Med Chart is live at SCDHB Helen Sharples

Med. Chart is live at SCDHB Helen Sharples

In May, South Canterbury DHB introduced Med. Chart for the electronic prescribing and administration of medicines at Timaru Hospital staff are pushing 30 new COWs around the wards, but instead of distributing milk these technical bovines are used for medication. Relying on paper and pen attached to a clipboard at the end of the bed will eventually be over-ridden, now that Med. Chart is here.

Affectionately called COWs (Computers on Wheels) the trolleys have been individually named with the quintessential Daisy and Blossom monikers. They were installed for all adult inpatient wards in May. Children's medication dosage relies on a weight formula and that aspect of the computer programme is being developed in Dunedin.

The system was trialled in two of Dunedin Public Hospital's medical wards in 2010 and has since been rolled out there, Invercargill and some parts of the Canterbury District Health Board. It is hoped all hospitals in New Zealand will use the system eventually as well as General Practitioners and rest homes.

We know that paper-based prescribing, both in NZ and overseas, is associated with a high rate of medication errors. Electronic prescribing helps with prescribing safely, staff with access can log on to Med. Chart from anywhere in the hospital, there are checks for errors and duplications, automatic warnings show up if a higher-thanusual dose is prescribed, and it is very clear when changes are made. Administration of medicines is easier, because prescriptions are clear and there is an overview of when medication is due.

Nursing staff at Timaru Hospital give dietary supplements as prescribed on Medchart. When meds are due an alarm clock icon appears on the screen against the patient's name. An alert also shows when medications/supplements are late or if not given. There is increased compliance with nursing staff giving dietary supplements with good documentation if supplements are declined or with held.

Drug chart errors due to illegible hand writing a thing of the past.

The Dietitians, Clinical and Nursing staff have responded really positively to the significant changes imposed by the move from paper charts to the new system. The new system is easy to use and clear.

Multiple back ups are in place in case of computer malfunction and staff could revert to paper again as a last resort. The introduction of the $300, 000 programme over three years was a big task with 400 staff members undergoing training for it. The system will have ongoing costs of about $50, 000 a year for the licensing software, maintenance and replacements.

Support was provided by the Southern DHB team who were onsite to help with the implementation and training once the Dietitian’s formulary was provided by our team. Only supplements/sip feeds/vitamins or minerals/enzymes on the dietitian’s formulary can be prescribed by the Dietitians but of caution all meds can be ceased. To cease a medication you need to enter your pass word and the reason is asked for.

South Canterbury DHB Dietitian Formulary Special Foods For up to date information go to www. pharmac. govt. nz Vitamin products Vitamin A with vitamin D and C Soln 1000 u with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops Pyridoxine hydrochloride Thiamine hydrochloride Vitamin B complex Ascorbic acid Alpha tocopheryl acetate Multivitamins Vitamins Folic acid Mineral products Tab 25 mg or Tab 50 mg Tab, strong, BPC Tab 100 mg Water solubilised soln 156 iu/ml, with calibrated dropper Tab or Powder or Oral liq Tab (BPC cap strength) or Cap (fat soluble vitamins A, D, E, K) Tab 0. 8 mg Sodium fluoride Ferrous fumarate with folic acid Tab 1. 25 g (500 mg elemental) or Tab 1. 5 g (600 mg elemental) or Tab 1. 75 g (1 g elemental) Tab 1. 1 mg (0. 5 mg elemental) Tab 200 mg (65 mg elemental) Tab 310 mg (100 mg elemental) with folic acid 350 μg Ferrous sulphate Tab long-acting 325 mg (105 mg elemental) or Oral liq 30 mg per 1 ml (6 mg elemental per 1 ml) Ferrous sulphate with folic acid Tab long-acting 325 mg (105 mg elemental) with folic acid 350 μg Potassium iodate (iodine) Tab 268 mg Calcium carbonate

Oral electrolyte replacement products Compound electrolytes Powder for soln for oral use 5 g Dextrose with electrolytes Soln with electrolytes Potassium bicarbonate Tab eff 315 mg with sodium acid phosphate 1. 937 g and sodium bicarbonate 350 mg Potassium chloride Tab eff 584 mg (14 m eq) with chloride 385 mg (8 m eq) or Tab long-acting 600 mg Sodium chloride Oral liquid Pancreatic enzymes Cap 10, 000 units

Sip feeds and food modules Ensure Plus Fortisip Muilti Fibre Glucerna Select Diasip Fortijuce Two Cal HN Pulmocare Suplena Nepro Renilon Calogen MCT oil

The formulary can include special foods and supplements not on the Hospital Medicines List ( HML ) however prescribing these will come with a warning and you need to select override to continue. This could be used to include supplements provided by the patient which can then be prescribed. A note can be entered in the qualifier box, such as “continuation use patient’s own supply”

Fluids are still prescribed on fluid balance charts. Enteral feeding regimes are written on enteral feeding charts by the Dietitians. Med. Chart is then updated that an “Infusion Chart Exists”

Med. Chart in summary Pros • Improved patient safety • Access to prescribing records easier eg. audits possible • Can easily check administration of supplements • Automatic alerts • Can include protocols • Rapid access to hospital formulary • Reference viewers eg. MIMS, Auckland Guidelines, Medication resources etc. Cons • Cost to set up and administer • Human error still possible