Introduction
Network members identified a core area where some systems have helped to improve compliance with VTE risk assessment and prophylactic treatment through linking the assessment with the prescribing workflow. Many organisations used the paper prescription chart to assess Venous Thromboembolism Risk, so the nature of replacing the prescription chart meant that the risk assessment also needed to be incorporated. There are operational targets in place for assessment for all admissions and through enforcing completion of this assessment as part of prescribing workflow, network members described how they were able to now hit targets around assessment as a direct benefit of ePMA implementation (this varied depending on the system being implemented).
What peers in the network found
Simplify workflow and consider hard v soft stops
A ‘hard stop’ is where you make it so someone can’t prescribe without a VTE being present (i.e. unable to override), whereas a ‘soft stop’ is where you use nudges or reminders for staff to complete VTE, but allow for an override. Some trusts found having a soft stop to prevent prescribing of regular medications until a VTE risk assessment is completed was what pharmacists wanted, but it led to worse outcomes than counterparts who had implemented a hard stop. You must simplify the workflow around admission prescribing and implement it at the point of prescribing.
Make training an ongoing process
Our network felt training worked best when initial training to use the system was carried out as part of onboarding, and as a continual process so new staff didn’t miss out.
Include information on limitations and known issues too
Don’t gloss over bits that don’t work as it’s as important for people to know what the technology can’t do as what it can, to avoid people expecting miracles or over-estimating its capability.
Make training contextualised
The more patient scenarios (with devices) the better. The training should be in-situ too, so instead of learning at a screen, you should be learning in the patient care area, using the actual workstations, next to patients. This allows for patient experience to be part of the training.
Involve clinicians
You shouldn’t just show people how to use the functionality or have just training solely run by technical people. Instead, provide training from clinicians too who will likely run through how to use the kit and approach the new way, in a manner that most speak to their clinical peers.
What to look out for
- Poor adoption
- Recommendations to prescribe medicines not taken forward
- Complex workflow requires more training
- Complex workflow requires more training
- Hard stop v soft stop
What to read
Short Reads
‘Studies have shown that soft stops are often overlooked or quickly overridden without careful consideration of the warning for a variety of reasons, including alert fatigue and poor warning design’ – read more https://www.pharmacytoday.org/article/S1042-0991(16)31659-0/fulltext
Long read/study results:
BMJ Open Quality – UK study citing improvements from linking of the ‘recommended outcome’ of the electronic venous thromboembolism risk assessment directly to electronic prescribing, through an increase in appropriate thromboprophylaxis – https://bmjopenquality.bmj.com/content/8/2/e000459
Mixed methods study of medication-related decision support alerts experienced during electronic prescribing for inpatients at an English hospital – https://ejhp.bmj.com/content/26/6/318
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