Patient-centric implementation of an electronic medication management system at a tertiary hospital in Western Sydney

BackgroundTraditional implementations of electronic medication management (EMM) systems have involved two common formats – a ‘big bang’ approach on the day of go-live, or a phased ward-by-ward approach over months.ObjectiveTo describe the patient-centric roll-out, a novel implementation model in converting from paper to EMM.MethodThis model iteratively converted a large tertiary teaching hospital to electronic from paper medication charts, commencing the roll-out in the emergency department (ED). The tenet of ‘one patient, one chart’ was maintained with new patients commenced on EMM, while existing inpatients were maintained on paper charts until their discharge. In the second week, all other intake points commenced patients on EMM, and in the third week, all remaining patients were manually converted to EMM. The implementation was assessed with training completion rates, staff satisfaction surveys, focus group interviews and incident logs.ResultsAt go-live, 79% of doctors, 68% of nurses and 90% of pharmacists were trained in the EMM system. The ED converted to electronic prescribing within 24 hours; by day 20, all patients were on EMM. Two hundred and thirty issues were logged, none critical, of which 22 were escalated. Of the 51,063 medications administered, there were 13 EMM-related clinical incidents including three double dosing errors, none of which led to an adverse event or death. Overall, 77% of staff surveyed were satisfied with the EMM implementation.ConclusionsThe patient-centric roll-out model represents an innovative and safe approach with a single medication chart reducing transcription and improved medication safety for the patient and the organisation.

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ACUTE POST COMPLICATIONS IN STROKE PATIENTS VISITING A TERTIARY TEACHING HOSPITAL

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2018v10i4.24396 ◽

2018 ◽

Vol 10 (4) ◽

pp. 94

Author(s):

Spurthi T. ◽

Rekha Rani K. ◽

Navya Y. ◽

Swathi D. ◽

Ramesh Kumar P.

Keyword(s):

Tertiary Hospital ◽

Stroke Patients ◽

Drug Classes ◽

Disability Rate ◽

Symptomatic Management ◽

Tertiary Teaching ◽

High Incidence ◽

Study Population ◽

Tertiary Teaching Hospital ◽

High Degree

Objective: The study was focused on assessing the incidence of stroke and their association with types of the risk factor, with an emphasis on acute post complications and their symptomatic management for early detection.Methods: A prospective observational study was carried out on stroke patients visiting a medicine department of a tertiary hospital, Andhra Pradesh, India from August 2017 to November 2017. Patient’s demographics and lab data was collected for analysis.Results: A total of 110 patients participated in the study. Among them high incidence is males (69%), 61-80yrs (48%), with 2 risk factors (35%) among which age (67%) and hypertension (66%) were related to the high degree of prevalence. 47% of the study population were identified with one complication, among which seizures account for 38% of patients. All the complications associated with the condition were treated with drug classes, in which anti-epileptic drugs (AEDs) were the mainstay in the management of epilepsy.Conclusion: Brain edema and seizure attack were the most accountable complications identified in the study population. The early detection of these problems can improve the stroke outcomes and can reduce the mortality or disability rate.

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Surgical handover in a tertiary hospital: a working model

Australian Health Review ◽

10.1071/ah09859 ◽

2011 ◽

Vol 35 (1) ◽

pp. 14 ◽

Cited By ~ 2

Author(s):

Frank Piscioneri ◽

Guan C. Chong

Keyword(s):

Patient Information ◽

Working Hours ◽

Tertiary Hospital ◽

Junior Doctors ◽

Verbal Reports ◽

Working Model ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

Sentinel Events ◽

Working Day

The trend, in the last few years, of shorter working hours for junior doctors has been driven by the need for safer working conditions. This has led to the loss of continuity of care and the introduction of shift work for residents and registrars, resulting in up to three handovers per 24-h period. Many sentinel events occurring in hospitals can be attributed to a breakdown in communication. Clinical handover is important because it not only facilitates continuity in the transfer of patient information between healthcare professionals but also helps identify potential problems that may occur in upcoming shifts. Methods of handover include verbal-only reports, verbal reports with note-taking and the use of printed handouts containing relevant patient information. This paper presents an exposition of a working model for morning surgical handovers in a tertiary teaching hospital that uses a printed handover sheet, is consultant-led and conference-based, and with an educational focus. A survey of resident staff confirmed the morning handover as important in both patient care and education. There was a marked improvement in tertiary trauma survey completion rates after the introduction of the morning handover. It is now an accepted and important part of the working day in the surgical unit of the hospital.

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The efficiency–thoroughness trade-off after implementation of electronic medication management: a qualitative study in paediatric oncology

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa086 ◽

2020 ◽

Vol 32 (8) ◽

pp. 511-516

Author(s):

Melissa T Baysari ◽

Bethany A van Dort ◽

Mirela Prgomet ◽

Wu Yi Zheng ◽

Magdalena Z Raban ◽

...

