North Tees and Hartlepool NHS Foundation Trust, which employs over 5,600 staff and has a 570-bed capacity, was the first English NHS trust to deploy the InterSystems\u2019 TrakCare electronic patient record, in 2015. Since then, the trust has been using TrakCare to help it achieve its digital health ambitions. Having built on these firm foundations, the global digital exemplar \u2018fast follower\u2019 trust is starting to realise the multiple clinical and efficiency benefits that come with digital transformation.<\/p>\n
The trust has recently completed the roll out of a new electronic prescribing and medications administration (EPMA) module to all inpatient and emergency wards, marking the next stage in the \u2018trust\u2019s ambitious digital journey. <\/p>\n
Described by Dr Graham Evans, the trust\u2019s chief information and technology officer as \u201cone of the biggest transformational changes we will implement as part of our EPR programme,\u201d the successful adoption of the EPMA is changing and improving the way clinicians work, cutting red tape and improving outcomes for the 400,000 people who the trust cares for every year. Consultant physician Dr Jay Vasani and senior clinical matron Claire Ranson describe the impact the new EPMA is having on patients and professionals at one of the UK\u2019s most technologically advanced hospitals.<\/p>\n
Dealing with hundreds of patients every day that need urgent care and support, TrakCare is changing how the busy emergency department at North Tees and Hartlepool NHS Trust works, says consultant physician Dr Jay Vasani. \u201cThe main benefits are that medications are visible whenever and wherever we need them,\u201d says Dr Vasani. \u201cYou can access vital prescribing information in seconds, which is essential in a crisis.\u201d<\/p>\n
The admissions and A&E departments are the latest to benefit from the introduction of a trust-wide electronic prescribing and medicines administration (EPMA) system, part of the TrakCare deployment. \u201cPatients want the person who is looking after them \u2013 the doctors, nurses and pharmacists \u2013 to have the information they need when they need it\u201d, Dr Vasani says, a situation he concedes wasn\u2019t possible with the previous system in place. In the past, patients admitted to A&E would be prescribed medications which would be recorded on paper, photocopied and shared across the trust. A sea of paperwork would follow patients from A&E to the admissions unit, much of it written in haste as patients rapidly move between wards and care responsibility shifts between teams. <\/p>\n
It\u2019s a frustrating and inefficient process for clinicians which could potentially lead to unnecessary errors with paper records sometimes incomplete, difficult to find or even lost altogether. Replacing it with EPMA has changed everything. \u201cTrakCare EPMA has made prescribing much simpler and more effective,\u201d says Dr Vasani. \u201cClinicians can now access a complete prescribing record from the portable terminals, making it quicker to monitor and prescribe medications.\u201d The system uses FDB\u2019s Multilex for its medication clinical decision support. <\/p>\n
Comprehensive prescribing information follows the patient throughout their recovery journey, from A&E to the admissions unit to any specialist ward. The new EPMA, integrated within the comprehensive PAS and EPR systems, facilitates the effective handover of patient information between clinicians, across shifts and between wards, seamlessly connecting them all. The information can also be used to provide a complete clinical record that can be shared with GPs, with the PDF document accepted into the EMIS and SystmOne systems used in primary care. <\/p>\n
The roll-out of the EPMA is the most recent phase of a trust-wide adoption of TrakCare, a process that began with the introduction of a new patient administration system (PAS) and electronic patient record (EPR) in 2015. <\/p>\n
Nurses play a crucial role in administering and monitoring medicines, a process that\u2019s being improved with TrakCare, says clinical matron Clare Ranson. \u201cIt\u2019s definitely reduced the amount of time nurses spend on medication rounds,\u201d she says. \u201cThe real-time record allows all those involved in care to see what\u2019s happening \u2013 the nurse, doctors or pharmacist \u2013 not just the person holding the piece of paper.\u201d It\u2019s making rounds \u2018leaner\u2019 with less time spent chasing up paper records across wards, Ranson says, freeing up time for nurses to focus on what\u2019s important \u2013 time with patients.<\/p>\n
Anything that makes life simpler is to be welcomed, Ranson adds, but the new EPMA is also playing a crucial role in reducing the risk of prescription and medicine administration error. Digital records are clear and accessible to all, important in the frenetic and challenging urgent care environment where clinicians will deliver \u2018stat doses\u2019 \u2013 a drug prescribed outside of a scheduled drug round – rather than full prescriptions. \u201cIt\u2019s really visible from the chart if there are any omissions,\u201d Ranson says, \u201cthey can then be rectified, reducing the risk of any negative impacts.\u201d<\/p>\n
The system also enables nurses to contact doctors for information, advice and support when needed. \u201cYou can contact a doctor directly from the ward wherever they may be. They can use TrakCare to review records and check medications wherever they are in the hospital.\u201d The process is saving crucial time, particularly during peak periods when doctors may be in demand or during night shifts when doctors may be working remotely or on other wards. \u201cIt\u2019s a significant benefit clinically,\u201d says Dr Vasani.<\/p>\n
As one of England\u2019s most technologically advanced trusts, North Tees and Hartlepool NHS Foundation Trust has made great strides in digital adoption \u2013 but any change of this magnitude demands solid support. \u201cAny new technology meets some form of resistance,\u201d says Marie Graham, the project manager in charge of the EPMA roll-out. \u201cIt\u2019s our role to work closely with all affected by the change to minimise this risk and ensure they\u2019re able to rapidly embrace its benefits.\u201d <\/p>\n
