The Impact of EPMA on Day to Day Working for Clinical Staff By Jane Coleborn, Chief Pharmacist Richard Musk, EPMA Pharmacist Great Western Hospitals NHS Foundation Trust Doctors What we thought What actually happens • Clinical decision support • Currently being over ridden without - aid less experienced discussion with EPMA staff team • Mobile IT improved • Lack of mobile devices bedside care for Dr’s, leading them not to review medication charts on rounds, systems too slow Doctors (2) What we thought • Robust audit trail • Improved communication – Internal – External • Transcription error reduction • No re-writes What actually happens • There but training required to pull/interpret information • Need an understanding of the system (int) • External - working but need to audit suitability of information • No transcription required • No re-writes required Nurses What we thought • Visual aide for when medicines are required • Electronic prescriptions always available • Status of order sent to pharmacy • Communication improved What actually happens • Happens, however constraint by limited window of opportunity – 2hrs • Happens, but records can be locked, but not hidden • Happens, but delivery not specified • Happens, however no substitute for face to face contact Nurses (2) What we thought • Legible prescriptions • Robust audit trail • Ordering named pt medication What actually happens • Happens • There but training required to pull/interpret information • Safer and more efficient ordering process Pharmacy What we thought • Medication charts always available • Populating discharge letter • Instantaneous receipt of medication orders • Legible prescriptions • Robust audit trail What actually happens • Happens, but records can be locked, but not hidden • Happens • Happens, but need to be clinically checked by pharmacy • Happens, safer system • There but training required to pull/interpret information Pharmacy (2) What we thought • Audit • KPI reporting • Paper light What actually happens • Happens, but skill required in writing reports/extracting data • Happens, but as above • Supplementary chart still required, print out for transfer to non-EPMA wards, print out paper copy of TTA & I/P orders Organisation What we thought • Better governance • Reduced risk • Data for service line reporting • Enhanced reputation for Trust What actually happens • Happens but high lighting previous poor practices that can no longer be ignored • Happens but introduces own set • Trust is not able to utilise as other systems need to be in place • Potentially but…………. Patient What we thought • Patient allergies recorded • Improved turn around times for TTA’s • Medication history stored centrally • Right medication, to right pt at right time What actually happens • Happens but users still have to enter data first time round • Not currently obvious • Happens but increasing benefit over time • Not closed loop system e.g no pt positive identification functionality at present Summary • We have been live since May 2015 – still embedding, some people love system and some don’t • Majority of EPMA benefits medium to long term • A lot of time still spent by pharmacy convincing trust and driving agenda, not optimising system • Prescribing was not perfect before EPMA but often overlooked – short memories CQC visit Oct 2015 • Raised as an issue during CQC visit • Transfer of information between paper based and electronic systems • Visibility of EPMA risk/issue log • Response to concerns • Training uptake