Keyword(s):

Medication Management ◽

Qualitative Interview ◽

Paediatric Oncology ◽

Structured Interviews ◽

Trade Off ◽

Medication Information ◽

Tertiary Teaching ◽

Qualitative Interview Study ◽

Tertiary Teaching Hospital ◽

Sydney Australia

Abstract Objective The efficiency–thoroughness trade-off (ETTO) principle proposes that people and organizations are often required to make a trade-off between being efficient and being thorough, as it is difficult to be both efficient and thorough at the same time. This study aimed to compare pre- electronic medication management system (EMMS) expectation of how an EMMS is likely to impact on efficiency and thoroughness to post-EMM experiences of an EMMS and the ETTO. Design Qualitative interview study. Setting A paediatric oncology cancer centre in a large paediatric tertiary teaching hospital in Sydney, Australia. Participants Forty-four semi-structured interviews with doctors, nurses and pharmacists six months prior to and two years following implementation of an EMMS. Results Prior to EMM implementation, staff identified a number of areas of work where both efficiency and thoroughness were expected to improve with EMM. These included ease of accessibility of the medication record, and organization and legibility of medication information. Following EMMS implementation, staff reported improvements in these areas. However, the EMMS was perceived to drive thoroughness (safety) benefits at the expense of efficiency (time). Measures to improve safety in the EMMS enforced processes that required time, such as medication double-checking procedures. Conclusions Overall, staff were aware of the competitive interplay between thoroughness and efficiency and reported that introduction of an EMMS had imposed processes that favoured improvements in thoroughness at the expense of efficiency.

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Codeveloping an effective EMPA to maturity in an acute NHS Trust: an implementer report

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2021-100477 ◽

2022 ◽

Vol 29 (1) ◽

pp. e100477

Author(s):

Geeth Silva ◽

Tim Bourne ◽

Graeme Hall ◽

Shriyam Patel ◽

Mohammed Qasim Rauf ◽

...

Keyword(s):

Big Bang ◽

Error Rates ◽

Alternative Methods ◽

Electronic Prescribing ◽

University Hospitals ◽

Clinical Workflow ◽

It Systems ◽

Agile Approach ◽

The Big Bang ◽

Roll Out

IntroductionUniversity Hospitals Leicester has codeveloped, with Nervecentre, an Electronic Prescribing and Medicines Administration System that meets specific clinical and interoperability demands of the National Health Service (NHS).MethodsThe system was developed through a frontline-led and agile approach with a project team consisting of clinicians, Information Technology (IT) specialists and the vendor’s representatives over an 18-month period.ResultsThe system was deployed successfully with more than a thousand transcriptions during roll-out. Despite the high caseload and novelty of the system, there was no increase in error rates within the first 3 months of roll-out. Healthcare professionals perceived the new system as efficient with improved clinical workflow, and safe through an integrated medication alert system.DiscussionThis case study demonstrates how NHS trusts can successfully co-develop, with vendors, new IT systems which meet interoperability standards such as Fast Healthcare Interoperability Resources, while improving front line clinical experience.ConclusionAlternative methods to the ‘big bang’ deployment of IT projects, such as ‘gradual implementation’, must be demonstrated and evaluated for their ability to deliver digital transformation projects in the NHS successfully.

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Screening, diagnosing and treating deafness: the knowledge and conduct of doctors serving in neonatology and/or pediatrics in a tertiary teaching hospital

Sao Paulo Medical Journal ◽

10.1590/s1516-31802009000200002 ◽

2009 ◽

Vol 127 (2) ◽

pp. 61-65 ◽

Cited By ~ 5

Author(s):

Patrícia Colozza ◽

Adriana Ribeiro Tavares Anastasio

Keyword(s):

Hearing Loss ◽

High Risk ◽

Teaching Hospital ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Cross Sectional ◽

Pediatric Residents ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital ◽

Human Disorder

CONTEXT AND OBJECTIVE: Infant hearing deficiency is a human disorder with devastating effects and serious implications for the development of speech and language. Early diagnosis of hearing loss should be the objective of a multidisciplinary team, and early-intervention programs should immediately follow this. The aim of this study was to investigate the knowledge and conduct of pediatricians and pediatric residents in a tertiary teaching hospital regarding deafness. DESIGN AND SETTING: Cross-sectional study in a tertiary hospital in the state of São Paulo, Brazil. METHODS: Eighty-eight questionnaires were randomly distributed to pediatricians and pediatric residents. RESULTS: Thirty-six questionnaires were analyzed. Most respondents (61.1%) were residents in pediatrics and/or neonatology. Eighty-three percent of them performed special procedures on babies presenting a high risk of deafness, and 55% reported that they had no knowledge of techniques for screening hearing. Most of them were unaware of the classifications of level and type of hearing loss. According to 47.2% of them, infants could begin to use a hearing aid at six months of age. Most of them reported that infants could undergo hearing rehabilitation during the first six months of life, and all respondents stated 's responsibilities. CONCLUSIONS: Even though most of the participants followed special procedures with babies presenting a high risk of deafness, they did not routinely investigate hearing. All respondents believed that it is a doctor's responsibility to be concerned about child communication.

