How we introduced electronic prescribing during the COVID-19 pandemic

Rushika Patel explains how one of the UK's largest hospitals managed risk and rapidly changing clinical guidance to implement an electronic prescribing and medicines administration system.
drawings of pills on an electronic tablet

In 2018, Barts Health NHS Trust was one of 13 NHS trusts allocated funding to start implementing an electronic prescribing and medicines administration (ePMA) system. My colleagues and I were excited by how the new system would generate clinical data that allow prescribing trends to be analysed and create new pathways for auditing medication use.

However, launching any changes in a large NHS trust can be a massive challenge — even more so during the COVID-19 pandemic, when staff are exhausted and working incredibly hard.

Our first step began in October 2019, when the trust enabled nurses to document their notes and various observations through the trust’s electronic health record. This meant that when ePMA was live, our end users were already familiar with the system.

Then, in August 2021, we began implementing ePMA at the largest of our four hospital sites — the Royal London Hospital. We started here to capture any issues and give us time to fix them before moving to another. We did encounter a host of technical and clinical issues, such as incorrectly assigned smartcard roles and technical glitches with the discharge workflow. We also found that certain medicines were unavailable on the ePMA system, which is an ongoing problem with new COVID-19 treatments emerging rapidly.

However, one of the greatest challenges we faced was implementing the system across ten intensive care units (ITUs) — containing approximately 130 beds — during the pandemic, which meant that, to deliver individual support, we needed to ‘don and doff’ PPE, putting our training staff at risk.

It was challenging to design one system that works for each ITU across all sites … However, it was also extremely important to standardise patient care

It was important to understand that our clinical staff were going through a particularly strenuous time and learning a new system in that environment could be frustrating. We took extra care to be compassionate and deliver the system with empathy.

Another challenge that the pandemic presented was the rapidly changing guidance in clinical practice. This led to a large influx of clinical specialties demanding specific new drugs and care plans be built into the ePMA system in the middle of implementation. So, alongside managing the pressures of implementation, we were also continuing to build the system at the same time.

Despite all these frustrations, under the leadership of Sarah Jensen, chief information officer, and Charles Gutteridge, chief clinical information officer, supported by Louise Hicks, chief nursing information officer, and our chief pharmacist Raliat Onatade, we completed ePMA implementation for all adult inpatient areas on 3 December 2021.

Given the number of ITUs our trust has, and the complexity of drugs which are used, such as sedation and various other continuous infusions, it was challenging to design one system that works for each ITU across all sites at Barts Health. However, it was also extremely important to standardise patient care.

This became especially apparent during ‘go-live’, as our transcribing team went through long days transcribing drug charts in each ITU in PPE. But, thanks to our lead pharmacist Amanpreet Sidhu and deputy lead pharmacist Reena Lal, we had the process completely streamlined by the time we were implementing ePMA at the fourth hospital. We found this process to be vital owing to our tight implementation schedule, where delays could impact future go-live plans.

Immediately, the ePMA system has brought advantages; for instance, being able to prescribe and review medications for patients remotely, which reduces the risk of COVID-19 infection to our staff. Eliminating paper drug charts has also reduced the risk of cross-contamination.

We have also recently begun building reports to understand our progress. Between 26 November 2021 and 6 December 2021, our data shows a total of 357,477 drugs were electronically administered, with paracetamol and enoxaparin the most commonly prescribed through ePMA (see Table). We are able to track who prescribed these, as well as when and how each medicine was administered, at a click of a button. This in itself is an immense achievement.

In the near future, we expect to see many more benefits from ePMA, such as improved patient safety through ensuring more legible and complete prescriptions and increased sharing of real-time data between different disciplines to streamline processes, such as transcription of medication orders.

It is also anticipated that ePMA will help achieve national and local targets, including implementation of National Institute for Health and Care Excellence guidance, antimicrobial stewardship monitoring and preventing ‘never events’, defined by the NHS as “serious incidents that are entirely preventable”.

After implementing ePMA in the four hospital sites within Bart’s Health NHS trust, each with their different demands and clinical specialties, I can confidently say that we learned something new at every site. We supported staff post-implementation and published troubleshooting bulletins, as well as Q&A meetings, to address any problems. Training was central to our success, as well as great team work.

I would encourage other trusts that are looking to successfully implement the ePMA to engage with different disciplines early in the process, to ensure the system works for specialties across the trust and is not specific to one site.

Our adult inpatient areas are now fully electronic, but the real work begins now as we discover new ways to optimise the system and unlock its true potential to streamline our workflows. The ePMA system provides the scope to deliver significant improvements in prescribing practices and could help standardise practice across the trust.

The next step is to roll out electronic prescribing in paediatrics and outpatient areas, which are currently still using paper.

Drug nameNumber of administrations
Nutritional supplements10,973
Macrogol 3350 with electrolytes6,283
Sodium chloride6,130
Table: Top 20 ePMA-administered medications across all four hospital sites at Barts Health NHS Trust

Rushika Patel is an ePMA and specialist pharmacist in infection and immunity at Barts Health NHS Trust

Last updated
The Pharmaceutical Journal, PJ, January 2022, Vol 308, No 7957;308(7957)::DOI:10.1211/PJ.2022.1.122699

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