Electronic Prescribing and Medicines Administration Project Overview

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1 Electronic Prescribing and Medicines Administration Project Overview 1. Project Background The purpose of the project is to implement an Electronic Prescribing and Medicines Administration (epma) system across Northampton General Hospital NHS Trust. epma or eprescribing is described by NHS England as: the utilisation of electronic systems to facilitate and enhance communication of a prescription or medicine order, aiding the choice, administration and supply of a medicine through knowledge and decision support and providing a robust audit trail for the entire medicines use process ( Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record, NHS England, 2013) In January 2014, NGH was awarded capital funding from the NHS England Safer Hospitals, Safer Wards (SHSW) Technology Fund, to support this project. The Trust went live with the Ascribe Pharmacy system in November The procurement of the Pharmacy system (via OJEU) and subsequent award of contract to Ascribe included the option to implement, as a second phase, the Ascribe electronic Prescribing and Medicines Administration system before This negates the need for a further procurement exercise, and provides the benefit of an integrated Pharmacy / eprescribing system from a leading supplier. The eprescribing project commenced in February 2014, following the SHSW Technology Fund award. 2. Project Aims and Objectives The overarching aim of the project is to improve medicines safety through the implementation of the Ascribe Electronic Prescribing and Medicines Administration software throughout NGH: a patient orientated Prescribing system that will support electronic medicines administration and medicine management in clinical areas. Electronic prescribing will demand changes in work practices within the Trust, moving from a predominantly handwritten prescription / administration exercise to electronic recording and communication. In its simplest form, an overview of a typical eprescribing process within a hospital ward setting is as follows: Doctors prescribe on the ward round, recording the prescription electronically using handheld tablet computers; medicines are selected from the Trust formulary, supported by templates The prescription is automatically transmitted to the Pharmacy system The Pharmacy Department processes result in prescription dispensing 1

2 Medicine administration is done by nurses on the ward, and recorded electronically in the eprescribing system The system will integrate with existing Trust systems such as Pharmacy, PAS, Finance and electronic discharge notifications to primary care. Appendix A provides a summary of the overarching principles of an eprescribing and Medicines Administration System. 3. Benefits A range of benefits is anticipated. The following are examples from an NHS Connecting for Health (CfH) report on Electronic prescribing in hospitals Challenges and lessons learned (2009): Providing prescribers with access to decision support, for example BNF lookup, default doses, drug-allergy and interactions checking, checking doses against patient s age Helping to support the use of a trust formulary Removing need to rewrite medication charts, and associated potential for transcription errors Supporting direct communication of prescribing information to pharmacy Allowing the easy and direct production of discharge prescriptions Supporting the supply of medicines to the ward in a timely fashion Removing the problem of missing or illegible drug charts Prompting when doses are due Allowing easy review of previous medication history The benefits described above will support a key Trust / CQC priority: the production of discharge medications (TTO), through improved processes including real time prescribing and better communication and workflow. 4. Implementation Approach Planning has commenced for the phased implementation of eprescribing: Technical implementation and Phase 1 Pilot expected early 2015 Phase 2 Early Adopters Phase 3 Full Implementation Lessons learnt from other Trusts indicate that whilst implementing eprescribing is very achievable, it will also face challenges. The 2009 CfH report states the following: eprescribing projects require a strong and committed multi-disciplinary team to lead them. Doctors, nurses and pharmacists must work together with other healthcare professionals and managers to prepare for eprescribing 2

3 implementation. eprescribing projects require the active support of senior managers and senior clinical leaders, who must be briefed to ensure that they understand the challenges of eprescribing, the changes it will bring and the benefits. Project activities include: Initial project planning, selection of pilot clinical areas (ward / outpatient), definition of benefits Technical Planning, e.g. IT infrastructure, defining business as usual support requirements Business change analysis describing current prescribing / medicines administration processes, and a detailed future state process maps; plus interim electronic / paper processes whilst the system is being implemented across the Trust) Software configuration and testing Reporting requirements definition and implementation End-user Acceptance Testing Installation of new end-user hardware / software Training Go live, including floorwalking support Ensuring ongoing support and training for the system and users Planning further phases Full implementation across the Trust is expected to take around three years, although implementation of lessons learnt from the pilot and further detailed planning is required. 5. Project Board The Project Board represents at managerial level the business, user and supplier interests of the project. The Board is made up as follows: Project Sponsor / Senior Responsible Owner (SRO) and Chair of the Project Board: Dr Natasha Robinson (Associate Medical Director and Chair of Medication Safety Group) Senior User Doctor: Dr Melanie Blake (Consultant), Dr David Sharman (Consultant) and Dr Dominic Cox (Consultant) Senior User Nurse: Natalie Green (Lead Nurse Surgical Care Group) Senior User Pharmacy: Paul Rowbotham (Chief Pharmacist) Operations Lead: Fiona Lennon (General Manager Medicine And Emergency Care) 3

4 Senior Supplier, NGH: Christine Malcolmson (Deputy Director of ICT) and Kirstie Watson (ICT Service Development Manager) Senior Supplier and Project Manager, Ascribe: Steve McEwan Project Manager, NGH: Andy Brown Business Change Manager, NGH: Claudine Ferguson Finance Representative: Derek Stewart (Head Of Financial Services) Department of Health, Health and Social Care Information Centre (HSCIC) Representative Project Board roles and responsibilities include being accountable for the success or failure of the project, providing unified direction, providing the resources and authorising the project funding, and ensuring effective decision-making. They will approve all major plans and will authorise any major deviation from those plans. It will be the authority that signs off the completion of each stage of the project and will authorise the start of the subsequent stage. It will ensure that the required resources are committed to the project, will arbitrate on any conflicts within the project and will negotiate solutions to any problems between the project and external bodies. The composition of the project board must contain three senior individual roles. Appendix B provides further detail on the project roles. Andrew Brown, Project Manager Claudine Ferguson, Business Change Manager May 2014 Click here for more information on eprescribing at NGH Contact details: E: T: or ext

