briefing note template - heart of england nhs … · web viewthe current system for chemotherapy...
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INVESTMENT APPROVAL BRIEFING TO: Group 2 Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt/Gaynor Hill
1. EXECUTIVE SUMMARYDECISION REQUIRED Justification Case Approval / Endorsement GATE 1
INVESTMENT DRIVER(S) PROPOSAL SCOPE
Patient safety / Prescription and administration error avoidance – clear legible prescriptions for chemotherapy with decision support and assistance for dose calculations. Improved communication in the pharmacy ordering process. Improved patient waiting times for outpatient prescriptions and continuous track of previous medications. Capture of contracting and cancer intelligence information.
Inpatient and Outpatient prescribing of chemotherapy by the oncology and haematology directorate at Solihull, Heartlands and Good Hope. Procurement and implementation over 9 months following funding approval. Full time project management.
BENEFITS / FIT TO STRATEGY
Improved clinical Governance Support accurate HRG reporting
Meet regional strategy (Pan Birmingham Cancer Network)
Compliance with National Chemotherapy Advisory Group Report
FORECAST FINANCIAL IMPACT £k* PYE 08/09 FYE 09/10 FYE 10/11 FYE 11/12 TotalInitial Capital to Delivery 215,640Company set up costs 73,320
Pharmacy recurrent staffing costs 174,216 174,216 174,216IT recurrent staffing costs 91,000 91,000 91,000
Gross Initial InvestmentGrants/external funding (+ source)Net Initial InvestmentMarginal cost/savings excl dep’nMarginal incomeTotal Cash Flow impactImpact on Trust Surplus 0 0 554,176 265,216 265,216
Proposed Funding SourceInitial Investment Quality Central Costs to next
Gate X £xkOngoing Business Unit
Project Life xyrs FYE Pay £xk NPV £xk Drivers Matrix xxxPrior
approvalNA?
Cap £xkFYE Drugs £xk Payback X mths Delivery
Rev £xk
Drivers for investment
The implementation of an oncology e-prescribing system will help meet challenges faced by the Trust and will support the trust meeting the following objectives:-
To meet a National Cancer Standard. Without e-prescribing we will fail Peer Review for chemotherapy.
To utilise e-prescribing so as to make efficient use of the clinical and administrative resources. To use the planning and decision support tools of the system to simplify the management of clinical
complexity.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt/Gaynor Hill
To use electronic protocols and regimens in order to minimise clinical risk. To have a comprehensive audit facility to improve patient safety. To improve safety To enable NICE guidelines to become an inherent part of clinical practice. To meet the cancer waiting times targets and service improvement as defined by the Department of
Health. To utilise scheduling tools in order to allow the optimisation of resources and booking of
appointments. To track and report on high cost drug usage and chemotherapy contracting. To report the chemotherapy dataset to the NCIN. To reduce the risk of medication errors by nursing staff around clarity of prescriptions.
Based on the above assessment of drivers, needs and the current position, the following investment aims have been defined for the proposed oncology prescribing investment:-
To reduce waiting times To improve patient safety To reduce drug wastage To reduce drug cost Improve tracking and reporting of high cost drugs usage.
The following table presents a series of specific objectives that have been set against each aim.
Aim Associated ‘SMART’ Objectives
Reduce waiting times Meet 31 and 62 day cancer waiting time targets for 100% of patients where first treatment is chemotherapy
Improve patient safety To reduce prescribing errors by 5% on 2005/06 figures
Prevent avoidable deaths
Human error kept to a minimum by reducing the number of staff involved in checking and reducing the total number of checks required
Stop clinical staff being involved in note pulling and therefore release their clinical time for patient care and administration
Safe prescription checking and administration of blood products
Reduce drug wastage Improved scheduling of patients
Access to patient blood results
Support the unit’s efficiency drives to reduce drug wastage by 0.5%
Reduce drug cost Protocol based prescribing
Transparency of agreed protocols to enable improved contracting of drug prices
Improve tracking and reporting of High Cost Drugs
Ability to monitor total spend on cancer drugs by HRG and thus inform payment by results calculations
There is clear need, support and commitment for the implementation of a software solution to
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INVESTMENT APPROVAL BRIEFING TO: Group 2 Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt/Gaynor Hill
support electronic chemotherapy prescribing to improve patient safety and quality.
