Experiences with eForms:

Medicines Reconciliation on the Receiving Unit at GRI

6th March 2013

Ruth Waters

Highly Specialist Pharmacist

Introduction• Senior pharmacist (secondment) for Acute Receiving Unit at GRI

• Implemented and currently using eForms (med rec) ~ 10 months

• Present logical approach to using the application

• Present experiences in integrating into practice

Start Date          

  01/01/2013   End Date 31/01/2013

Hospital Name Specialty

Canniesburn Hospital 65

Gartnavel General Hospital 5

Gartnavel Royal Infirmary 4

Glasgow Royal Infirmary 861

Inverclyde Royal Hospital 117

Royal Alexandria Hospital 6

Royal Hospital for Sick Children 3

Southern General 250

Stobhill Hospital 2

Victoria Infirmary 4

Western Infirmary 32

Total 1349

eForm completion figures

eForms (Med Rec)

• Electronic system for support in medicines reconciliation process

• Ensure availability to all relevant staff

• All appropriately trained staff can use the system and shouldn’t rely solely on pharmacy

eForms implementation

• Key to gain leadership and support from senior medical staff (cascade)

• Education and training for medical staff and pharmacists (only) rolled out

• Support from IT essential

• Encouraging and supporting junior medical staff in completing the forms

Use of the eForm

• Essential to understand “in practice” use of the form

• Describe overview of the application and key points when completing

• Describe idiosyncrasies we’ve experienced since rollout

Initial access and consent

Completed form

Editing a completed form

Experiences• Overall…. Positive

• Uptake has been good although not consistent at present

• Logistical aspects of completing the form with the patient– but overall feedback is it reduces time spent

– reduces transcribing

• The use of handheld tablets/ portable laptops would improve use of time– access to reliable printers essential

Experiences

• Persistent job encouraging medical staff!

• Only as accurate as ECS (completeness)– maintain use of 2 sources essential

• Support from ECS team has been excellent

• Has reduced reliance on pharmacists but could still be improved – although current SPSP figures Jan 2013 : 95%

• Caution with allergies – ECS not always accurate so use “add” function on eForm

Experiences• For medicines with long directions sometimes full text doesn’t show– eg. isosorbide mononitrate

• On “saved” eForm only start date shows not date of last Rx issue (can be misleading)

• Be aware of 6 monthly dispensing in terms of dates of issue– maintain use of 2 sources

• Be vigilant for “bugs” in the application and report promptly– eg. acutes, allergy record issue, saving of “edited” forms

Experiences• Excellent for permanent record of…– Pluspak details, B12 injections, warfarin dosing, depot injections, issues with compliance…

• Ensure staff have access to ALL eForms for Med Rec– different specialities– means the individual may not be able to view some saved forms

Experiences• Clinical technicians don’t have access– not in a position to complete “plan”

• Our senior medics have agreed that they are happy for pharmacists to complete the “plan” as it could always be changed– pharmacists should be in a position to do this and taking responsibility

Experiences• If doctor doesn’t have access to the eForm will hand write in Med Rec section of our UPR

• Means that no permanent electronic record made – pharmacist will probably just confirm by hand in the Med Rec section– to ensure only single record and no scoring through

Experiences• Some repeat lists are vast! – although this was included in initial design…

– can have many different entries for the same medicine– we’ve observed doctors “continue” ALL meds!– doctors should be aware of “dates” issue– Long lists of sundries, catheter bags, needles, test strips – meds may get missed

Summary• Positive and productive roll out

• Takes time to get used to but reduces time spent and transcribing

• Be aware of limitations of the application

• Continue to encourage and support completion of the eForm