Clahrc ps cmeeting_21st_sept2015_spacer_project_dt
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Transcript of Clahrc ps cmeeting_21st_sept2015_spacer_project_dt
David RP Terry
Study into Paediatric Advanced Clinical
Electronics - Prescribing
Dr David [email protected]
David RP Terry
Background to BCH & EPMA
David RP Terry
Over 270,600 patient visits every year
361 beds
43,151 inpatient admissions each year
David RP Terry
£10M annual drug spend
200,000 drug transactions per year.
David RP Terry
Hand written drug-charts!
David RP Terry
Developing eRx’ing
EPMA – 5yrs
PICs … built at UHB, but excludes children.
David RP Terry
Prescribing Information and Communications System Safety
QualityResources
David RP Terry
Prescribe Supply Administer
Medication Process
David RP Terry
Medication errors up to 13%?2/3 IV’s not given according to guidance.
Prescribe Supply Administer
David RP Terry
SPACER
Aims: To identify the benefits and disbenefits of EPMA compared to paper-based system
David RP Terry
SPACER
• Before, during and after study• 3 years• 3 strands
David RP Terry
SPACER
EthnographicData
Envelopment Analysis
Drugs Data Decisions (3D)
David RP Terry
EthnographicData
Envelopment Analysis
Drugs Data Decisions (3D)
• Safety• Quality• Resources• Culture• Technology• Processes• Organisation structure
David RP Terry
EthnographicData
Envelopment Analysis
Drugs Data Decisions (3D)
• Safety• Quality• Resources• Culture• Technology• Processes• Organisation structure
David RP Terry
Safety
Quality
Resources
Strand A Ethnographic strand
Mixed method – Qualitative and
Quantitative study
Observe the organisational change, explore staff
perspectives of doctors, nurses and pharmacists as e-prescribing is implemented
Strand B Efficiency – “DEA model”
strand
DEA – Data Envelopment Analysis
What is the impact of e-prescribing on the
efficiency of the services?
Strand C – 3D study – Drugs, Data, Decisions
What Key Performance Measures does the hospital
measure before implementation of e-prescribing, how much
resources are used to generate it?
What will be measured during and after implementation?
Culture
Technology
Processes
Structure
Pre-implementation
(year 1)
Peri-implementation
(year 2)
Post-implementation
(year 3)
David RP Terry
SPACER 3D – Drugs, Data, DecisionsBackground
• BCH uses currently available data - define and measure progress towards organisational goals
• Surveillance and audits are used to support medication governance … via an organisational structure.
• Enables decision making.
David RP Terry
SPACER 3D – Drugs, Data, Decisions
Questions: What data / metrics are used?How are they used?How will EPMA change this?
David RP Terry
SPACER 3DAims and objectives- To observe the relevant metrics before, during and
after implementation of electronic prescribing.
- To identify changes to metrics, processes, reporting systems and decision making, in relation to the medication process.
David RP Terry
SPACER 3DAims and objectives
- Capture metrics … catalogue being assembled- By analysing the documentation and reports in
circulation during the three periods of transitionDATA - Identify the medication related changes that occur.PROCESSES - Identify process (report) changes due to EPMAREPORTS - Observe committee oversight & responses to reports.
David RP Terry
BCH Medicines Governance Structure
Trust Board
CRAC
DTC
Medicines Safety Committee
AntimicrobialsNon-medical prescribing
Data - KPIs and Metrics
David RP Terry
SPACER 3D – Drugs, Data, Decisions
Pre- implementation Peri- implementation Post implementation
KPI managerInterview – document field notes + record resources required
SelectionGatheringProcessed Reported
Catalogue of KPIs with X
domains monitored
Catalogue of KPIs with X domains monitored – X obsolete + Y
domains incorporated (in anticipation to
implementation)
Method
KPI managerInterview – document field notes + record resources required
SelectionGatheringProcessed Reported
KPI managerInterview – document field notes + record resources required
SelectionGatheringProcessed Reported
Catalogue of KPIs with X domains
monitored – (Xobsolete + Y obsolete) + Y domains + Z
domains
David RP Terry
SPACER 3DExpected outputs
• An increase in clarity in how data is used.
• Reduction in the time and resources recorded to produce the audits.
• Develop metrics not available in paper system.
• The quality and depth of information from the reports may improve.
• Identification of novel underlying problems within the system that cannot be measured under the current paper system.
David RP Terry
No Domain/KPI
1 Nursing quality indicators
2a Drug Chart audits
2b Jeff Martin exercise
3 Medication (not Patient) Safety thermometer
4 Incident reporting IR1 / SUI
5 Antibiotics usage
6 Surgical Prophylaxis
7a Antibiotics TDM Audit
7b Respiratory TDM Audit
8 Restricted antibiotic usage (BCH Formulary)
9 Point prevalence surveys, comparators.
10 PAU / MAU antibiotic prescribing
11 PN usage
12 Dispensaries activity
13 Dispensary errors, both internal and external
14 Medicines Information - activity.
15 Pharmacist interventions - frequency
16 Nurse interventions
17Pharmacy Technician interventions (administration of drugs).
18 Pharmacy end of month reports
No. Domain/KPI (NB Check if official title)
a Contact
b Selection – What
c Population scope/subset
d Gathering: Who/how/technology
e Frequency & Duration
f Location
g Processed (by):
h Reported (To)
i Who uses it
j Follow up – what is done as a result
k Does it relate to procedures?
l General Comment
m Type
Overlays to consider Healthcare Service Measures Safety
Quality
Resources
Organisation Change/Business Measures
Culture Changes
Technology
Processes
Structure
Also Costs
Example output obtained?