Electronic prescribing has a demonstrable impact upon prescribing errors. The recent safety data audited by UCLH indicated a 45% reduction in the level of catastrophic and major errors after the implementation of a specialist chemotherapy prescribing system.
Electronic prescribing is an expected standard for chemotherapy prescribing as indicated by it being a National Cancer Standard measure which currently we fail..
The current system for chemotherapy using pre-printed prescription proformas does not provide decision support. Although space to prompt for lab results and information to support dose calculation is provided the system is unable to mandate their use and prescribing errors result. The system relies on an additional manual check by pharmacy staff to intercept these errors before they reach the patient.
The electronic prescribing system in use across the rest of the Trust is not designed to deal with the complex scheduling, infusion regimens and specific special considerations of this speciality.
Moreover it does not give the option to prescribe IV fluids and blood products which are crucial for most of the Haematology/Oncology patients thus putting more pressure to the delivery of care to the patient
Electronic chemotherapy prescribing systems facilitate both prospective and retrospective audit at all levels. The adoption of common, structured, disease based protocol driven prescribing ensures patients are offered the most appropriate and equitable treatments.
Electronic chemotherapy prescribing supports Health Related Groups (HRG) reporting, providing a high level of accuracy and thus ensures that the correct level funding is secured for the oncology service to accurately finance the activity being provided and it also permits automatic recording of chemotherapy activity required by the NCIN..
The purchase of an electronic chemotherapy prescribing system will improve standards of clinical governance and facilitate risk management by providing a fully auditable record of all chemotherapy prescribed and administered. Accurate documentation of clinical and pharmacy workload and appointment scheduling may facilitate the achievement of performance targets, e.g. the Booked Admissions Programme.
The implementation of an electronic chemotherapy prescribing system is viewed as part of the Pan Birmingham Cancer Network’s overall strategy to integrate the clinical systems into a whole care record; this option has the potential for integration into the national Integrated Care Record Service.
The proposed procurement route is via OJEU tender. Full time project management and ongoing support would be required. A robust and maintained infrastructure (e.g. wireless network) and access to computer hardware (e.g. mobile computer devices) will be vital to the success of the project.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt/Gaynor Hill
Expected Project Benefits
The following list outlines the additional specific benefits for chemotherapy:
Eliminate the need for paper based chemotherapy protocols by establishing a central repository of protocols and regimes accessible by all relevant staff at the point of need which reduces time writing prescriptions;
Computer printouts make the prescriptions legible; on the other hand if the EP system supports a remote tablet form across the Haemato-oncology Unit computer printouts might not be necessary at all
An automatic interface to the patient’s hospital record. This will eliminate duplicate work to write out patient details every time a prescription is made;
Improved retrieval of patient information;
Opportunity to audit all chemotherapy prescriptions including the audit of NICE drugs and reduce drug wastage;
Integrating working practices and support of multi-location treatment;
Improve management and audit data;
Monitor side effects and outcomes to treatments;
Reduce risk of prescription and preparation errors;
Enable Haematology and Oncology SpR trainees to increase their confidence in chemotherapy prescribing
Enable Trusts to inform commissioners of chemotherapy activity and drug costs so that effective use of resources and accurate coding of OPCS\HRG codes as planned by the Department of Health.
