E-Meds in ED Lynne Keith ED Educator/Clinical Informatics analyst - PowerPoint PPT Presentation

E-Meds in ED Lynne Keith ED Educator/Clinical Informatics analyst

 Major Tertiary Health Provider in Northeast Melbourne  3 Campuses - The Austin Hospital - Heidelberg Repatriation Hospital - Royal Talbot Rehabilitation Centre  Major Services - Liver and Gastro-Intestinal Transplantation - Spinal Cord Injuries - Oncology - Victorian Respiratory Services - Olivia Newton John Cancer Centre

 93,000 Inpatient Admissions  900 Beds  176,000 Outpatients  8,000 staff  50 bed Emergency department  83,000 Emergency Attendances annually  Approx. 230 Emergency presentations daily  Adult and paediatric Emergency service

E-Med implementation to ED April 2013 Scope : Inclusion • Oral medications • Short Infusions – eg IV antibiotics, amiodarone • Paediatric meds • Nurse initiated meds • Discharge scripts Policy to clearly define what is out and what is in Exclusions • Continuous infusions : (One order = one bag) • Blood products

E-Med implementation to ED April 2013 Implementation • Devices one per clinician implemented 6 weeks prior to go live • Go live day at 0800 paper medication charts removed • Progressive go live only new presenting patients commenced on E-Meds • At the elbow support for clinicians by clinicians • 24hr support • Designated command center to manage and solve evolving issues

Benefits-clear legible orders

Benefits- Pre-Built Order Sentences

Benefits- Decision support

Benefits- antimicrobial prescribing guidance Entering an Approval Number is Mandatory

Benefits- SSW pathways

Benefits- Quick orders

Benefits- Transparency in Med admin/orders

Benefits • Significant decrease in error prone abbreviations on discharge prescriptions from 47.7 to 7.2 (per 100 orders) • Improved consistency between the discharge medication regimen and the discharge summary sent to the GP • Significant reduction in information that needed to be corrected/added to a prescription to ensure reimbursement by Medicare Australia • No increase in prescribing time for consultants in ED fast track • Rate of update 95% for Inpatient Discharge prescribing

Benefits • No wasting time looking for drug charts • Clear administration instructions- better patient care • Reference text available for all ordered medications • Supports streamline PBS authority • PBS information available in prescribing screens

Challenges-care sets

Challenges- Scheduled Meds

Challenges- nurse initiated analgesia

Clinical adoption success factors • Staff engaged in Change process and established their prescribing requirements in the system • Right devices at the right time- one per clinician • 100% training required and achieved either face to face or e- learning • 24hr support for 2 weeks post go live • Super users were ED doctors /nurses/pharmacists • Follow-up with any queries and address issues