IV Prescribing and Administration at LHCH: Evolution of Digital Solutions
Explore the transformation from JAC EPMA to Allscripts EPR for IV prescribing and administration at LHCH, highlighting the benefits, challenges, and future directions in enhancing patient care and safety through digital innovations.
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IV Prescribing and administration the LHCH solution Mrs Pamela Gardner (Senior Pharmacist) Dr Johan Waktare (Chief Clinical Information Officer) with Dr Gillian Gow (Chief Pharmacist) Caroline Waine (Senior Pharmacy Technician) Lyndsey Waktare (Clinical Systems Manager) December 2014
Overview Where we started from JAC EPMA How did Allscripts differ? Benefits of Allscripts EPMA Issues raised with EPMA IV prescribing The future
JAC EPMA 209 bedded (including 50 critical care beds) cardiothoracic hospital Implemented May- Nov 2010 Version 4.47 no IV solution Paper charts IVs prescribed on EPMA e.g Glucose 5% infusion - see paper chart Risk if not prescribed on EPMA but mitigated by intense training of staff
Allscripts Full EPR implemented June 2013 American system IV Rx and admin established Drugs built on series of forms- required reworking to meet Trust requirements Discussion with consultants to determine options for individual drugs and hence build format
Build format Simple fluids e.g. Glucose 5% Once only e.g. Cefuroxime Once (stat care US interpretation is different) Drug choose diluent e.g. Flucloxacillin Pre-built formulations e.g. Magnesium infusions; Noradrenaline infusions (variable rate) Complex Infusions e.g. Amiodarone, Insulin sliding scale; Dopamine
Build format Simple fluids e.g Glucose 5%
Build format Once only e.g. Cefuroxime - Once
Build format Drug choose diluent e.g. Flucloxacillin
Build format Pre-built formulations e.g. Magnesium infusions
Build format Pre-built formulations e.g Noradrenaline infusions (variable rate)
Build format Complex Infusions e.g. Amiodarone
Build format Complex Infusions e.g. Insulin sliding scale
Build format Complex Infusions e.g. Dopamine
Benefits of IV build All IV drugs visible on EPMA Easy selection of IVs commonly used Ability to pre-formulate a complicated regimen for prescribers thereby reducing error on manual input
Issues raised Cannot avoid mistakes if doses not set as no dose range checking IV continuous start and stop time not clear to admin staff Critical care still using paper charts for recording IV drugs, flow rates etc causing duplicates to sometimes occur Dual signature workflow not matching UK workflow
The Future? Work with Allscripts to improve view of prescribed and administered medication e.g. continuous infusions to make duration more visible Critical care new format for recording flowsheets and obs required Dual signature workflow enhancement built but not implemented yet.