Automatic recording of chemotherapy delivery to the NCIN
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
2. BENEFITS REALISATION REVIEW PLANTitle of Business Case: Electronic Chemotherapy Prescribing Review Dates Due CompletedBusiness Case Reference No: Overall Project Lead Dr G Pratt First Review: (after
implementation) +3 monthsBusiness Unit: Group 2 and 4 Operations Director Sarah Rose Second Review: +9 monthsDirectorate: Oncology/Haematology/
Pharmacy Clinical Director: Dr J Ewing Subsequent Reviews: Annual
Directorate Accountant: Richard Barratt Project Manager: Estates/ICT TBC
Agreed current prices Actual Variance Reasons for VarianceInitial Investment (£k) 554,176 554,176 4554,176 Full funding required
Revenue Cost Base Increase (£k)
Revenue Savings Impact (£k)**
Income Impact (£k)Contribution (£k)
Implementation DateJanuary 2013
Project outline scope:*Costs savings positive, cost increases negative. Income impacts: increase positive, decrease negative **Show savings separately from impact on cost base
Ref Critical Success Factors & link to KPI. Benefit Type
Key Measures (KIM)
Base Value
Target Value
Target Date Review Status Comments / Actions
Agreed
C1Implementation of electronic chemotherapy prescribing at SH, BHH and GH (inpatient and outpatient)
Chemotherapy prescribed
electronically0% 100%
C2 Link to Pathology results Automatically
filled on prescription
0% 100%
C3 Reduction in prescribing calculation or regimen errors detected by pharmacy
Reduction of error rate 0% 100%
C4Reduction in pathology results related errors detected by pharmacy
Reduction of error rate 0% 100%
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
Ref Additional Success Factors/Benefits to be Achieved & link to KPI.
Benefit Type KIM Base
ValueTarget Value
Target Date Review Status Comments / Actions
Agreed
A1Automated collection of data for:
HRG costingCancer Minimum Data Sets
Reduction in additional data
entry0% 100%
Overall Status Comment: Where not green or ‘grey area’ summarise issues which have defined status eg. ‘Delayed recruitment , risk to LOS’ Investment Team Lead: Name
Key Review status Key : Red – Delivery at risk and mitigating actions ineffective. Amber – Delivery at risk, mitigating actions agreed. Green Delivery not at risk.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
BUSINESS CASE: CONTENTST*
Page No.
1. Executive Summary 12. Project Benefits Realisation Review Plan ‘BRRP’ 3
3. Summary and Recommendations 54. The Case for Change 5
APPENDICESA. The Strategic Context 7B1: Current Risk Assessment Matrix 8B2: Project Drivers Matrix Score 9C. Option Appraisal Summary 10D. Option Appraisal 11E. Initial Investment Analysis 13
3. SUMMARY AND RECOMMENDATIONS
The other options – do nothing, employ additional resource to better maintain the paper system – do not, or do not fully, address the risks in the current system
The approving body is asked to agree to proceed to full business case.
4. THE CASE FOR CHANGE
The current system for chemotherapy using pre-printed prescription proformas does not provide decision support. Although space to prompt for lab results and information to support dose calculation is provided the paper is unable to mandate their use and prescribing errors result. The system relies on an additional manual check by pharmacy staff to catch these errors before they reach the patient. In addition the complexity and number of cancer treatment regimens continues to increase putting further pressure on this system and the team maintaining the pre-printed proformas.
The management of aseptic dispensing in the pharmacy aseptic unit is managed manually. The management of this work is key to the flow of patients in the treatment areas. Delays in communication can cause delays to treatment and clinics to overrun making patients dissatisfied about the level of service they receive and putting additional pressure to the nursing, medical, pharmacy and managerial staff.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
The electronic prescribing system in use across the rest of the Trust is not designed to deal with the complex scheduling, infusion regimens and specific special considerations of this speciality. In addition it doesn’t provide the option of IV fluids and safe blood product prescribing which is crucial for patients receiving chemotherapy
Electronic prescribing for chemotherapy is part of the Pan Birmingham Cancer Network Strategy and has been supported by Lord Warner’s ministerial commitment to the widespread deployment of solutions across all cancer networks. It will also support the multidisciplinary team meet the aims of the NHS Cancer Plan (2000).
It is assumed that the benefits realised at other Trusts can be emulated at HEFT. The primary benefits expected to be achieved are an improvement in patient safety and improvement in the management of treatment preparation and delivery.
The project is dependent on the Trust’s ICT infrastructure and robust network provision.
Indicative way forward
The proposed next step is to develop a detailed specification and to tender a contract through the OJEU process for an electronic chemotherapy prescribing system.