A central part of this is about engaging clinicians and nurses from the start, explains Graham. The trust has established a monthly clinical informatics group that discusses all proposed changes in technology. Chaired by the medical director, the board provides a forum to discuss the implementation of new technologies and develop strategies to mitigate any potential negative impact. At a ward level, staff were engaged throughout the planning process to help develop solutions to potential problems, a process welcomed by both Claire Ranson and Dr Vasani.<\/p>\n
The phased roll-out saw wards shift to the new system, with help always on hand during the switchover period. Between 8am \u2013 11pm there was support from the digital programme team available for staff to seek help with any questions or concerns they may have had. \u201cThe digital programme team were on each ward, each week, as the system was rolled out, helping those unfamiliar with it to navigate it effectively,\u201d Dr Vasani says. The wards also benefitted from peer support, with clinical \u2018super-users\u2019 offering words of wisdom and advice on how to best use the system. \u201cThe technical aspect is about 25% and the rest is just workflows,\u201d says Dr Vasani. The roll-out programme began in March 2018 and was completed by October.<\/p>\n
The support provided during these months was intense, something that all agree was necessary. \u201cI definitely think we needed that period,\u201d Ranson says. Once completed all nurses and doctors were comfortably embracing the new ways of working demanded. \u201cIt tackled some of the existing frustrations nurses had with the paper-based system,\u201d Ranson says. <\/p>\n
Software is only as good as the hardware it runs on, with the trust relying on aged infrastructure and a poor wi-fi connection, both issues have been recognised and rectified as part of their digital transformation programme. \u201cThere has been a massive infrastructure investment,\u201d Dr Vasani says. The trust is also responding to clinicians\u2019 concerns by rolling out single-sign on devices as standard. \u201cWithin a few seconds, you\u2019re logged into systems. It\u2019s a small thing that has made a huge difference,\u201d Dr Vasani adds.<\/p>\n
Anecdotal feedback has been positive, with nurses and doctors clear about the impact the system is having at a patient and ward-level. The next stage is to undertake a comprehensive benefits realisation programme to quantify the impact that TrakCare is having on the trust\u2019s performance on key indicators. <\/p>\n
North Tees and Hartlepool NHS Foundation Trust is one of the UK\u2019s leading adopters of TrakCare, with a board that fully embraces the potential for technology to transform healthcare, Dr Vasani says. To him, the transformation journey within the hospital is one of evolution, not revolution. \u201cEverybody is bought into the idea that we need to digitise a lot of processes, reduce our reliance on paper and improve clinical care,\u201d Dr Vasani adds. <\/p>\n
In the near-term, the EPMA system will be rolled out to day case areas of trust. It\u2019s the start of a more ambitious programme to embed TrakCare completely within the trust \u2013 something demanded by medical professionals. \u201cIn the medium to long-term clinicians want to have everything available within TrakCare, where it is quickly accessible,\u201d Dr Vasani adds. \u201cWe\u2019re in the middle of a process that\u2019s connecting the dots of care.\u201d <\/p>\n
The adoption of the EPMA is the first stage in a shift toward more intelligent prescribing, Dr Vasani says. He\u2019s keen to embrace the potential for order sets and, in the future, more intelligent prescribing with decision support. All will be completely digital, with the trust hoping to go entirely paper-free by 2020. It\u2019s helping the trust realise significant efficiencies, including reduced software license costs and a significant reduction in expenditure on paper. Replacing the existing Kardex paper-medicine system with TrakCare has helped the trust save over \u00a32,000 per quarter. Across the hospital, system savings could increase exponentially. In total, the trust hopes to save up to \u00a38m in efficiencies and improved productivity by adopting TrakCare.<\/p>\n
The next stage for the EPMA is a planned move to incorporate complex medications and \u2018injectables\u2019. The trust is currently investigating the approach necessary to safely and successfully manage this integration. In a future phase, the EPMA system could be used in ITUs, where the real-time information exchange and prescribing information could help to improve care for some of the sickest patients being treated at the hospital. <\/p>\n
TrakCare is changing the way North Tees and Hartlepool NHS Foundation Trust delivers services. It\u2019s changing systems and processes and behaviours. What advice would he give to other trusts considering making a similar shift toward a comprehensive digital system? Focus on the outcomes, not the technology. \u201cThe best system is the one which you engage with and improve for the benefit of the user,\u201d says Dr Vasani. How is this achieved? \u201cYou need constant dialogue and engagement from all three aspects: the vendor, the project team and crucially the clinical users \u2013 doctors, nurses and pharmacists.\u201d <\/p>\n
No system will be perfect from day one, Dr Vasani cautions, but in time the system can be shaped and formed to deliver the outcomes trusts need and deliver the improvements in care that patients expect. In partnership with InterSystems, the trust is doing just that \u2013 using TrakCare to join the dots, developing a connected healthcare system that inspires and empowers clinicians, enabling them to deliver on the promises of a digital future.<\/p>\n","protected":false},"excerpt":{"rendered":"
Joining the dots to improve care \u2013 Inside North Tees\u2019 adoption of the TrakCare EPMA North Tees and Hartlepool NHS Foundation Trust, which employs over 5,600 staff and has a 570-bed capacity, was the first English NHS trust to deploy the InterSystems\u2019 TrakCare electronic patient record, in 2015. Since then, the trust has been using […]<\/p>\n","protected":false},"author":1,"featured_media":849,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"spay_email":""},"categories":[8],"tags":[],"jetpack_featured_media_url":"https:\/\/ec-projects.co.uk\/intersystems-uki\/wp-content\/uploads\/2019\/07\/blog13.jpg","yoast_head":"\n