E-Prescribing in SWLStG Mental Health Trust

Over the past year South West London and St. George’s Mental Health NHS Trust (SWLStG) has achieved a major reduction in prescription errors and saved over £400,000 with the help of WellSky’s Electronic Prescribing and Medicine Administration (EPMA) solution which supports medicines management in NHS Trusts, homecare and crisis management services.

Based at Springfield, Queen Mary’s and Tolworth Hospitals in South-West London, the Trust serves five boroughs with a total population of 1.1 million. In May 2016 SWLStG began implementing WellSky EPMA to increase patient safety and business efficiency prescribing in medicines management.

The system went live in early 2017.

“With System C’s EPMA I can see exactly what my patients are treated with, and prescribe wherever and whenever I’m working. Given our three separate hospital sites and 22 wards, with paper-based system it took time for prescriptions to move from the wards to dispensary then back to the patient.

It also meant the process of auditing if drugs had been signed-for and administered on time could take several days. With real-time data continually updated on a central server, we can now check this in a matter of minutes and have almost eliminated unintended missed doses.”
Dr. Sean Whyte, Consultant Psychiatrist, Clinical Director at the Trust & Clinical Lead for the EPMA project

Finding the right system

The Trust already had basic e-prescribing bundled into its EPR system but wanted a more robust, function-rich alternative that could support the paperless workflow across the hospitals and remotely. At the time the only EPMA provider with an operational system in a mental health Trust was WellSky, which enabled the project team to gain valuable support from System C’s long-established site, Leicestershire Partnership NHS Trust.

Says Katy McLachlan, SWLStG’s Advanced Specialist IT Pharmacist: “The fact they had been down the CMM EPMA road before us and has a similar environment helped to jumpstart our development.”

“By reducing selection errors and discouraging over-used or non-compliant medication orders, defaults help deliver safe and best practice care while reducing drug costs.”
Katy McLachlan, Advanced Specialist IT Pharmacist at SWLStG

Reducing prescription errors

Because System C’S EPMA replicates the paper chart environment, the transition to EMPA was swift. The training rollout to the Trust’s 1000 clinical staff included best practice procedures for working within a computerised environment which has contributed to the reduction in medicines related incidents.

The system also removes errors associated with bad handwriting and manually transposed drug charts (consuming several months of medical & pharmacist time per year). All drug and patient information is centralised (and automatically duplicated to prevent workflow interruptions and data loss), for access by qualifying clinicians via ward screen or remotely, and enables routine and ad-hoc clinical, regulatory and business reports to be generated automatically.

Says Dr. Whyte: “Previously medicines reconciliation and clinical audits involved nurseshad to walk miles between wards and buildings and took up to 25 hours a month, with stock checking requiring many more hours per week. We estimate we’ve cut this time by up to 80%. And though we started with a low prescription error rate, System C EPMA has helped reduce it by well over 50%.

Offsite medicines management

System C

EPMA also supports homecare and community services. Instead of returning to the hospital for authorisation or waiting for a doctor’s signature, nurses can discuss patient needs by telephone and doctors can order prescriptions remotely from their laptop; vital in time-critical situations like clozapine dose titration. Obviating the need to admit patients simply to administer medicines can also save up to £450 per bed night.

Next steps

The Trust estimates that since system go-live it has already achieved the equivalent of over £400,000 in staff hours and vastly more in the
value of clinician and pharmacist time.

Soon the dispensary will be connected up to complete the paperless flow from doctor to pharmacy to nurse to back to patient. SWLStG is also currently upgrading to the new web based WellSky EPMA which delivers additional functionality including dose range clinical checking and support for electronic prescribing of depot injections for community patients.