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Use of the JAC electronic prescribing system to facilitate audit data collection

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 . Overview. Two audits performed eight months apart

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Use of the JAC electronic prescribing system to facilitate audit data collection

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  1. 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

  2. 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

  3. Dr. Richard Hughes, BHH Nov 2003

  4. Clinical Problem Thromboprophylaxis in high risk surgical patients Dr. Richard Hughes, BHH Nov 2003

  5. 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

  6. Audit 1 - Manual data collection Dr. Richard Hughes, BHH Nov 2003

  7. Efficiency – Audit 1 • Manual audit collection • 20 minutes per patient • 114 patients • 38 hours i.e. SLOW Dr. Richard Hughes, BHH Nov 2003

  8. Interpretation problems Dr. Richard Hughes, BHH Nov 2003

  9. 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

  10. 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

  11. Dr. Richard Hughes, BHH Nov 2003

  12. 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

  13. 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

  14. Manual data collection • Outstanding Data • Operation date and time • Procedure Dr. Richard Hughes, BHH Nov 2003

  15. 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

  16. CACHÉ Post relational database 1. Drug File 2. Patient File 3. User File JAC prescribing system JAC electronic prescribing 1. Prescribing record 2. Administration record 3. Dispensing record Dr. Richard Hughes, BHH Nov 2003

  17. Manual data collection • Outstanding Data • Operation date and time • Procedure Dr. Richard Hughes, BHH Nov 2003

  18. Operation Code Format Procedure Date Time . ABCD 131103 1130 Dr. Richard Hughes, BHH Nov 2003

  19. Operation Codes Operation Code Lobectomy LOBE Pneumonectomy PNEU Wedge resection WEDG Open Biopsy OPBI Oesophagectomy OESO Decortication DECO VATS VATS Mediastinoscopy MEDI Bronchoscopy only BRON Oesophagoscopy OSCP Other major OTMA Other minor OTMI Dr. Richard Hughes, BHH Nov 2003

  20. Dr. Richard Hughes, BHH Nov 2003

  21. Dr. Richard Hughes, BHH Nov 2003

  22. Dr. Richard Hughes, BHH Nov 2003

  23. Manual data collection Dr. Richard Hughes, BHH Nov 2003

  24. CACHÉ Post relational database 1. Drug File 2. Patient File 3. User File JAC prescribing system JAC electronic prescribing 1. Prescribing record 2. Administration record 3. Dispensing record Crystal reports Dr. Richard Hughes, BHH Nov 2003

  25. 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

  26. Select required tables • Active patients • Patient basic • Clinical notes • General users Dr. Richard Hughes, BHH Nov 2003

  27. Dr. Richard Hughes, BHH Nov 2003

  28. LOBE 131103 1100 Dr. Richard Hughes, BHH Nov 2003

  29. Dr. Richard Hughes, BHH Nov 2003

  30. Dr. Richard Hughes, BHH Nov 2003

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

  32. Results – Audit 2 Dr. Richard Hughes, BHH Nov 2003

  33. 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

  34. Other potential uses • Countless other uses in clinical audit • Pain audit • Reviewing analgesic prescribing and administration Dr. Richard Hughes, BHH Nov 2003

  35. Weaknesses • Only as accurate as the data already in caché • Relies on accurate input of coded information • Manually inputted reasons for non-administration not analysed Dr. Richard Hughes, BHH Nov 2003

  36. 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

  37. Questions? Dr. Richard Hughes, BHH Nov 2003

  38. Thank You! Dr. Richard Hughes, BHH Nov 2003

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