The other options – do nothing, employ additional resource to better maintain the paper system – do not, or do not fully, address the risks in the current system.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
APPENDIX A: THE STRATEGIC CONTEXT
The implementation of electronic prescribing for chemotherapy will drive up quality of care for patients and remove the inherent risks of dosing errors. This is clearly one of the requirements laid out in NCAG and in the directorate strategy as a must do. The National Chemotherapy Advisory Group Report “Chemotherapy in England: Ensuring Quality and Safety” and the Cancer Reform Strategy have clearly identified DH expectations that competent providers of chemotherapy will quickly move to electronic prescribing and that competent commissioners of cancer care will expect this of their providers. There are two key drivers. The first is to improve safety in treating patients with chemotherapy. There is good evidence that e prescribing reduces prescription errors and provides much better, easily available, information on previous therapy and cumulative doses. Secondly, it will become critical to have accessible information on treatment regimens. These will be needed for accurate contracting information when chemotherapy moves into tariff and to improve the information available to the NCIN for better quality data on clinical outcomes demanded by the Coalition White paper.
Organisational or Departmental Overview
The current system for chemotherapy using pre-printed prescription proformas does not provide decision support. Although space to prompt for lab results and information to support dose calculation is provided the paper is unable to mandate their use and prescribing errors result. The system relies on an additional manual check by pharmacy staff to catch these errors before they reach the patient. In addition the complexity and number of cancer treatment regimens continues to increase putting further pressure on this system and the team maintaining the pre-printed proformas.
The management of aseptic dispensing in the pharmacy aseptic unit is managed manually. The management of this work is key to the flow of patients in the treatment areas. Delays in communication can cause delays to treatment and clinics to overrun.
The chemotherapy prescribing system is capable of interfacing with Trust systems, especially the PAS and Pathology systems.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
Oncology and Haematology Activity – April 2010 – March 2011
Inpatient AttendancesActivity - 1st April 2010 to 31st March 2011
Inpatient Activity by Patient Spells
Daycase Elective Emergency TotalGood Hope 0Clinical Haematology 2,266 8 2 2,276Medical Oncology 3,559 6 4 3,569Oncology 0Heartlands 0Clinical Haematology 4,942 359 228 5,529Medical Oncology 1 1Oncology 3,962 169 53 4,184Solihull 0Oncology 240 1 241Total 14,970 543 287 15,800
Outpatient Activity (ward attenders excluded)
Good Hope Heartlands Solihull TotalFirst attendance
Haematology Anti-Coagulant 866 725 397 1,988Haematology Clinical 401 1,556 224 2,181Medical Oncology 612 263 875Oncology 147 922 255 1,324
First telephone or telemedicine consultation
Haematology Anti-Coagulant 1 1Haematology Clinical 2 63 65Oncology 72 257 76 405
Follow-up attendance Haematology Anti-Coagulant 18,910 16,320 8,112 43,342Haematology Clinical 3,370 8,074 30 11,474Medical Oncology 4,532 1,341 5,873Oncology 27 4,495 1,732 6,254
Follow-up telephone or telemedicine consultation
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
Haematology Anti-Coagulant 2 1 3Haematology Clinical 36 136 172Medical Oncology 2 2Oncology 134 1,426 185 1,745Total 29,114 35,579 11,011 75,704
Daycase
Specialty Site DaycasesHaematology Clinical Good Hope 2266Haematology Clinical Heartlands 4942Medical Oncology Good Hope 3559Medical Oncology Heartlands 1Oncology Heartlands 3962Oncology Solihull 240
Business Strategies
The purchase of the chemotherapy prescribing system will improve standards of clinical governance and facilitate risk management by providing a fully auditable record of all chemotherapy prescribed and administered. Accurate documentation of clinical and pharmacy workload and appointment scheduling may facilitate the achievement of performance targets, e.g. the Booked Admissions Programme. Furthermore, the data stored by the system may, in the future, allow improved documentation of chemotherapy costs to defined purchasing organisations, and hence be of considerable benefit to the Cancer Network.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
Other Organisational Strategies
The benefits of implementing electronic chemotherapy prescribing have been long understood and have been supported by Lord Warner’s ministerial commitment to the widespread deployment of solutions across all cancer networks.