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Implementation of an Electronic Medication Management System in a large tertiary hospital: a case of qualitative inquiry

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01584-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Milan Rasikbhai Vaghasiya ◽

Jonathan Penm ◽

Kevin K. Y. Kuan ◽

Naren Gunja ◽

Yiren Liu ◽

...

Keyword(s):

Implementation Strategy ◽

Medication Management ◽

Implementation Process ◽

Clinical Information ◽

Healthcare Facility ◽

Tertiary Hospital ◽

Qualitative Inquiry ◽

Design Issues ◽

Implementation Team ◽

Patient Centric

Abstract Background Hospitals across Australia are implementing Clinical Information Systems, e.g. Electronic Medication Management Systems (EMMS) at a rapid pace to moderate health services. The benefits of the EMMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy that was based on the guiding principle of “one patient, one chart” to avoid a patient being on a hybrid medication chart. This paper aims to study the factors facilitating or hindering the adoption of the EMMS as viewed by clinicians and the implementation team. Methods Four focus groups (FG), one each for (1) doctors, (2) nurses, (3) pharmacists, and (4) implementation team, were conducted. A guide for the FG was based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Results A total of 23 unique subthemes were identified and were grouped into five main themes (1) implementation strategy, (2) organisational outcome of EMMS, (3) individual impact of EMMS, (4) IT product, and (5) organisational culture. Clinicians reported improvement in their workflow efficiency post-EMMS implementation. They also reported some challenges in using the EMMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMMS implementation, namely: (1) the patient-centric implementation strategy, and (2) the organisation readiness. Conclusion Overall, this study outlines the implementation process of the EMMS in a large healthcare facility from the clinicians’ and the implementation team’s perspectives using UTAUT model. The result suggests that clinicians’ acceptance of the EMMS was highly influenced by the unique implementation strategy (namely, patient-centric approach and clinical leadership in the implementation team). Whereas the level of adoption of EMMS by clinicians was determined by their level of perceived and realised benefits. On the other hand, a number of barriers to the adoption of EMMS were discovered, namely, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems. It is suggested that promptly resolving these issues can improve the adoption of the EMMS.

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Factors Impacting CTCA Quality in a Major Tertiary Teaching Hospital

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.06.212 ◽

2021 ◽

Vol 30 ◽

pp. S189

Author(s):

I. Button ◽

J. Bradley ◽

R. Roberts-Thomson ◽

B. Lorraine

Keyword(s):

Teaching Hospital ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

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Tube Feeding Practices and Transition to Breastfeeding Experiences of Mothers of Preterm Infants at a Kangaroo Mother Care Unit of a Tertiary Hospital in South Africa

Global Pediatric Health ◽

10.1177/2333794x211037032 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110370

Author(s):

Sphiwe Madiba ◽

Malmsey Sengane

Keyword(s):

South Africa ◽

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Tube Feeding ◽

Feeding Practices ◽

Tertiary Hospital ◽

Very Preterm Infants ◽

Mothers Of Preterm Infants ◽

Group Interviews

To receive human milk, most preterm infants initially receive the mothers’ expressed milk through a nasogastric tube. However, breast milk feeding the preterm infant and making the transition to direct breast-feeding come with significant challenges. The study explored and described the experiences of mothers of preterm infants regarding initiation and expressing breast milk, tube feeding practices, and transition to breastfeeding during the infants’ stay in a kangaroo care unit (KMC) of an academic hospital in South Africa. Using a qualitative design, focus group interviews were conducted with 38 mothers of preterm infants after discharge from the neonatal intensive care unit (NICU). We analyzed transcripts following the 5 steps for qualitative thematic data analysis. Tube feeding and breastfeeding preterm infants was challenging and exhausting for the mothers. Many described their experiences of initiating expression and sustaining milk supply as negative. They had constant concerns about their ability to produce adequate milk volumes to feed their infants. They had immense dislike of expressing, which they described as physically exhausting, stressful, and painful. Those who had initiated breastfeeding were highly motivated to breastfeed their preterm infants. They described breastfeeding as a positive bonding experience that they derived pleasure from. The mothers’ dislike of expressing was overshadowed by their emotional obligation toward their preterm infants. Although the KMC unit promotes breastfeeding, mothers encountered problems and struggled to initiate expression and sustain milk production. Mothers of extreme and very preterm infants need support to continue with milk expression during the long NICU and KMC stay.

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Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study

Nutrients ◽

10.3390/nu13020314 ◽

2021 ◽

Vol 13 (2) ◽

pp. 314

Author(s):

Shelley Roberts ◽

Wendy Chaboyer ◽

Zane Hopper ◽

Andrea P. Marshall

Keyword(s):

Patient Satisfaction ◽

Patient Engagement ◽

Early Discharge ◽

Nutritional Risk ◽

Dietary Intakes ◽

Intervention Delivery ◽

Nutrition Care ◽

Tertiary Teaching ◽

Hospital Patients ◽

Tertiary Teaching Hospital

Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.

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