Transcript Use of the JAC electronic prescribing system to facilitate

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
Overview
•
•
•
•
Two audits performed eight months apart
One manual data collection
One electronic data collection
Methods of electronic data collection
using electronic prescribing
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Clinical Problem
Thromboprophylaxis in high risk surgical patients
Dr. Richard Hughes, BHH Nov 2003
Audit 1
• Routine audit of thromboprophylaxis
amongst thoracic surgical patients
completed January 2003.
• Data collected on paper forms by
reviewing notes and drug charts.
Dr. Richard Hughes, BHH Nov 2003
Audit 1 - Manual data collection
Dr. Richard Hughes, BHH Nov 2003
Efficiency – Audit 1
• Manual audit collection
20
minutes per patient
114 patients
=38 hours
i.e. SLOW
Dr. Richard Hughes, BHH Nov 2003
Interpretation problems
Dr. Richard Hughes, BHH Nov 2003
Results – Audit 1
•
•
•
N=114
Only 42% patients had full
compliance with protocol
Majority of failure due to prescription
timing errors.
Dr. Richard Hughes, BHH Nov 2003
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.
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Manual data collection
Data stored in caché
Name
PID
Age
Admission date
Admission time
TEDS
Enoxaparin prescription time
Prescriber
Time of first dose
If not before theatre why not?
Date enoxaparin discontinued
Dr. Richard Hughes, BHH Nov 2003
Manual data collection
Data stored in caché
Name
PID
Age
Admission date
Admission time
TEDS
Enoxaparin prescription time
Prescriber
Time of first dose
If not before theatre why not?
Date enoxaparin discontinued
Dr. Richard Hughes, BHH Nov 2003
Manual data collection
Outstanding Data
1. Operation date
and time
2. Procedure
Dr. Richard Hughes, BHH Nov 2003
JAC prescribing system
• EPS to be mandatory in acute
hospitals by 2005.
• JAC (John, Andy,?)
• Supplying pharmacy software for
20 years.
Dr. Richard Hughes, BHH Nov 2003
JAC prescribing system
CACHÉ
Post relational database
1. Drug File
2. Patient File
3. User File
JAC electronic
prescribing
1. Prescribing record
2. Administration record
3. Dispensing record
Dr. Richard Hughes, BHH Nov 2003
Manual data collection
Outstanding Data
1.Operation date
and time
2.Procedure
Dr. Richard Hughes, BHH Nov 2003
Operation Code Format
Procedure Date Time .
ABCD 131103 1130
Dr. Richard Hughes, BHH Nov 2003
Operation Codes
Operation
Code
Lobectomy
Pneumonectomy
Wedge resection
Open Biopsy
Oesophagectomy
Decortication
VATS
Mediastinoscopy
Bronchoscopy only
Oesophagoscopy
Other major
Other minor
LOBE
PNEU
WEDG
OPBI
OESO
DECO
VATS
MEDI
BRON
OSCP
OTMA
OTMI
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Manual data collection
Dr. Richard Hughes, BHH Nov 2003
JAC prescribing system
CACHÉ
Post relational database
1. Drug File
2. Patient File
3. User File
JAC electronic
prescribing
1. Prescribing record
2. Administration record
3. Dispensing record
Crystal reports
Dr. Richard Hughes, BHH Nov 2003
Crystal reports
• READ ONLY access to caché
• Generates report of pre-selected
values
• Enables full control over accessed
data
Dr. Richard Hughes, BHH Nov 2003
Select required tables
1.
2.
3.
4.
Active patients
Patient basic
Clinical notes
General users
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
LOBE 131103 1100
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Dr. Richard Hughes, BHH Nov 2003
Efficiency
• Manual data
collection
20
minutes per
patient
114 patients
=38 hours
•Electronic data
collection
2
minutes per
patient
114 patients
=4 hours
Dr. Richard Hughes, BHH Nov 2003
Results – Audit 2
Percentage of patients recieving enoxaparin at different times
Temporal relationship between first dose of
enoxaparin and operation
90%
45
81%
80%
41
39
40
70%
70%
35
58%
60%
30
50%
25
21
20
46%
40%
30%
15
10
20%
5
5
10%
0
Greater than 12
hours pre-op
Less than 12
hours pre-op
Less than 12
hours post-op
Greater than 12
hours post-op
0%
received pre-op
received either pre-op received either pre-op received either pre-op
or within 6hrs
or within 8hrs
or within 10hrs
Dr. Richard Hughes, BHH Nov 2003
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
Dr. Richard Hughes, BHH Nov 2003
Other potential uses
• Countless other uses in clinical
audit
• Pain audit
– Reviewing analgesic prescribing and
administration
Dr. Richard Hughes, BHH Nov 2003
Weaknesses
• Only as accurate as the data
already in caché
• Relies on accurate input of coded
information
• Manually inputted reasons for nonadministration not analysed
Dr. Richard Hughes, BHH Nov 2003
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
Dr. Richard Hughes, BHH Nov 2003
Questions?
Dr. Richard Hughes, BHH Nov 2003
Thank You!
Dr. Richard Hughes, BHH Nov 2003