Across the NHS, an estimated 237 million medication errors occur every year. While around 70 percent of these do not cause harm, they still contribute to up 22,000 deaths annually, over 700 of which are directly attributed to medication errors. These errors cost the NHS, as a whole, £98.5million per year due to increases in admission, increased length of stay and litigation.i
Errors can occur at any point during the medications process, leading to:
- Wrong medications being given
- Incorrect doses dispensed
- Delays in medication being administered
Accuracy in medication prescribing and administration is a fundamental part of a safe patient experience.
E-prescribing and medication administration (ePMA) presents a huge opportunity to ensure accuracy and safety throughout the patient journey. Alongside reducing avoidable deaths, eliminating medication-related ‘never events’ii and improving the patient experience, ePMA can help reduce lengths of stay by tackling up to 181,626 avoidable NHS bed days, and decrease the £14.8m annual cost associated with secondary care.
Many NHS Trusts still rely on paper-based or manual processes, disconnected data, or disparate clinical systems. Digitalised and connected workflows ensure clinicians are supported throughout the decisionmaking process – at the point of prescribing, screening, dispensing or administration of a medication, resulting in enhanced clinical safety, optimised patient outcomes, and an overall improved patient experience.
Cerner’s Millennium® electronic health record (EHR) platform enables seamless ePMA functionality that crosses all venues of care and provides clinicians with more streamlined medicine management workflows.
At the point of prescribing, clinicians are supported with evidence-based plans of care driven from diagnosis and enhanced clinician decision support, including the identification of allergy restrictions, drug-drug or drug-therapy interactions, and even duplicate therapy.
As medications are administered, barcode technology supports nursing staff to fulfil the minimum ‘five rights’ of medicines administration (right patient, right drug, right dose, right route, right time), thereby reducing the risk of incorrect medication or doses being given.
Integration with smart pumps has transformed the administration of intravenous medicines through a real time bi-directional flow of information between the EHR and the device. This allows prescriptions to be sent directly to the pump, and any changes made at the pump to be fed back into the EHR. Integrated pump programming reduces the manual steps involved from up to 40 down to just five – an 87.5 percent reduction – releasing time back to patient care.
For pharmacists, dynamic worklists enable them to better plan and prioritise their work with easy visibility of new and discharging patients, as well as having a greater insight into those patients
on high-risk medications. Activities are driven from admission, prescribing, and discharge workflows, therefore ensuring screening and dispensing is completed without undue delay.
We spoke to some of our NHS partners - Kingston, West Suffolk, Calderdale and Huddersfield, and Bradford - to see how Cerner Millennium helps them to deliver smarter, high quality care and improve patient outcomes.
Reducing risk to improve safety at Kingston
At Kingston Hospital NHS Foundation Trust, using ePMA within the EHR has helped medication processes across the hospital to improve efficiency, care quality and patient safety. Time previously used for transcription can now be put into patient care and unnecessary travelling to the ward is avoided by remote prescribing.
Risk to patient safety associated with duplication and hand-written notes is also minimised, while digitising workflows – with embedded clinical decision support and smart alerting – ensures that they adhere to Blue Book guidelines around reducing incorrect prescriptions – cutting waste and driving down risk of clinical incidents.
Mayce Alyousif, senior pharmacist CRS and medicines administration, and Annette Nicholson,
lead informatics pharmacist at Kingston Hospital NHS Foundation Trust, highlight the benefits that ePMA within the EHR can bring to reduce risk.
“ePMA [in Millennium] allows medication prescribing and administration errors to be easily audited to quickly identify what, where, when and who was involved. As a pharmacy team, we work closely with the Trust’s medicines safety officer to investigate medication incidents, review why they occurred and implement staff training or make changes within our EHR to reduce future risks. These changes can involve bespoke workflows or alerts for particular highrisk medications, in some instances these are small changes that will reduce or eliminate the risk of a future incident happening.
“This ability to quickly address medication risks and work to find a solution has been a major benefit, and e-prescribing the Trust to improve patient safety.”
Reducing interventions at West Suffolk
The ePMA functionality within Millennium reduces the requirement for pharmacists to intervene and thus minimises interruptions to the patient journey. Fewer interventions means that pharmacists have more time to focus on delivering high quality medicine optimisation services – a key recommendation of Lord Carter’s 2016 report – which ultimately results in a safer process, reducing the risk to the patient and improving outcomes.iii
Within three months of using Millennium to connect the clinical information across the patient journey, West Suffolk had reduced the number of prescriptions that required intervention from 806 in just one week, to 462 – a 43 percent reduction.
Simon Whitworth, chief pharmacist at West Suffolk NHS Foundation Trust, was encouraged by the impact of the EHR on prescribing: “Prior to the implementation of Cerner Millennium… a significant amount of pharmacy time had been spent ensuring prescriptions met basic minimum prescribing standards, e.g. legibility, allergy status and dose unit clarity.
“Since implementation, these basic functions are mandated and other high-risk areas, such as insulin prescribing, have been built to ensure high standards of prescribing are achieved. The need for this type of intervention has fallen significantly and the majority of pharmacy interventions now relate to medicines optimisation where professional knowledge and clinical expertise are required improving efficacy and clinical use of medicines.”
Reducing allergy incidents at Calderdale and Huddersfield, and Bradford
Following the implementation of Millennium across the Trust, the pharmacy department have been able to see value in a number of ways. Presenting at a recent clinical pharmacy conference, they identified a 75 percent reduction in allergy incidents by having patient medication information available at the point of prescribing, alongside major drug interactions and embedded alerts to support clinicians. In addition, the team have been able to show their 100 percent compliance with NICE CG 183 Allergy Standards in their recent audit.
Antibiotic usage has also been reduced following the implementation of EHR, as ePMA allows optimisation of restricted antibiotics and improved visibility of antibiotic usage across the Trust. VTE assessment rates have also seen an increase as a result.
Penny Daynes, lead pharmacist at Calderdale and Huddersfield NHS Foundation Trust and Bradford Teaching Hospitals NHS Foundation Trust, sees value in the process and the ePMA solution, saying:
“The ePMA implementation has improved pharmacy workflows by highlighting newly admitted patients awaiting medicines reconciliation, and those prescribed new medication which require counselling such as warfarin.
“Cerner ePMA enables one single source of truth for the whole medication process of prescribing, pharmacist clinical checking and drug administration. Having full visibility of all medications prescribed and administered throughout the Trust has allowed pharmacists to focus on monitoring and intervening on high-risk medications.”
i. Prevalence and Economic Burden of Medication Errors in the NHS In England. Policy Research Unit in Economic Evaluation of Health & Care Interventions (EEPRU). p.150. http://www.eepru.org.uk/wp-content/uploads/2018/02/eepru-report-medication-error-feb-2018.pdf
ii. Never events list 2018. NHS Improvement. P8-10. NHS Improvement https://improvement.nhs.uk/documents/2266/Never_Events_list_2018_FINAL_v5.pdf
iii. Operational productivity and performance in English NHS acute hospitals: Unwarranted Variations. Dept of Health. (2016). P.9. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf