“What’s wrong with a piece of paper?”

1. “What’s wrong with a piece of paper?” The Electronic Transfer of Care Princess of Wales Hospital Rowena Lewis

2. Electronic Transfer of Care (e-TOC) • Clinical information • Medication information • Sent electronically to GP • 10 medical wards over two sites • 2 mental health wards • 2 orthopaedic wards

3. The situation that had to change • “Mind the gap!” • Carbon copy paper take-home prescription • Patient had to transfer information • Varying clinical summary sent or not sent at all • GPs asked for better communication

4. Aims of e-TOC project • Improve discharge communication from hospital to primary care. • Improve patient safety and reduce clinical risk by providing better medication information to GPs. • GPs to receive in a timely manner with a target of 80% discharge summaries within 5 working days.

5. Objectives • Carbon copy → typed medication list • Transfer electronically to GP immediately • Reasons why medicines are started and stopped - NICE/NPSA medicines reconciliation • Provide GP with full clinical details in uniform format

6. Designed by clinicians Produced by our IT department Accessed via PIMS+ Hospital wide wireless network Method

7. Ward Process • Junior doctor enters initial information • Updated during patient stay • Doctor marks “ready for discharge” • Pharmacist verifies medication list • Junior doctor completes clinical info • Consultant approves it for GP

8. Implementation • One ward pilot • Many improvements made initially • Dosage codes taken from the pharmacy system • Colours and symbols distinguish between new, changed and stopped medicines • Format of printed list of medication to improve clarity • Screen icons to aid communication between staff • Laminated crib sheets • Helpful hints boxes

9. Key Success Factors • Gradual roll out • Dedicated project manager • Multidisciplinary training sessions • Regular feedback from all users

10. Key Success Factors • Frequent updates to system • Regular audits of doctors input • On site IT support • Determination to succeed

11. Pharmacist users Entering medication Verifying medication Signing off medication Trouble shooting Regular updates Listening to feedback Ward Technicians Marking drug chart Dispensing from drug chart Dispensary staff New format of discharge prescriptions Printing medication orders Training within Pharmacy

44. Benefits of e-TOC • Patient • Pharmacist • Doctor • Nurse • GP • 96% of patients have verified medication sections sent to their GP on day of discharge – includes diagnosis and follow up arrangements

45. 89% 70% 5.7%

46. How much have we achieved? • Increased number of summaries sent to GPs • Improved timeliness of communication to primary care • Gradual implementation helped acceptance of system in hospital

47. Have targets been reached? • Not achieved on all wards yet! • Average is 70% in 9 days • Much better than 5.7% in 37 days • Changes to practice have been challenging • Sharing workload has helped

48. Benefits to Pharmacists • Medication on e-TOC system prior to discharge • Order function linked to dispensary • Access to previous e-TOCs • Legible list to give patient at discharge

49. Thorough training required Need modern computers Helpful IT staff available to assist Regular updates to system Enthusiasm and determination Lessons learned

50. The future • Finish implementation across hospital • Electronic learning package for users • Medication reminder cards • Pharmaceutical care plan