ePrescribing Masterclass 9 th October 2019 www.england.nhs.uk
Masterclass 9 th October 2019 1.00pm Welcome & Introductions Ann Slee, Associate CCIO, NHS X 1.05pm Improving the Safety of Gentamicin use in ePrescribing systems Hannah Heales, ePrescribing Lead, Royal Free NHS FT 1.35pm A shared medication record – what you can achieve if you adopt standard Paul Johnston, Salford Royal NHS FT 1.50pm Summary and Next Steps www.england.nhs.uk
The Gentamicin Calculator Hannah Heales, Lead Clinical Informatics Pharmacist Royal Free London NHS Foundation Trust
The problem we are trying to solve: Survey results from BH, CF and RFH 16/17 (Pre-calculator)
The volume Between 25-30 orders placed for gentamicin per day.
Workflow • Ordered as a careset • Gentamicin (IV) is hidden in the order catalouge so can only be prescribed as part of the careset.
Gentamicin Calculator Powerform developed to input patient demographics. Auto populates where information is available within the system.
Gentamicin Calculator
Gentamicin Calculator
Gentamicin Calculator
Dose banding Treatment Prophylaxis 7mg/kg 2.5 mg/kg 5mg/kg 2mg/kg <15kg 80 mg 40-45.99kg 200mg <50kg 80mg 15-25 kg 160 mg 25-30 kg 200 mg <25kg 40 mg 46-51.99kg 240mg 50-69.99kg 120mg 30-40 kg 240 mg 25-40 kg 80 mg 52-60kg 280mg >70kg 160mg 40-45 kg 280 mg 40-62 kg 120mg 61-67kg 320mg 45-50 kg 320 mg 62-70 kg 160mg 50-55 kg 360 mg 68-76kg 360mg > 70kg 180mg 55-60 kg 400 mg >76kg 400mg 60-65 kg 440 mg 66-72 kg 480 mg 72-78 kg 520 mg 78-83 kg 560 mg > 83 kg 600 mg
Impact
Lessons Learnt • Prescribing plan not possible • Can not trigger rules off prescribing plans • Prescribers don’t like inputting ‘weight measured’ when they don’t know the weight. • Gentamicin OEF shadow • Removed start date/time as this confused prescribers • Only kept special instructions field • Prescribers entering height in m rather than cm ! • Calculator doesn’t work as unable to calculator CDW and IBW • EKM: Lower weight band was set to 40kg • Patients under 40kg- calculator didn’t work • Change logic to include patients down to 15kg
Current priorities • Still incidences reported regarding incorrect frequency • Levels not taken at correct time • Nomogram mis-interpreted.
Gentamicin Therapeutic Drug Monitoring Form (linked to 7mg/kg prescription) Displays: • Dose of gent given and date/time administered • Gentamicin serum level, result date/time Advice text: Use Hartford Nomogram to interpret level and adjust prescription in requests window to add suggested frequency. Monitor levels twice weekly 6-14 hours after dose if stable renal function If level is above the 48-hour line DO NOT give another dose until level < 1 mg/L
What are other Trust’s doing? - Interested to know how others are using EPMA to support gentamicin monitoring . - Tasks? - Alerts? - Placeholders?
Paul Johnston Senior Implementation Specialist -Enterprise
Salford Royal Primary Care
Catalogues Medications DM+D DM+D DM+D Allergies SNOMED CT SNOMED CT SNOMED CT Problems / SNOMED CT SNOMED CT SNOMED CT Diagnoses Standardised selection of medication from each system’s select lists retain compatibility in all systems due to standardised DM+D coded catalogues
This is the view that It contains all acute appears with an EMIS care prescribing data of Vision system and entered into Salford can be expanded or Royal’s EPR and can be contracted depending grouped and filter on the clinicians according to users requirements preference
Viewed within Hospital EPR with Additional view of standard DM+D medication description and administration further details of information with full medication details of review history as held in and prescription GP record collection
• Improved Clinical Communications – Time Saving • Reduction in Errors – Safer Handover of Care • Better Antibiotic Stewardship Examples • Community monitoring of INR for warfarin therapy is fed through DbMotion enabling safer monitoring of dosages. • Changes to insulin regimes or inhaler therapy, made in Salford Royal outpatients, are communicated directly to neighbourhood pharmacist teams • Follow-up instructions post hospital discharge are immediately available to primary care teams
GP Systems Locally coded or DM+D coded drug catalogue Cross-mapping Software • Synchronisation of software versions of DM+D • Code changes and reconciliation both Primary and Secondary and vice versa. • Patient drug history and allergies • Levels of coding in systems – VTM v. AMP • Specific patient requirements for branded drugs • Free text drugs and local preparations • Special Medications and Trials
Many thanks for your time and attention Any Questions? Paul Johnston Senior Implementation Specialist -Enterprise
Summary and Next Steps Followed by Q&A www.england.nhs.uk
Novembers Masterclass – 6/11/2019 www.england.nhs.uk
Save the date! All presentations are on the ePMA NHS Futures Website and the toolkit – www.eprescribingtoolkit.com www.england.nhs.uk
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