5 Appendix A Overarching Principles of an eprescribing and Medicines Administration System The following section describes the overarching principles of an eprescribing system, based on eprescribing Functional Specification for NHS Trusts (2007) (available at: Note that this specification was the basis for the NGH eprescribing procurement exercise undertaken in Supports electronic prescribing, medicines administration and dispensing activities, including worksheets, treatment / patient labels, dispensing and storage details in all settings: inpatient, discharge (TTH) (including day or short leave), day case and outpatient, and all prescriber types Allows for all verification procedures and compliance with the Medicines and Healthcare Products Regulatory Agency (MHRA) and legal requirements BNF templates Scheduling of treatment and medicines administration Stock management and costs / charging functionality through interface to pharmacy system User friendly, fast and efficient (assuming supplier specified hardware / network requirements are met) Clear identification of the patient at all times Allergies and intolerance to medicines must be recorded and link to decision support to generate reminders and alerts should similar medicines be selected in future. Appropriate system security, including role based access for prescribers working in certain areas (e.g. paediatrics, ITU, oncology) All actions are auditable (date, time and user stamped) Multiple user access to a single record, but only one user update, at any one time Complex specialty requirements provided within the same system e.g. anaesthetics, oncology etc Full range of reporting tools for clinical and management requirements, including both bespoke and functionality to develop local reports (reporting achievable by non-it qualified staff) Details of the medicines within the final discharge prescription / supplied on discharge must be available to be sent electronically to the GP and/or other identified location e.g. tertiary centre to secondary care see integration scope below The system must utilise and maintain a comprehensive drug Reference File using the national drug dictionary (dm+d) descriptions; including (but not limited to): o International Non-Proprietary Name (rinn) or approved BP name or clinical trial name o Dose, form, strength, pack size(s) (where applicable) o SNOMED clinical terms 5

6 (Reference GEN.DR.001) Decision support functionality, including: o Tools for prescribing access to online knowledge sources o Electronic BNF o Guidance incorporated into pathways o Checks on demographic and clinical parameters; suggest altering dose or choice and require attention o Generating alerts, check and supply warning/links to facilitate management of areas below :- - allergy checking; - adverse reaction checking; - intolerance checking; - parameter checking, e.g. renal function, path lab result - checking etc. as required by individual medicines; - contra-indication checking; - dose range checking; - drug interaction checking. 6

7 Appendix B Project Board roles The Executive (Project Sponsor / Senior Responsible Owner) is ultimately responsible for the project, owns the project, and has overall responsibility for the business case viability/validation, and the realisation and measurement of the business benefits. This individual will be a senior figure within the Trust. They sit on the project board, often as chair and have ultimate responsibility for the success of the project. In addition to their responsibilities as a member of the project board, the Executive will: Be accountable for the project end to end. Chair the project board meetings. Own project budget, validate and monitor Business Case against external events and against project progress Monitor any supplier and contractor payments Monitor business risks to ensure that they are kept under control Advise higher corporate management on all project matters. Be an enthusiastic project and change champion. Provide strategic direction for the project. Inform the project of any changes caused by a Programme of which the project is part, or changes in the external environment Own final decisions affecting the project, and given sufficient grounds, be the one who ultimately decides to terminate the project. The Senior User(s) (Project Owner) will represent the project within the business and vice versa and will sit on the project board. The role represents the interests of all those who will use the final products of the project. The Senior User will: Represent the interest of the business and specify the business requirements Sign-off acceptance certificates for supplier deliverables, in consultation with the Trust Project Manager Identify business resource for the project including the arrangement and management of external contracts Promote and maintain focus on the desired project outcome. Obtain business buy-in commitment for the project and champion the change within the business. Communicate regularly to the business on project progress. Resolve business conflicts and priorities on a daily basis Ensure testing of the products/deliverables has appropriate user representation Ensure that any user resources required for the project are made available 7

8 Pharmacy Representative: this person is normally the representative from the Pharmacy department. They are often the most senior person within the department. They sit on the project board in Senior User capacity. The Senior Supplier is accountable for the quality and timeliness of the products and services delivered by the supplier, and will have responsibilities that include: Agree objectives and plans for supplier activities Ensure the supplier resources required for the project are made available Make sure that progress towards the outcome remains consistent from the Supplier perspective. Promote and maintain focus on the desired project outcome from the point of view of Supplier Management Monitor any risks in the implementation of the project Ensure quality assurance procedures are used correctly so that products adhere to requirements and are fit-for-purpose The NGH Project Manager and Supplier Project Managers will jointly lead the Project on a day-today basis on behalf of the Project Board. Their prime responsibilities will be to ensure that the Project produces the required Products/Deliverable, to the required standard of quality and, where appropriate, within the specified tolerances of time and cost. The Ascribe project manager is the nominated Ascribe contact for participation at Project Board level. The Project Business Change Lead will be responsible for detailing existing working processes and the development of business change brought about by the implementation of the new system. This role will include process mapping, the identification and realisation of business benefits, both qualitative and quantitative, communication and change workstreams. This individual will work day to day with Ascribe s Change Manager and Clinical Change Consultant. 8

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