges - Getting the message across • ENGAGEMENT. Link • Capturing the ‘hearts and minds’ of staff, with benefits to the organisation. • achieved when “a positive attitude is held by the employee towards the organisation and its values”.

  18. Engagement Running around in circles meeting the same small groups of characters in a seemingly endless loop

  19. The engagement reality check • You won’t really understand what you are asking or saying. • People won’t really understand your questions / proclamations. • Answers will be a best guess. • You will not really understand the answers. • Your interpretation will be a best guess.

  20. Engagement successes • Terrify people • Get yourself known. • Identify Mavens, Connectors and Salesmen. • Hear it all before • Develop a tough skin

  21. Training Questions • Who to train? • When to train? • What to train on? • How many people? • How to get bums on seats? • What about the night shift? • Who will do this in the long term?

  22. Training Questions • Should we even bother?

  23. Go-Live

  24. Go-Live • Now is not the time to debate the relative merits of electronic prescribing • Shut-up, Listen, Learn

  25. Looking Back – Rollout differently? • Where first? • Quicker / slower? • More nursing staff? • Wards first / pharmacy second. • Knowledge transfer • Reporting tools first.

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