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Health

How clinical staff are helping to shape our future hospitals

Pharmacists on the wards. Photo Steven Barber

The pace and scale of digital change at University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) over the past few years has been staggering, transforming both patient care and experience.

Simon Roser is one of seven clinical members of staff who are helping to drive forward UHMBT’s vision that patient care is paper-free from the point of admission to discharge.

Simon started his role as Clinical Prescribing Pharmacist and Pharmacy Lead for IT in 2017. He led on the design and implementation of the Trust’s current online prescribing system ‘Electronic Prescribing Medicines Administration (EPMA)’, which went live across the Trust’s three main hospital sites in April 2018.

“The ability to search our electronic prescribing system via synonym, as well as drug name, has been a game-changer and has helped staff to find medication quicker. It has also reduced the potential risk of prescribing the wrong drug by highlighting which drugs are appropriate for different groups of patients, improving patient safety. Additionally, the inclusion of preconfigured prescribing order sentences has further improved user experience, improved decision support and benefitted patient safety further.” Simon says.

A midwife using the EPR. Photo Steven Barber

Hundreds of thousands of medicines have been prescribed electronically since the launch of EPMA and it has provided multiple benefits including staff being able to view patients’ electronic records across all three hospital sites and remotely, reducing staff travel time and associated costs to and from the sites which would have occurred when accessing a paper record. Patient safety has also been improved by alerts on the system which flag up when patients have particular allergies and when a patient needs a particular medication dose to avoid missed doses.

Simon adds: “There are so many benefits to electronic prescribing. We can now reuse patient data so clinicians involved in their care can see their previous admission history, and even access their GP records so they can see what medications they are currently taking – staff are not having to ask patients the same questions multiple times so it is also improving patient experience.”

The Trust’s IT systems are now linked better with other health organisations across the bay through systems such as the Analytic Command Centre at the Royal Lancaster Infirmary which is aiding patient flow meetings, giving staff live information of patients throughout their hospital stay, from incoming patients travelling via ambulance to patients waiting for discharge home.

A fundamental moment for the Trust was the introduction of the Lorenzo Electronic Patient Record (EPR) in 2010 and benefits have included:

Around 7,500 users are now on Lorenzo reducing the amount of paper used
More than 80% of outpatient clinics do not need paper notes improving patient care and experience. The EPR flags safeguarding needs for patients who are frequent fallers or have had infections and staff can access a patient’s history meaning they don’t have to ask for the same information twice
The diabetes outpatient department is now 100% paperlite with other services close to this target improving the Trust’s carbon footprint.
Melanie Waszkiel, an Orthoptist, started her role as EPR Clinical Lead 10 years ago and has helped to shape the EPR in outpatients and theatres and the nursing digital record, as well as working with individual departments to help standardise documentation and allow staff easier access to the patient records.

Mel said: “Every day is different, as well as being involved in a number of different projects such as ePrescribing and eRequesting I also work with clinicians to look at how we can move from paper to digital and how we can improve their experience of working digitally which can be a huge change in practice. I am also a Clinical Safety Officer, so I have to assess the risks and issues for every project as well as reviewing any clinical safety issues identified during everyday use of clinical IT systems.

“​I think it is really important to involve clinical staff in shaping the systems – it is a big learning curve for clinical staff to understand the technical aspects as to what can and can’t be done and there are always competing priorities which I think clinical staff need to be involved with. Things have changed since there has been clinical involvement but with an Electronic Patient Record – it is vital for the evolution to involve clinical staff as processes change. When I initially joined there were two clinical staff – we now have seven.”

From nurses carrying out comfort rounds using iPods to midwives using laptops remotely to access the latest information relating to a woman’s care – we can see how firmly embedded technology is within local healthcare.

Karen Bridgeman works closely with the Health Informatics Team to develop the EPR in the maternity setting through her role as Digital Midwife. This change has allowed community midwives to use mobile laptops when they visit a woman, access previous notes and update them there and then.

Karen along with Kathleen Holmes is also working on a maternity app for the Trust which will allow women to access to pregnancy information and also their pregnancy records in the comfort of their own home without making unnecessary calls and trips to the hospital.

Karen said: “The digital roadmap for maternity is constantly evolving at UHMBT. I am passionate about using technology to make the pregnancy journey easier for women and their families. I also want to be an advocate for the clinicians to ensure the system suits their workflow. Giving women access to their pregnancy notes enables them to be in control of their care and allows them to provide information to other services if they go outside UHMBT. Increasingly we are working closely with the local maternity services (four local trusts) and primary care services to enable sharing of information, with the vision to enable a safer transfer of care across the local trusts. This provides a wider choice of care across the local area.”

Colin Brown, Chief Clinical Information Officer, UHMBT, added: “Having the input of clinical staff is pivotal in order to shape our hospital systems so they work the best that they can for staff to enable them to provide great and safe care for our patients. We have seen some tangible benefits since introducing the EPR which have helped to give our patients a better experience of our hospitals.”

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