use of the jac electronic prescribing system to facilitate audit data collection dr. richard hughes,...

Use of the JAC electronic prescribing

system to facilitate audit data collection

Dr. Richard Hughes, Anaesthetic Research Fellow

Dr. Nicola Edwards, Anaesthetic SHO

Dr. Niall Poole, Pharmacist and EPS manager

Birmingham Heartlands Hospital

Dr. Richard Hughes, BHH Nov 2003

Overview

• Two audits performed eight months apart• One manual data collection• One electronic data collection• Methods of electronic data collection

using electronic prescribing


Clinical ProblemThromboprophylaxis in high risk surgical patients


Audit 1• Routine audit of thromboprophylaxis

amongst thoracic surgical patients completed January 2003.

• Data collected on paper forms by reviewing notes and drug charts.


Audit 1 - Manual data collection


Efficiency – Audit 1• Manual audit collection

20 minutes per patient 114 patients

=38 hours

i.e. SLOW


Interpretation problems


Results – Audit 1

• N=114• Only 42% patients had full

compliance with protocol• Majority of failure due to prescription

timing errors.


Completing the audit cycle• Action taken:

– Correspondence to all SHOs and Ward Nurses highlighting problem

– Increased flexibility of drug dosing agreed

• Repeat audit planned.

• Electronic prescribing system introduced.


Data stored in caché

NamePIDAgeAdmission dateAdmission timeTEDSEnoxaparin prescription timePrescriberTime of first doseIf not before theatre why not?Date enoxaparin discontinued

Manual data collection


Outstanding Data

1. Operation date and time

2. Procedure



JAC prescribing system

• EPS to be mandatory in acute hospitals by 2005.

• JAC (John, Andy,?)

• Supplying pharmacy software for 20 years.



CACHÉPost relational database

1. Drug File2. Patient File3. User File

JAC electronic prescribing

1. Prescribing record2. Administration record3. Dispensing record


Outstanding Data

1.Operation date and time

2.Procedure



Operation Code Format

Procedure Date Time .

ABCD 131103 1130


Operation Codes

Operation Code

Lobectomy LOBEPneumonectomy PNEUWedge resection WEDGOpen Biopsy OPBIOesophagectomy OESODecortication DECOVATS VATSMediastinoscopy MEDIBronchoscopy only BRONOesophagoscopy OSCPOther major OTMAOther minor OTMI



CACHÉPost relational database

1. Drug File2. Patient File3. User File

Crystal reports

JAC electronic prescribing

1. Prescribing record2. Administration record3. Dispensing record


Crystal reports

• READ ONLY access to caché

• Generates report of pre-selected values

• Enables full control over accessed data


Select required tables

1. Active patients2. Patient basic3. Clinical notes4. General users


LOBE 131103 1100


Efficiency• Manual data

collection 20 minutes per

patient 114 patients

=38 hours

•Electronic data collection

2 minutes per patient 114 patients

=4 hours


Results – Audit 2Temporal relationship between first dose of

enoxaparin and operation

41

5

39

21

0

5

10

15

20

25

30

35

40

45

Greater than 12hours pre-op

Less than 12hours pre-op

Less than 12hours post-op

Greater than 12hours post-op

Percentage of patients recieving enoxaparin at different times

46%

58%

70%

81%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

received pre-op received either pre-opor within 6hrs

received either pre-opor within 8hrs

received either pre-opor within 10hrs


Strengths of electronic audit

• Fast, efficient assimilation of data

• Benefit increases as size of audit increases

• Allows viewing of additional variables at a later date


Other potential uses

• Countless other uses in clinical audit

• Pain audit– Reviewing analgesic prescribing and

administration


Weaknesses

• Only as accurate as the data already in caché

• Relies on accurate input of coded information

• Manually inputted reasons for non-administration not analysed


Summary• Golden Ideal - universally compatible

IT system throughout NHS

• Avoidance of duplication of data input

• Principle of utilising existing electronic data

• Doors open to a powerful tool for clinical audit


Questions?


Thank You!

use of the jac electronic prescribing system to facilitate audit data collection dr. richard hughes,...

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