Harnessing the power of collaborative working to optimise the electronic patient record systems across south east London 

In October 2023, two large NHS teaching trusts in south east London launched a new electronic health record. Within each trust, a single electronic health record was already allowing different care settings to align (e.g. critical care areas, accident and emergency departments and community teams using the same system), representing a significant reduction in risk to patients when transferring between care areas and across multiple health record systems. With the two trusts now also using the same electronic health record, an opportunity was identified by the pharmacy departments to align and standardise key clinical pharmacy processes across all sites.

With each trust being a renowned tertiary referral centre for a range of clinical specialties — from hepatology to paediatrics to complex cardiac and respiratory — the collaboration brought together a south east London pool of specialist pharmacy professionals across a broad spectrum of clinical areas, achieving wide consultation and consensus on the best way to harness the functionality within the electronic health record to optimise care. By sharing best practice, we have developed and standardised a suite of collaborative standard operating procedures (SOPs) which cover the clinical pharmacy processes and workflows, from the point of admission to discharge. This includes medicines reconciliation, inpatient clinical screening and the processing of prescriptions for discharge and accompanying discharge summaries. A collaborative approach to establishing shared metrics and reporting systems has also facilitated meaningful benchmarking against national standards between trusts.

Standardisation has had multiple benefits across the trusts and beyond, most notably at the point of patient transfer, ensuring that information is complete and accurate and reducing the risk associated with medication errors. Standardisation of the placement of information in the electronic health record allows for outstanding tasks and monitoring requirements to be clearly handed over between pharmacy teams when patients move between wards, minimising the need for reconciliation of medication histories for inter-hospital transfers between the two trusts. A subsidiary benefit to improved patient care has also been a reduced training burden on staff who may often rotate through hospital sites and even between the trusts as part of the ‘Structured Training for Pharmacists’ (STEP) programme. 

A multi-faceted approach was used across both trusts for training to accompany the launch of procedures, thereby ensuring that staff were trained to the same standard and adopting updated practice simultaneously. This included the creation of a training patient profile and recording a series of training videos, using the same patient case, to work through the patient journey and the content of SOPs related to each stage (i.e. from medicines reconciliation to discharge documentation). Q&A sessions were held, open to all across both trusts, with a spreadsheet hosted for the posting of questions relating to SOPs. This was checked and updated daily by the authors providing written answers to questions and staff feedback was used to inform decisions about immediate refinements or revisions for future versions.  

Benefits have also stretched beyond the hospital walls, leading to a rise in the quality and completeness of shared information and supporting our colleagues in primary care to easily locate required information relating to patients’ pharmaceutical care needs. To establish consistency, we engaged with the South East London Integrated Care Board and considered feedback from care services across the local boroughs on the quality of information transferred.

The collaboration of two large trusts to standardise and align ways of working inevitably brings its own set of challenges alongside opportunity.

One of the biggest challenges is the longer timeframe to progress and ratify procedures, as consultation must take place across both trusts, requiring specialist input across both organisations. While this extended process may impede on desired timelines, it ultimately delivers significant benefits by strengthening the quality and scope of the finalised procedures. Compromises have, at times, been necessary with consensus reached through a shared commitment to delivering consistent, high-quality and standardised patient care. It is recognised that some minor site-specific nuances will be necessary and distinct within each trust’s procedure (e.g. multi-compartment compliance aids); however. these are only embedded after thorough consideration of whether they are truly essential. This ensures that the primary objective of the collaboration remains at the forefront, bringing together the best of both trusts to standardise care for patients across south east London.

The focus of the next phase of work is to extend the partnership into an optimisation phase. Each trust has its own dedicated cohort of digital champions, and formally pooling these resources could enable a more structured and sustained realisation of shared benefits, many of which have already begun to emerge organically. Another longer-term ambition is to extend shared metrics to a wider pool of NHS trusts utilising the same electronic health record. While variation is expected owing to local differences and stages of digital maturity, promoting a nationally consistent methodology would further strengthen benchmarking capability. Building on these models will further strengthen joint working, patient safety and support the ongoing optimisation of digital systems in the delivery of patient care.

Renita Bindra, principal pharmacist, clinical services, King’s College Hospital NHS Foundation Trust

Stephen Prestwich, principal pharmacist, clinical services, King’s College Hospital NHS Foundation Trust, Princess Royal University Hospital and South Sites

Anna Szmigin pharmacist, Guy’s & St Thomas’ NHS Foundation Trust