The cancer action team (CAT), in collaboration with NHS Connecting for Health (CfH) and Professor Mike Richards has been keen to ensure that cancer networks implement appropriate and compliant electronic systems.
The implementation of a chemotherapy prescribing system is viewed as part of the Pan Birmingham Cancer Network’s overall strategy; this option has the potential for integration into the national Integrated Care Record Service.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
APPENDIX B1: CURRENT RISK ASSESSMENT MATRIX
Table 1 – MEASUREMENT OF LIKELIHOOD
Level Descriptor Description0 Never The event cannot happen under any circumstances1 Rare The incident may occur only in exceptional circumstances2 Unlikely The incident is not expected to happen but may occur in some circumstances3 Possible The incident may happen occasionally4 Likely The incident is likely to occur, but is not a persistent issue5 Almost Certain The incident will probably occur on many occasions and is a persistent issue
Table 2 – MEASUREMENT OF CONSEQUENCE
Level Descriptor Description0 None No injury or adverse outcome. Low financial loss1 Insignificant No injury or adverse outcome; First aid treatment; Low financial loss
2 Minor Short term injury/damage (e.g. resolves in a month); a number of people are involved
3 Moderate Semi permanent injury (e.g. takes up to year to resolve)
4 Major Permanent injury; major defects in plant, equipment, drugs or devises; the incident or individual involved may have a high media profile
5 Catastrophic Death
Table 3 - ASSESSMENT MATRIX THE RISK FACTOR = LIKELIHOOD X CONSEQUENCE
CONSEQUENCE
LIKELIHOOD None0
Insignificant1
Minor2
Moderate3
Major4
Catastrophic5
0 Never 0 0 0 0 0 01 Rare 0 1 2 3 4 52 Unlikely 0 2 4 6 8 103 Possible 0 3 6 9 12 154 Likely 0 4 8 12 16 205 Almost Certain 0 5 10 15 20 25
By using the matrix above the risk score can be calculated to determine risk category. This ranges ranging from 1 (low severity and unlikely to happen) to 25 (just waiting to happen with disastrous and widespread consequences). The risk score can now form a basis upon which to determine the urgency of any actions. *Risks which have a priority score of 9 or more should be reviewed by the Directorate Management Team immediately. Green status denotes low risk. Yellow can denote moderate to Significant risk. Red risks which score 15 or more must be notified to the Risk Register Officer.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
APPENDIX B2: PROJECT DRIVERS SCORE MATRIX
SCORE
RISK AVOIDANCE
(i.e. CURRENT RISK OF DOING NOTHING) (25%)
IMPROVEMENT TO PATIENT CARE (25%)
FIT WITH MISSION/STRATEGY
(25%)
IMPACT ON MARKET
SHARE (10%)FINANCIAL
VIABILITY (15%)
5
Very high risk score (> 20) as per Trust’s Risk
Assessment Matrix
Clear evidence that the case
delivers a specific & tangible
improvement to patient care
Clear evidence that the case delivers a specific & tangible
element of the Trust’s Strategy
Growth in Market share is real, sustainable,
increases income & is
agreed with the Trust’s key
stakeholders
Revenue Surplus/ Prevention of Lost Revenue > £500k
&/or Pay back period < 3 years AND NPV
+ve
4
High risk score (15 to 19) as per
Trust’s Risk Assessment
Matrix
Clear evidence that the case
directly drives a specific & tangible
improvement in patient care
Clear evidence that the case directly
drives a specific & tangible element of the Trust’s Strategy
Case identifies real potential for
future sustainable increases in
income & Market share
Revenue surplus £251k to £500k &/or Pay Back period < 4 years AND NPV +ve
3
Medium risk score (9 to 14) as per Trust’s Risk
Assessment Matrix
Clear evidence that the case
directly drives the Strategy on
improving patient care
Clear evidence that the case directly
drives the delivery of the Trust’s Strategy &
Mission
Case directly influences other opportunities for future growth in
income & Market share
Revenue surplus £101k to £250k &/or Pay Back period < 5 years AND NPV +ve
2
Moderate risk score (4 to 8) as per Trust’s Risk
Assessment Matrix
Evidence that the case
influences a specific part of the Strategy on
improving patient care
Evidence that the case influences a specific
part of supports the wider delivery of the Trust’s Strategy &
Mission
Case is needed to maintain our current market share & income
Revenue surplus £0 to £100k &/or Pay
back period < 5 years AND NPV +ve
1
Low risk score (1 to 3) as per Trust’s Risk Assessment
Matrix
Evidence that the case
influences improvements in
patient care
Evidence that the case influences the
delivery of the Trust’s Strategy & Mission
No impact on market share &
income
No revenue implications – cost neutral AND NPV
+ve
0 No risk, score 0No impact on patient care
improvements
No impact on delivering the Trust’s Strategy & Mission
Reduces market share & income
Net revenue loss and/or NPV –ve
SCORE Eg. 4 Eg. 3 Eg. 3 Eg. 1 Eg.2
WEIGHTING 4 x 25 = 100 3 x 25 = 75 3 x 25 = 75 1 x 10 = 10 2 x 15 = 30
WEIGHTED SCORE 290
.
