ePMA Implementation – Experiences from East London Foundation NHS Trust

| March 31, 2020

Background and Methods

East London Foundation NHS Trust provides mental health and community health services to 3 boroughs in London and to Luton and Bedfordshire.  There are over 5500 employees of which nearly 1500 are nurses, nearly 400 doctors and 404 therapists and allied health professionals.  There are 9 inpatient sites and 56 wards with nearly 900 beds most of which provide mental health care. The trust has embarked on an ambitious digital transformation programme with various new innovations. However despite the significant steps taken in implementing Electronic Health Records, mobile working, electronic correspondence, our medicines management and prescribing was still very much paper based and this was impacting on the ability to share a complete patient record with our partners and was also negatively impacting on our digital maturity. Our Pharmacy Stock Control system was electronic while prescribing and administration was manual. There were significant benefits in introducing EPMA including, reduction of administration errors, reduction in prescribing errors , and reduced drug administration times for nurses as well as remote prescribing. The project kicked off on the 1stof April 2018. Our pilot site went LIVE on the 27thof November 2018 with one ward. 2 fast follower wards were added in January and February of 2019.

Post pilot, it has taken 1 year to deploy EPMA on all our mental health wards. Our EPMA rollout to the remaining 50 mental health wards commenced  in  April 2019 and we are on schedule to complete the EPMA rollout by end of March 2020.

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How we did it

Planning: 

The trust project plan was aligned to the supplier project plan for delivery of infrastructure, technical training and business continuity system design. With regards to deployment, the planning approach was informed by lessons learnt from other “buddy” organisations around piloting in Older People’s services where there is a lower turnover of patients allowing us to learn lessons while avoiding the risks associated with acute inpatients wards in mental health.

A just in time approach to delivery of infrastructure and equipment was taken. Deployment was done on a borough  by borough basis, with deploying EPMA to two wards at a time and allowing pauses for transformation activities and review of lessons learnt. Planning took a long term view, factoring trainee doctor rotations, new nurse intakes and other changes that are resource intensive from a planning perspective.  Most of the change activity was adopted from an ADKAR model of change.

Governance:

  • There is an EPMA Project Board that provides direction and is constituted as follows:
  • Chief Medical Officer – Chair
  • Chief Nurse – Deputy Chair
  • Chief Pharmacist
  • Chief Informaiton Officer
  • Chief Clinical Information Officer
  • Medicine Safety Officer
  • EPMA Project Manager
  • EPMA Lead Pharmacist
  • Associate Director for IT
  • Head of Communications
  • Associate Director of Information Governance
  • AD HOC attendees including Borough directors, consultants, EPMA Nurses and suppliers where required. The benefit was clear communications, senior sponsorship and steering.
  • There is also the Medicines Committeethat advises the EPMA Project delivery team on issues e.g where there are conflicts in current practice and policy and how these conflicts can be safely resolved in configuring the system. The Medicines Committee also provides signs off on aspects of system set up. The benefit was freeing the EPMA Project team from dealing with policy and procedure issues and focusing on delivery.
  • There is a separate Medicines Safety Incident and Risk Reviewgroup comprising the EPMA Medical Lead (Consultant Psychiatrist), Specialty Doctor, EPMA Nurses, EPMA Pharmacists and Pharmacy Technicians and Medicines safety officer. They review all DATIX incidents investigate root causes and practice issues and make recommendations where changes to practice, process or system configuration may be required. They also track and manage the ePrescribing risks on the risk register. The benefit is having a team that understands the product as well as the clinical environment.
  • The EPMA Project Boardreceives a report at each project board from the EPMA Medical Lead on the thematic analysis of clinical and ePMA incidents that occur within a reporting period. Where necessary actions are taken to issue comms to specific groups on change of practice, or contact is initiated with with suppliers with regards to highlighting key areas of concern e.g Clozapine protocol prescribing.
  • Data & Information:

To measure data for business intelligence and reporting a Data Analyst was seconded to the project for the year as part of a data warehouse project to ensure data from EPMA was available in the trust’s data warehouse. The result is collaboration between the Informatics and Business Intelligence team, key members of the EPMA Project and the informatics team to create reports available via our trust’s Reporting services.

In addition, there is information analysis and reporting capability within the EPMA Project Team where the EPMA Pharmacy Technician produces ad hoc tactical reports on an “as required” basis e.g when an incident occurs and the investigation requires information from the back end or for intelligence around benefits reporting.

When migrating information into a new system, the supplier was able to perform a bulk patient load based on an extract from our EPR system RiO. However, as a result of an ADT Feed that had been inactivated previously, a decision was taken to employ some data quality clerks to manually carry out patient merges, manual registrations and corrections to areas where data quality issues had been encountered.

Lessons learnt – How could others do this? 

  1. Visible senior/executive project and change sponsorship – the introduction of EPMA is a significant change in process, practice and culture. The pace of change and the resulting disruption can result in significant resistance even from middle managers. An engaged senior and executive management team can go a long way towards “selling” the benefits and expediting adoption.
  2. Resourcing: Dedicated subject matter experts (pharmacists, nurses, doctors, IT technicians) working FULL TIME in a multi-disciplinary project team makes for better understanding of the end users’ challenges, ensures better targeted communication, ensures relevant and high quality profession specific training and expedites issue resolution.
  3. Supplier management: Understand your supplier, hold them to account. Understand their deployment methodology, tools and communication methods. Ensure you understand what they require from your organisation in order to deploy the application, upgrade and deliver fixes. Demand supplier side project plans and key contacts within their organisation.