Implementing an Electronic Prescribing and Medication Administration System

to Paediatric and Neonatal Wards

Overview Electronic Prescribing and Medicines Administration (EPMA) systems have been shown to reduce medication errors and lead to safer medicines management processes1,2,3. County Durham and Darlington NHS Foundation Trust (CDDFT) successfully rolled-out EPMA to adult inpatient wards in 2015 but this was not extended to paediatric and neonatal units during that process. Systems developed for use in adults may be sub-optimally designed for use in paediatrics due to the added complexity of prescribing in this patient cohort. The need to calculate doses on an individual patient basis using age, weight and surface area and further factors such as dilutions and manipulations means that medication errors during prescribing and administration are more frequent4 when compared to adults. Children and adolescents are at greater risk of adverse effects from medication errors5 and the incidence of errors was shown to be 27% in a US Systematic Review6. The need to improve prescribing safety in paediatrics is evident and some hospital trusts in the UK have successfully developed and tailored existing EPMA programmes for use on inpatient paediatric wards7,8. The trust has secured funding to further extend EMPA to paediatric and neonatal wards as part of the CDDFT Health Informatics Strategy and NHS Five Year Forward View. This poster outlines how I will plan the delivery of this project and how my CLIP journey will help to implement change.

Project Planning The implementation of EPMA to paediatric and neonatal inpatient wards will require detailed project planning and collaborative working with numerous stakeholders within CDDFT and external to the trust. Using the project planning cycle covered on day 4 of CLIP, the following strategy has been devised to assist with the implementation.

Stuart Spence, Senior Clinical Pharmacist, County Durham and Darlington NHS Foundation Trust email: stuartspence@nhs.net

My CLIP Toolkit

Throughout the programme I have had many opportunities to learn about myself as an individual and a leader. My increasing sense of self-awareness and emotional intelligence has empowered me to become a more confident, capable and adaptable leader. The skills and techniques covered during CLIP will be central to successfully delivering EPMA to inpatient paediatric and neonatal wards within CDDFT. A repeating theme of CLIP was the need to embrace a flexible approach to multiple situations. Tools such as the Myers-Briggs Type Indicator, Skill-Will matrix, colours model and Thomas-Kilmann Instrument were instrumental at demonstrating that adaptability is central to effective leadership. Another personal highlight of the CLIP programme was the GROW coaching model, which is fundamental to developing myself and other members of CDDFT. Over the past 9 months, I have taken the time to coach other members of my current team, which has yielded positive results for the individuals involved, their organisations and has ultimately helped to deliver better patient care. My CLIP toolkit will contribute to the successful delivery of EPMA on paediatric and neonatal units within CDDFT. It is inevitable that challenges and obstacles will be encountered along the way but I definitely feel better equipped to overcome these thanks to the CLIP programme.

•Skill-Will Matrix

•Coaching

•Mentoring

• Flexible Leadership

• Project Management

• Developing High Performing Teams

• Adaptable and assertive communication

• Conflict Management

• Negotiation Skills

• Resilience

• Myers-Briggs Type Indicator

• Leadership self-assessment and 360° feedback

• My communication style

Increased Self-

awareness

Enhanced Interpersonal

Skills

Peer development

Collaborative Working

• Stakeholder Mapping, Analysis and Engagement

• Project scoping and outline

• Timeline

• Cost benefit analysis

INITIATION

• SMARTER objectives

• Gantt Chart

• Quality Control

• Risk and Contingency Planning

• Effective Communication

PLANNING

• Monitor and record project progress

• Implement any contingency plans if required

• Frequent, succinct communication with stakeholders and sponsors

IMPLEMENTATION AND MONITORING

• Review success and challenges encountered

• Regular audit to ensure safe and effective prescribing and administration of medicines

• Identify further training needs

CLOSE AND REVIEW

References 1 Ahmed Z et al. Impact of electronic prescribing on patient safety in hospitals: implications for the UK. Clinical Pharmacist. 2016, 8(5) 2 Franklin G, et al. The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: A before-and-after study. QualSaf Health Care. 2007;16:279–84. 3 Nuckols TK et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Syst Rev. 2014;4(3):56 4 Farre A, Cummins C. Understanding and evaluating the effects of implementing an electronic paediatric prescribing system on care provision and hospital work in paediatric hospital ward settings: a qualitatively driven mixed-method study protocol. BMJ Open. 2016;6:e010444

5 Maaskant JM et al. Interventions for reducing medication errors in children in hospital. Cochrane Database of Systematic Reviews 2015, Issue 3 6 Miller MR et al. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Qual Saf Health Care. 2007;16(2):116–126 7 Yusuf A and Choudhury C. P24 Developing a paediatric electronic prescribing system. Archives of Disease in Childhood. 2018;103:e1 8 Johnson KB, Lehmann CU. Council on clinical information technology. Technical report: Electronic prescribing in paediatrics: Toward safer and more effective medication management. Paediatrics. 2013;131(4):e1350–e1356 9 NHS England. Five Year Forward View [online: https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf] – Accessed 24th April 2019