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
Option Appraisal
Baseline Option – Do nothing
The current system of prescription proformas for individual treatment regimens fails to deliver a sufficiently consistent safe service to patients. The forms are able to prompt clinicians to check the appropriate results and make the appropriate dose calculations – but these actions must be manually completed and cannot be mandated which introduces the possibility for human error.
Current staff resources have not allowed the prescription proformas to be kept up to date and this further exacerbates the risks presented by this option. In some cases prescribers using out of date proformas are required to make manual amendments to the prescription and, as such, the benefits of the proforma are negated.
Baseline Option Risk Assessment
Description of risk: Inappropriate dose or scheduling of dose is prescribed due to miscalculation by the prescriber, omission of lab results check, or poorly laid out proforma.
Possible consequence: Major/Catastrophic (4/5)Likelyhood: Possible (3)Score: 12 - 15
Project Drivers Score
No change – not applicable
The baseline option IS NOT the preferred option.
Option 1 – Invest in current system – Paper based prescribing
An additional junior pharmacist to release more senior pharmacist time would allow the current system to be properly maintained. This would eliminate the risks associated with manual amendments to the pre-printed prescription forms.
Suggested resource: 1.0 WTE x Band 6 pharmacist
The problems associated with manual calculations and results checks would still persist.
Option 1 Risk Assessment
Description of risk: Inappropriate dose or scheduling of dose is prescribed due to miscalculation by the prescriber or omission of lab results check.
Possible consequence: Major/Catastrophic (4/5)Likelihood: Unlikely (2)Score: 8 - 10
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
Project Drivers Score
Score Weight Weighted ScoreRisk: 3 25 75Improvement to patient care: 2 25 50Fit with mission / strategy: 2 25 50Impact on market: 2 10 20Financial viability: 2 15 30
Total 225
Option 1 IS NOT the preferred option.
Option 2 – Electronic chemotherapy prescribing
The purchase of an electronic chemotherapy prescribing system will improve standards of clinical governance and facilitate risk management by providing a fully auditable record of all chemotherapy prescribed and administered. Accurate documentation of clinical and pharmacy workload and appointment scheduling may facilitate the achievement of performance targets, e.g. the Booked Admissions Programme.
The system will integrate with the Trusts existing results reporting and PAS systems to provide process and clinical decision support (e.g. no go ahead without blood results as well as dose reduction recommendations).
Option 2 Risk Assessment
Description of risk: Inappropriate dose or scheduling of dose is prescribed due to miscalculation by the prescriber or omission of lab results check.
Possible consequence: Major/Catastrophic (4/5)Likelihood: Never/Rare (0/1)Score: 0 - 5
Project Drivers Score
Score Weight Weighted ScoreRisk: 2 25 50Improvement to patient care: 5 25 125Fit with mission / strategy: 5 25 125Impact on market: 5 10 50Financial viability: 0 15 0
Total 350
Option 2 IS the preferred optio
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INVESTMENT APPROVAL BRIEFING TO: Group 2 July 2011Directorate: Oncology/Haematology/PharmacyProject Ref: P.Sponsor: P. Lead: Dr Guy Pratt
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