Use of the JAC electronic prescribing system to

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 Dr. Richard Hughes, BHH Nov 2003

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 h 20 minutes per patient h 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 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

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

Efficiency • Manual data collection h 20 minutes per patient h 114 patients =38 hours • Electronic data collection h 2 minutes per patient h 114 patients =4 hours Dr. Richard Hughes, BHH Nov 2003

Results – Audit 2 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