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Bradford Teaching Hospitals NHS Foundation Trust

Improving the quality of medicine information and advice

A digital single source of truth at Bradford is helping pharmacists provide accurate advice to clinicians, allowing them to deliver high quality care to their patients.

When healthcare professionals have a query about a patient's medications, their pharmaceutical circumstance or history, the medicines information (MI) team at Bradford Teaching Hospitals NHS Foundation Trust are available to answer questions and advise in order to support the safe, effective and efficient use of medicines.

Super charging medicine information

Having access to complete patient information when undertaking work in MI is an essential part of the clinical process. The MI team, staffed by pharmacists with clinical expertise, have long used their expertise to advise, and can now also utilise the information within their Trust-wide Cerner Millennium® electronic patient record (EPR), introduced in 2017. This supports the team and provides them with remote access to electronic drug charts and patient medical notes to supplement their judgement.

Looking at one month’s data of all enquiries to the MI team where they accessed the EPR,¹ Helen Wilson and Elizabeth Braun, from Bradford’s pharmacy department, set out to determine whether using the system impacts the quality and accuracy of information and advice provided by the MI team.

Summarising their findings at a national MI pharmacists conference, the answer was a resounding ‘yes’.

Equipping experts with better information

Using the EPR removes the sole reliance on the enquirer to provide complete, correct and relevant information. It provides the additional information that can build a more informed scenario, and provide vital information that can change the course of treatment.

Looking at the impact of the EPR, the team found that it does indeed have a positive impact on the quality of information and advice provided by the MI team.

The use of the EPR in MI improves the quality of the information and advice provided, and can lead to further clinical intervention - in fact 75% of questions or clinical situations were clarified as a result.

Quote, Helen Wilson, Medicines information pharmacist

Helen highlights that, “in 45% of enquiries, the team changed the advice given as a result of reviewing the EPR.”

Elizabeth also sees the impact of their advice with EPR information at hand, “we found that 32% of enquirer information was different to that available on the EPR. Supported by this relevant information 36% of enquiries resulted in a different or additional intervention being made.”

Bradford Teaching Hospital

Both experts note that in several cases, significant harm to a patient was prevented and care enhanced through an additional unrelated interventions. These included identifying drug history discrepancies, prescribing errors of critical medicines, and management of other conditions and interactions.

In other cases, the difference made by using the EPR was less visible, but allowed assurance that appropriate advice was provided. For example, checking that microbiologist advice was being followed or confirming opiate quantities actually taken by a patient.

Looking forwards

The research identifies that the EPR is not used for all enquiries, and individual judgement is used to decide when to use it. Elizabeth notes that “in light of the level of inaccuracy found in the patient information provided, the team anticipate benefits of incorporating the use of the EPR into standard work processes.

“We’ve found it makes a huge difference to our work, and I’m confident we’ll be doing other similar studies looking into how we use it.”

Helen Wilson and Elizabeth Braun, from Bradford’s pharmacy department

Above: Helen Wilson and Elizabeth Braun, from Bradford’s pharmacy department, presenting their findings at the UK Medicines Information pharmacists conference.

The MI team saw several examples of how their EPR helped them to improve experiences, safety and outcomes:

  • EPR notes indicate the patient was more concerned about their eczema management, rather than a specific condition being asked about.
  • The MI team were asked if a patient with a prolonged QT could be given fluconazole. Using EPR information, the team could see that fluconazole had already been prescribed and that the patient had low potassium levels. An alternative treatment and other management of QT prolongation was suggested.
  • Adminstration of co-amoxiclav was suspected of deranging liver function tests. The EPR notes indicated multiple recent courses of other drugs in primary care that could have been the cause.
  • Junior doctor (FY1) under pressure and had limited knowledge of patient; the MI team were able to save them time and still find the information needed.

 


1. Data sample taken throughout May 2019

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Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.