Introduction
Network members were seeking improvement of delayed and missed doses. Many had a particular focus on Parkinson’s dose delays. Network members wanted greater visibility of administration and reasons provided for missed/delayed doses. They wanted information on this in real-time and on dashboards. This greater visibility was sought to increase accountability and improved safety for patients.
What peers in the network found
Use reporting tools on delayed doses
The system benefit is not the reduction of delayed doses, but the availability of the data that will help you to identify reasons and solutions to reduce the problem
Have data analytic expertise within the ePMA team
Pulling masses of data into meaningful analysis that can be actionable is a real skill. Find people who can help you not only collect the data but translate it clearly – they are invaluable.
Prioritise medications
Some need more time to analyse (such as for Parkinson’s) and any time-critical medicines e.g insulin.
Start with why
Get under the skin of the real reason behind why something is happening by taking into account all the possible variables, such as time of day or workload. For example, missed dose data can be a sign that more resource is needed, providing valuable information to HR, or it could also be a sign of unavailable stock, rather than issues with staff.
Identify resource needed for BAU
Go live is just the beginning. You also need to identify what resource will be required for the ongoing tasks such as reporting, implementation, evaluation, education for new staff etc. You should also talk to suppliers about their recommendations as it may help your choice.
Treat careful design and consultation as an ongoing process
Linked to the above, go live is just the beginning.
Top tips from the network
Terminology differences
Even within the same trust, there can be differences that cause confusion. It’s important to standardise terminology based on the national definitions use within the missed dose audit point prevalence
Understand the benefits might not be immediate
ePMA in itself does not force timely administrations or show an improvement straight away – but clever and well-resourced use of reporting and data analytics does lead to focused interventions which then significantly improve delayed/omitted administration
Resistance to change
Many found that admin time increased and drivers to success varied hugely
Free text answer options are not always available
Not all systems allow you to select ‘other’ as a reason for not administering a medicine and input specific reasons, which is unhelpful
Review the data
Find people who will have time to review the data in advance. Making time to review the data can be harder than you thought.
Remember temporary staff in training and planning
One to consider throughout, not specific to delayed/omitted doses.
What to read
Long reads
The impact of a hospital electronic prescribing and medication administration system on medication administration safety: an observational study. BMC Health Services Research 2017 17:547
The effect of electronic prescribing and medication administration on nurses’ workflow and activities: an uncontrolled before and after study. BMC Safety in Health 2:13 DOI: 10.1186/s40886-016-0023-8
Who to talk to
Sarah Thompson – Head of Clinical Digital Optimisation Programmes, Stockport NHS Foundation Trust
Mark Livingstone – Head of Pharmacy, Pennine Acute Hospitals NHS Trust