The Importance of Local Records in Improving Patient Outcomes – the Wirral Example

Patrick Reed, Director of Informatics

Wirral Health Informatics Service

Jump to first page

Current Systems PCIS – used across whole Trust to support

administration and clinical care Departmental systems e.g. Triple G, JAC etc all

interfaced to PCIS EDR – our data repository which hold every

transaction that occurs on PCIS EHR – the Wirral wide Electronic Health Record WROCS – a remote ordering system used by GPs

across the WirralAll have in common: Ongoing involvement of clinicians Multidisciplinary use Good standards of security and confidentiality Integral to ways of working

Jump to first page

PCIS Decision Support Incorporate National or Local

Guidance into ordering pathways Promote best practice Reduce unnecessary/inappropriate

investigations

Jump to first page

Introduction of Pre-Op Chest & Radiology Guidelines

Total Number of Chest a/o Ribs Examinations by Quarter (all indications)

(General Surgery/Orthopaedics/Gynaecology)

200

1200

1000

1400

800

600

400

0

Q192

Q292

Q392

Q492

Q193

Q293

Q393

Q493

Q194

Q294

Q394

Q494

Q195

Q295

Q395

GYN

ORTH

SURG

Jump to first page

Electronic Prescribing One of the big successes of EPR project Clinician buy in from day one Improved patient safety

Legibility Supports getting product and dose correct

first time Decision support Involvement of risk management

Improved Medicines Management processes

Jump to first page

Methotrexate Pathway Can only prescribe oral Methotrexate

e.g. for Rheumatoid Arthritis User can select dose Will be prompted for a start date Then they only have one option for

frequency – once weekly

Jump to first page

Methotrexate Pathway

*All prescriptions free-typed93.5% adherence to prescribing pathway

1 (0.1)30 (3.9)Number of Errors (%)

878758*Number of Prescriptions

After Pathway Introduced

(11/03-10/04)

Before Pathway Introduced(7/02-6/03)

Jump to first page

Paediatrics Pathway High rates of prescribing errors in

Paediatric patients Very limited margin for error

Small number of drugs accounted for majority of prescriptions

Radical overhaul of Paediatric Prescribing Pathways

Re-audit to evaluate effect

Jump to first page

Impact Of Paediatric Screens On Non-PaediatricianPrescribing

Correct Incorrect Error Rate

Main System 8 20 71%

Paed System 102 5 4.6%

Impact Of Paediatric Screens On Paediatrician Prescribing

Correct Incorrect Error Rate

Main System 51 12 19%

Paed System 112 8 6.6%

Jump to first page

Formulary Management Supports Formulary Management

process Enables Trust to control escalating

Drug costs Encourages prescribing of most cost

effective therapy But does not formulate policy…..

Jump to first page

H2 Antagonist Usage

0

5000

10000

15000

20000

25000

30000

35000

40000

Time (months)

£ Nizatidine

Ranitidine

Jump to first page

Wirral EHR Contains data from primary and

acute care settings Read only, reference system Supports continuing care across

boundaries A&E and IP discharge summaries Pathology and radiology results Appointments and TCIs

Jump to first page

Jump to first page

Jump to first page

Jump to first page

Wirral EHR Benefits 1 Joined up working between

organisations Accessing patient information from a

single source Quicker access to some information ie x-

ray Better patient treatment/journey, reduced test duplications

Knowing what allergies and recent/repeat medication history (especially for 24hr emergency services)

Providing community services with patient information (instead of faxes and letters)..

Jump to first page

Wirral EHR Benefits 2 Improvements around administration in GP practices, less phone calls to lab Reduction in phone calls to A+E for

CAS card Improved clinical interaction Increased access to information Quality improvement for patients Support services ie Quality Outcomes

Framework…

Jump to first page

WROCS Wirral Remote Order Communication System

(WROCS) Allows users in primary and community settings to

order pathology and radiology investigations More efficient ordering – no request forms Reduces effort in lab and radiology reception Reduces duplication of investigations Results are sent electronically to GP systems, PCIS

and EHR Secondary care clinicians can see results on

admission e.g. MRSA screening Patients can have investigations performed before

OP appointments and the results are then available for review during the consultation

Jump to first page

Jump to first page

Jump to first page

Summary Provides information for improving

services and care. Implementing pathways and

guidance. Reducing risk – prevent errors. Share patient information to reduce

duplication and speed up access.