ePrescribing Masterclass 9 th October 2019 www.england.nhs.uk - - PowerPoint PPT Presentation

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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,

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www.england.nhs.uk

9th October 2019

ePrescribing Masterclass

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www.england.nhs.uk

Masterclass 9th 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

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The Gentamicin Calculator

Hannah Heales, Lead Clinical Informatics Pharmacist Royal Free London NHS Foundation Trust

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The problem we are trying to solve:

Survey results from BH, CF and RFH 16/17 (Pre-calculator)

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The volume

Between 25-30 orders placed for gentamicin per day.

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Workflow

Ordered as a careset
Gentamicin (IV) is hidden in the
rder catalouge so can only be

prescribed as part of the careset.

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Gentamicin Calculator

Powerform developed to input patient demographics. Auto populates where information is available within the system.

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Gentamicin Calculator

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Gentamicin Calculator

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Gentamicin Calculator

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Dose banding

Treatment 7mg/kg 2.5 mg/kg

<15kg 80 mg 15-25 kg 160 mg 25-30 kg 200 mg <25kg 40 mg 30-40 kg 240 mg 25-40 kg 80 mg 40-45 kg 280 mg 40-62 kg 120mg 45-50 kg 320 mg 62-70 kg 160mg 50-55 kg 360 mg > 70kg 180mg 55-60 kg 400 mg 60-65 kg 440 mg 66-72 kg 480 mg 72-78 kg 520 mg 78-83 kg 560 mg > 83 kg 600 mg

Prophylaxis 5mg/kg 2mg/kg

40-45.99kg 200mg <50kg 80mg 46-51.99kg 240mg 50-69.99kg 120mg 52-60kg 280mg >70kg 160mg 61-67kg 320mg 68-76kg 360mg >76kg 400mg

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Impact

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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

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Current priorities

Still incidences reported regarding incorrect frequency
Levels not taken at correct time
Nomogram mis-interpreted.

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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

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What are other Trust’s doing?

Interested to know how others are using EPMA to

support gentamicin monitoring.

Tasks?
Alerts?
Placeholders?

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Paul Johnston

Senior Implementation Specialist -Enterprise

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Salford Royal Primary Care

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Catalogues Medications DM+D DM+D DM+D Allergies SNOMED CT SNOMED CT SNOMED CT Problems / Diagnoses SNOMED CT SNOMED CT SNOMED CT Standardised selection of medication from each system’s select lists retain compatibility in all systems due to standardised DM+D coded catalogues

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This is the view that appears with an EMIS

f Vision system and

can be expanded or contracted depending

n the clinicians

requirements It contains all acute care prescribing data entered into Salford Royal’s EPR and can be grouped and filter according to users preference

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Viewed within Hospital EPR with standard DM+D description and further details of full medication history as held in GP record Additional view of medication administration information with details of review and prescription collection

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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
utpatients, are communicated directly to neighbourhood pharmacist teams
Follow-up instructions post hospital discharge are immediately available to

primary care teams

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Locally coded or DM+D coded drug catalogue GP Systems 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

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Any Questions?

Many thanks for your time and attention

Paul Johnston

Senior Implementation Specialist -Enterprise

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www.england.nhs.uk

Summary and Next Steps

Followed by Q&A

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www.england.nhs.uk

Novembers Masterclass – 6/11/2019

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www.england.nhs.uk

Save the date!

All presentations are on the ePMA NHS Futures Website and the toolkit – www.eprescribingtoolkit.com