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Workstream 1: Project Management – System Configuration and Business as normal

Workstream 1: Project Management – System Configuration and Business as normal. Andrew Heed Kathy Wallis 17 June 2013. Agenda. Some background to us – Trust and ePrescribing Project Workshop structure Pre-Go Live planning Roll-out considerations Maintenance and Support Any questions??.

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Workstream 1: Project Management – System Configuration and Business as normal

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  1. Workstream 1: Project Management – System Configuration and Business as normal Andrew Heed Kathy Wallis 17 June 2013

  2. Agenda • Some background to us – Trust and ePrescribing Project • Workshop structure • Pre-Go Live planning • Roll-out considerations • Maintenance and Support • Any questions??

  3. University Hospital Southampton • 1100 beds • Provides services for 1.3M people in Southampton and south Hampshire • specialist services such as neurosciences, cardiac services and children's intensive care to more than 3 million people in central southern England and the Channel Islands • major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust • treat around 140,000 inpatients and day patients, including about 50,000 emergency admissions

  4. Project timeline

  5. Newcastle upon Tyne Hospitals • Freeman Hospital • Transplantation, Cancer Centre, Cardiothoracic Surgery, ENT, Vascular…… • Royal Victoria Infirmary • Neurosciences, Emergency care, Children’s Services, Plastic Surgery, Ophthalmology, Dermatology, Maternity • Beds – 1792 (Inpatient) & 205 (Day case) • Activity • Inpatients – 192,000 • Outpatients – 870,000 • Lab/ Rad requests – 3 million • ePrescriptions – 1.7 million • eAdministration – 7.2 million

  6. ePx Project • Cerner Millennium system • ePx, electronic orders, A+E, Theatre scheduling, PAS, documentation. • Project timelines: • Work started April 2008 • Go-live November 2009 • Adult In-patient rollout completed March 2011 • Paediatric ward Feb 2013 (ongoing) • Starting 2nd system upgrade. • Documentation ongoing. • Never-ending story

  7. Workshop Session 1Pre-Go Live Planning • Design Considerations • Testing • Hardware • Roll-out plan • Training • ….

  8. Workshop Session 1Feedback / Discussion

  9. Design Considerations • The drug catalogue • VTM, AMP, AMPP • Terminology • Routes, forms, frequencies. • Decision support. • Dosing sentences. • Alerts (interaction / dose checking / allergy others) • Order sets • Future -proofing

  10. Scope • What can you actually do? • System limitations • Do you need documentation • Where can you do it? • Other systems? • What can you afford / support.

  11. Hardware • Can you ever have enough? • What kind? • Dispensing trolley? • Security / cleanliness / durability. • People will have better hardware at home • Or even in their pocket. • But what can an App actually do?

  12. Training • 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? • Should we even bother?

  13. Workshop Session 2Roll-Out Considerations • Support • Mixed Media Prescribing • Bank and Agency Staff • Real time PAS / ADT issues • ….

  14. Workshop Session 2Feedback / Discussion

  15. Roll Out planning • Start upstream or downstream? • Time between wards go lives – transfer of patients and outliers • Dual systems – paper and electronic

  16. Roll Out planning • Big Bang vs staggered rollout. • What can you support? • Staggered: • Arranged by directorate, patient flow • How does geography affect things • What is your transfer mechanism • Is it realistic • Too fast or too slow.

  17. Dedicated ePrescribing support 24/7 • ePrescribing team manager (Pharmacist) plus 5 full-time team members (Nurses or Pharmacy Technicians) • On-site 24 hour support for 7 days post go live; otherwise 0730 – 2300 on site and on-call over night • Used extra support for Theatres when surgical wards first went live (anaesthetists and recovery staff) • Bank staff to support staff shortages • Moving to be able to provide less on-site support over weekends • Key success area for the project: awarded ‘Hospital Heroes’ team prize of Education and Support

  18. Agency nurses and locum doctor access • Use NHS professionals and multiple other agencies • High agency usage – wards could not operate if agency staff not able to use the system • Agreed process where agency nurses (and locum doctors) access and complete training before starting their first shift • Agencies responsible for completing System Access Forms • Built into the performance metrics for the agencies • Difficult for first few wards, but easier as more wards are live

  19. Real-time ADT • Was an on-going issue for the Trust to have a accurate electronic bed-state – not a clinical task • With ePrescribing: • Patient must be admitted to be able to administer medications (can prescribe if pre-admitted) • If patient not admitted or transferred to the correct ward, they do not appear on the list of patients due medication • If patient not discharged, they will continue to appear on list of patients due medications – each ward needs to clear all non-administered medications overnight to be able to administer medications the next day • Nursing staff now complete ADT when ward clerk not on duty (also have a central ADT team to support) • ADT available on the drug trolleys – therefore can complete transfers etc ‘on the fly’ • Also supports the use of other systems (e.g. Doctors Worklist; Bed Management tools

  20. Workshop Session 3Maintenance and Support • Responding to incidents • Handling prescription errors • On-going maintenance of the system • Training • Managing Expectations • Reporting • Data for audit • Upgrades • Downtime

  21. Workshop Session 3Feedback / Discussion

  22. Responding to Incidents • We now have something to blame! • Who does this now? Who does this after go-live? • System fault? or user fault? • But what is the system? • software, user, computer, Wi-Fi, power cable, the workmen digging the road up 3 miles away? • Trend monitoring. • Feedback to users / training central team or department.

  23. Consultant review of the drug chart / Drug Chart Viewer • surgical consultant ward rounds • anaesthetist review pre procedure • (Demo)

  24. On-going modification of build • Link to stock control system limits naming of prescribable items: • Inclusion of strength and formulation • Modification of existing protocols – general prescribing practice is more open • Increasing list of protocols – standardise care and ease of prescribing

  25. On-going maintenance • Everything goes through the system • New policies • Clinical trials • Who designs or build this • Can the system / team become a bottleneck? • How do we handle changes to the system? • En masse change vs drip feed. • How does the system handle change? • Change control • Do we need a down-time.

  26. Future Proofing • Try to plan for every area you will be going to….. Or you potentially have a large rebuild / renaming process • Try to take the long view and avoid short cuts. • ???

  27. Benefits: Error rates

  28. Benefits: Drug Round times

  29. Questions?

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