Workstream 1: Project Management – System Configuration and Business as normal Andrew Heed Kathy Wallis 17 June 2013 Agenda • Some background to us – Trust and ePrescribing Project • Workshop structure – Pre-Go Live planning – Roll-out considerations – Maintenance and Support • Any questions?? University Hospital Southampton • 1100 beds • Provides services for 1.3M people in Southampton and south Hampshire • specialist services such as neurosciences, cardiac services and children's intensive care to more than million people in central southern England and the Channel Islands • major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust • treat around 140,000 inpatients and day patients, including about 50,000 emergency admissions Project timeline Newcastle upon Tyne Hospitals • Freeman Hospital • Transplantation, Cancer Centre, Cardiothoracic Surgery, ENT, Vascular…… • Royal Victoria Infirmary • Neurosciences, Emergency care, Children’s Services, Plastic Surgery, Ophthalmology, Dermatology, Maternity • Beds – 1792 (Inpatient) & 205 (Day case) • Activity – – – – – Inpatients – 192,000 Outpatients – 870,000 Lab/ Rad requests – million ePrescriptions – 1.7 million eAdministration – 7.2 million ePx Project • Cerner Millennium system – ePx, electronic orders, A+E, Theatre scheduling, PAS, documentation • Project timelines: – – – – – – – Work started April 2008 Go-live November 2009 Adult In-patient rollout completed March 2011 Paediatric ward Feb 2013 (ongoing) Starting 2nd system upgrade Documentation ongoing Never-ending story Workshop Session Pre-Go Live Planning • • • • • • Design Considerations Testing Hardware Roll-out plan Training … Workshop Session Feedback / Discussion Design Considerations • The drug catalogue – VTM, AMP, AMPP • Terminology – Routes, forms, frequencies • Decision support – Dosing sentences – Alerts (interaction / dose checking / allergy others) – Order sets • Future -proofing Scope • What can you actually do? – System limitations – Do you need documentation • Where can you it? – Other systems? • What can you afford / support Real-time ADT • • Was an on-going issue for the Trust to have a accurate electronic bed-state – not a clinical task With ePrescribing: – – – • • • Patient must be admitted to be able to administer medications (can prescribe if preadmitted) If patient not admitted or transferred to the correct ward, they not appear on the list of patients due medication If patient not discharged, they will continue to appear on list of patients due medications – each ward needs to clear all non-administered medications overnight to be able to administer medications the next day Nursing staff now complete ADT when ward clerk not on duty (also have a central ADT team to support) ADT available on the drug trolleys – therefore can complete transfers etc ‘on the fly’ Also supports the use of other systems (e.g Doctors Worklist; Bed Management tools Workshop Session Maintenance and Support • • • • • • • • • Responding to incidents Handling prescription errors On-going maintenance of the system Training Managing Expectations Reporting Data for audit Upgrades Downtime Workshop Session Feedback / Discussion Responding to Incidents • We now have something to blame! • Who does this now? Who does this after go-live? • System fault? or user fault? • But what is the system? – software, user, computer, Wi-Fi, power cable, the workmen digging the road up miles away? • Trend monitoring • Feedback to users / training central team or department Consultant review of the drug chart / Drug Chart Viewer • surgical consultant ward rounds • anaesthetist review pre procedure (Demo) On-going modification of build • Link to stock control system limits naming of prescribable items: – Inclusion of strength and formulation • • Modification of existing protocols – general prescribing practice is more open Increasing list of protocols – standardise care and ease of prescribing On-going maintenance • Everything goes through the system – – – – New policies Clinical trials Who designs or build this Can the system / team become a bottleneck? • How we handle changes to the system? – En masse change vs drip feed – How does the system handle change? – Change control • Do we need a down-time Future Proofing • Try to plan for every area you will be going to… Or you potentially have a large rebuild / renaming process • Try to take the long view and avoid short cuts • ??? Benefits: Error rates Benefits: Drug Round times Avg time / patient (Mins) Drug Round am lunch Eve Night pre / post eprescribing Ward Ward Ward Ward Ward Ward Ward Avg difference (mins / patient Ward pre 11.49 7.95 6.45 6.91 7.31 8.6 8.15   post 6.47 6.17 7.57 6.18 7.07 6.88 6.7 9.47 pre 8.68 3.75 4.71 3.43 3.82 4.08 10 4.12   post 3.15 2.73 4.11 3.11 4.47 4.19 3.72 pre 9.21 6.05 4.53 3.96 6.63   post 5.21 4.53 3.45 4.36 5.5 3.25 3.37 pre 10.47 4.26 4.81 4.5 5.47 12.65 post 5.78 6.42 4.9 5.43 5.39 6.45 9.38 3.7 0.92 1.67 5.85   1.68 8.71   10.57 0.19 Questions?