Yes, no? but……..
Whatever else you may say about ePMA it has to be worth £1m a site to get rid of this and all the associated risks doesn’t it?
If it were as straightforward as replacing that with a clear computer screen, I can’t imagine there would be any argument:
So why the but……?
There can be little doubt that illegibility, misinterpretation and not least the complete disappearance of paper drug charts has been responsible for patient harm anywhere on the spectrum between a missed dose to death.
I recently spent a day listening to the experiences of hospitals who have had ePMA for some years and there is much more to ePMA than replacing paper with a screen, mainly because of what goes on behind it.
Three areas that were highlighted that seem to me important for Trusts to be aware of when procuring and implementing ePMA:
1. Will it save time?
The evidence is yes in some areas but not as much as often hoped for in the list of quantifiable benefits and certainly not to start with. Experience included the successful redeployment of pharmacist and technician time to professional activities rather than searching for drug charts and trying to make sense of them however workflow for nursing staff will be significantly different and will involve doing things differently rather than quicker in many cases.
Being clear about how it will work with current and expected workflows ahead of go – live is really helpful
2. Reduction in errors?
Yes in some contexts but ePMA can be a source of new errors. An example is around the human factor of how a clinician will select from a drop – down box. There is still the potential to put in the first couple of characters and be presented with diazepam rather than diltiazem – and all the other well known couples. These and other unintended consequences are well documented. Interestingly some of these errors reduce over time. Trusts working with ePMA over some years have moved to restricting drop – down lists access and minimising free text. Order sets have helped enormously.Will it work with our other systems?
3. Will it work with other systems?
Stand alone systems are all very well but in clinical practice many decisions need to be taken in the context of the whole picture around the patient. Many of the genuine patient safety benefits come from Advanced Decision Support. But in many cases this requires access to demographics, diagnosis, laboratory results……. So should it actually be integrated with or part of the EPR? Difficulty obtaining such data for hard – pressed clinicians could lead to rejection of the system or unsafe workarounds. One of the key clinician speakers recommended “Integration, integration, integration…” so interoperability and the ownership of the stored data when changing systems is the key to unlocking the safety features.
Holy Grail? No, but………..
There are many lessons that can be learnt from these cautionary tales.
The hope of many Trusts is that overnight ePMA will improve patient safety. The features and functionality sold with the package are easy to believe and promise a panacea to all prescribing and administration ills.
Lets use the experience of the pioneers who can help short circuit some of the pain of discovering the reality that there is no Holy Grail.
Overwhelmingly ePMA is a journey, and once started there is no way back. The devil is in the detail and the further down the road the greater the challenge of getting that detail sorted.
AsePMA advances with the help of those who have travelled the road, it is starting to unlock some of those benefits we thought we would see on day one, albeit in years 5 – 10.
The development of that advanced functionality, integrating prescribing into the total clinical decision-making process must be the goal.
Integration is not just about systems talking to each other, it is about the seamless integration of digital systems into clinical workflow as reliable tools and that is the challenge being faced by pharmacists, nurses, medical staff and suppliers today.
it is in everyone’s interest to work together to achieve that in our continued quest not for the Holy Grail but to provide safe, effective patient care.