In 2012, St. George's University Hospitals NHS Foundation Trust UK made a commitment. This commitment was to leverage the use of technology to eliminate common medication errors in the short term, with a global aim of having a single comprehensive medication record.
The intial goals focused in a three pronged approach. Errors associated with poor handwritting, the transcription process - both medication orders for pharmacy supply, and transitions of care from department to department - and errors relating to incomplete documentation of allergies.
St. George’s longterm vision is to have one comprehensive electronic medication record, which flows throughout the patient pathway. Next year the organisation will take a further step towards this aim, by introducing Powerchart Anaesthesia. With the complete perioperative pathway brought together for the first time, it will enable the Trust to apply enhanced clinical decision support throughout the medicines management pathway.
The Trust decided to start this journey in the Paediatric Intensive Care unit in June 2014 and is now live across its Paediatric, Renal, Cardiac and Neurosciences directorates. The Trust’s electronic Prescribing and Medication Administration (ePMA) team, supported by Pharmacy, gathered large quantities of audit data pre go-live to benchmark the organisation against quality measures before and after implementation.
St. George’s has experienced errors associated with documentation of allergies, via either poor documenting, or misunderstanding of what has been documented. A common example seen is as follows. Patient X has a documented allergy of penicillin. Patient X is then prescribed Tazocin®, as the prescriber may not know that Tazocin® is a penicillin antibiotic. With Cerner Millennium decision support, the trust has prevented numerous errors of this type at the point of prescribing. In January 2015 alone, 12 clinical staff members avoided a medication error thanks to this decision support.
Moreover, patients’ allergies were not being consistently and completely documented. With ePMA, improvements have been seen across the documentation of allergies in the hospital as demonstrated in the graph below.
The antimicrobial stewardship team, Balpreet Dhanda - Lead Pharmacist and Dr Matthew Laundy - Clinical Lead, provide their views.
“ePMA has enabled the Trust to guide good antimicrobial prescribing as part of the Trust’s strategy in reinforcing antimicrobial stewardship. Prescribers are required to prescribe antimicrobials with a documented indication, and review or stop date, in line with Trust and National policy.
“Reporting functions help identify patients on antimicrobials automatically, that may benefit from a review with the clinical team to optimise management of infections. Auditing is also key in monitoring antibiotic consumption and monitoring adherence. ePMA has already helped in automating this process, in the future we will build on this foundation to deliver antibiotic consumption data at ward, team and trust level to ensure good antimicrobial stewardship.”
Improvements have also been delivered in compliance with our trust antimicrobial prescribing policy; all antimicrobials in a live area have indication and stop/review date documented.
Q4 2013/14 - Q3 2014/15
Indication on drug chart
Stop/Review date on chart
There are such a vast range of benefits that the trust has proven and delivered, we couldn’t present them all here, but we’ll leave you with a graph of prescribing standards which really says it all:
St. George’s University Hospitals NHS Foundation Trust has received visitors from around the globe to see for themselves our medicines management and clinical system. If you want to visit the Trust, please feel free to contact CernerReferenceManagement@cerner.com
This blog post was written jointly with Will Hall, ePMA Lead Pharmacist and Adrian Carroll ePMA Pharmacist at St George’s University Hospital