“What’s wrong with a piece of paper?”
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Transcript of “What’s wrong with a piece of paper?”
“What’s wrong with a piece of paper?”
The Electronic Transfer of CarePrincess of Wales Hospital
Rowena Lewis
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
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
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.
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
Method Designed by clinicians Produced by our IT
department Accessed via PIMS+ Hospital wide wireless
network
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
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
Key Success Factors Gradual roll out Dedicated project manager Multidisciplinary training sessions Regular feedback from all users
Key Success Factors Frequent updates to system Regular audits of doctors input On site IT support Determination to succeed
Training within Pharmacy 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
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
Time taken and percentage of discharge summaries received by GPs
0%10%20%30%40%50%60%70%80%90%
100%
Paper system Average of eTOC w ards Best performing eTOCw ard
0510152025303540
Percentage of discharge summaries received by GP
Time taken to receive summary (days)
5.7%
70%
89%
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
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
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
Lessons learned Thorough training
required Need modern
computers Helpful IT staff
available to assist Regular updates to
system Enthusiasm and
determination
The future Finish implementation across hospital Electronic learning package for users Medication reminder cards Pharmaceutical care plan
Summary Clear communication Greater detail of medication changes Transfer of information to GP is guaranteed