British Journal of Healthcare Computing
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Electronic prescriptions and automated dispensing will have a major impact on the way pharmacy services are delivered. Jonathan
Buisson (on the staff of The Journal) reports
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The conference, entitled “Advances in reshaping
pharmacy services fit for the 21st century”, was organised
by the British Journal of Healthcare Computing and took place in
Birmingham on 4 December 2003.
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New IT demands
new ways of working
Information technology must allow for the re-engineering of pharmacy
working practices, conference chairman Sean Brennan said opening the
meeting. “Otherwise, all you get is expensive working practices.”
Mr Brennan, who is chairman of consultants Clinical Matrix, pointed out
that IT has to support the way in which doctors, pharmacists, nurses
and other clinicians work. Without such support, clinicians will not
use the new technology.
Will Willson: nurses are the key to
installing electronic ward systems |
Will Willson, deputy chief pharmacist, Addenbrooke’s Hospital,
Cambridge, described his experiences with installing an electronic prescribing
(eP) and medicines administration record (eMAR) system on an acute medical
ward.
“Nurses are the key to installing a system like this successfully,” he
said. “They have most to gain if it is successful, and most to
lose if it is a failure. Projects will fail without involvement buy-in
from nursing staff.” Like most hospitals, Addenbrooke’s has
significant recruitment and retention problems with nursing staff and
this would be made worse by installing a poorly functioning system, Mr
Willson said.
The formal and informal process that operate at ward level need to be
understood before any new system is installed, Mr Willson advised. “Then
you have to ask: ‘Are we prepared to change and is this reflected
at the highest level?’”
Pharmacists will also have to respond to the changes brought about by
IT, Mr Willson said. “We need to move away from being seen as policemen
or accountants.”
Anthony Madden, consultant anaesthetist, described the installation of
an eP and eMAR system at Southmead Hospital, part of North Bristol NHS
Trust. Dr Madden noted that the trust had the worst budget overspend
in the NHS (£44m on a budget of £300m) and that “this
colours what we did and do now”.
Initially, the plan was to install the system within the surgical directorate
and theatres as a pilot, followed by a roll-out to the rest of the hospital
at a cost of £1m. Changes in senior management and trust priorities
had seen the scheme capped at a three-month pilot.
Speaking about overcoming resistance to the new system, Dr Madden said
that the
solution was: “Plan, plan, plan and communicate, communicate, communicate;
you can’t have too much communication.” Project meetings
to plan the new system took up about 10,000 person/hours — “equivalent
to five people working for a year”.
The results of the pilot were that a totally paperless eMAR system is
feasible, as long as there is a commitment to delivering it. It probably
contributes to patient safety by increasing completeness of key parts
of the prescription chart (such as patient name, dose and prescriber’s
signature) by making these mandatory entry fields, but it probably does
not save either time or money.
Keith Farrar, chief pharmacist, Wirral Hospital NHS Trust, said that
installing a dispensing robot at Arrowe Park Hospital had reduced dispensing
errors by half and saved around 30 per cent of technician time allowing
them to carry out ward-based duties.
“Do not get a prescribing system that has grown out of a dispensing system,” he
advised. If such prescribing and dispensing systems are linked then prescribers
learn to use common dispensing short-cut keystrokes. This can lead to
errors that can be difficult to spot in the pharmacy, such as where pharmacy
staff correctly pick medicines that were inaccurately prescribed.
He also advised that electronic prescribing terminals on wards should
be linked wirelessly to the hospital network. “Prescribing should
take place at the bedside, not from notes later.”
Looking ahead, Mr Farrar said that further developments in automation
will include labelling by machine — saving even more technician
time — and the delivery of dispensed items directly to wards by
air tubes.
He predicted that all hospital pharmacy staff could eventually be ward-based,
delivering a 24-hour pharmacy service.
Lessons that we have learnt from the pilots of electronic transmission
of prescriptions
The first lesson from the recent pilots of electronic transmission
of prescriptions (ETP), and from other trials run in the 1980s and 1990s,
is that “if it were easy, it would have been done by now”,
according to Martin Strange, then operations director of TransScript.
TransScript was involved in one of the three ETP pilots earlier this
year, but has now closed
down (PJ, 20/27 December 2003, p835).
Mr Strange said that it is crucial to understand both the formal and
informal processes used in the current prescription system before introducing
new technology. For example, the right-hand page of a computer-printed
prescription form is not part of the prescription against which payment
is made, but it plays a big part in most repeat prescription ordering
schemes.
The messages being sent by the system need to be defined after analysis
of business processes, not before. He said that it has been suggested
that a message should be sent back from the pharmacy to the prescriber
as a dispensed medicine is handed over (“issued”) to a patient
or representative. This would be in addition to messages sent when the
prescription is “dispensed” and payment is claimed.
He pointed out that most community pharmacies do not have computer equipment
at the point where prescriptions are issued. If such an “issued” message
was required — current processes do not — then it could increase
the costs of installing ETP.
The National Programme for Information Technology is now having meetings
with the pilot consortia — “six months after the pilots finished”,
Mr Strange said. Many areas of how a national ETP scheme might work still
need to be clarified, he said. Foremost among these is how and where
to connect community pharmacies to NHSnet.
Looking to the future, Mr Strange said that successful ETP could lead
to major changes in pharmacy services. He cited as examples the possibility
of dispensing through vending machines, of centralised dispensing services,
and of localised pharmacy payments rather than having a central prescription
payment authority. |
