Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHFT) is a digital health early adopter and supports patients who are referred to them by around 100 local GP practices and from other acute hospitals and GPs around the country. NNUHFT has been successfully using System C’s Electronic Prescribing and Medicines Administration (EPMA) solution since 2014 and has now rolled out the solution to their Emergency Department (ED) and used it to enhance their GP recommendation and referral letters.

System C’s EPMA solution enables the electronic prescribing, administering and clinical verification of prescriptions to be carried out at all locations within a healthcare setting. It is the most widely used e-prescribing solution in hospitals and community care facilities across the UK. System C’s EPMA uses FDB’s (First Databank) Multilex solution – the UK’s leading clinical decision support solution – for its integrated clinical decision support, which improves patient care and provides a range of context-specific drug knowledge and enhanced functionality that helps to reduce prescribing errors.

A need for a more joined up and safer onwards referral process, and a paper-light Emergency Department

In February 2020, the Pharmacy Department was approached by local Clinical Commissioning Groups (CCGs) who explained that they were unable to work with the handwritten patient recommendation forms that their GPs were receiving from the hospital. The team at the hospital used these forms as patient prescription recommendations and sent them from their clinics to patients’ GPs. The team at the CCG were concerned that the forms were often difficult to read, and they would be unable to accept them going forward.

The EPMA team said that they were willing to explore the possibility of enhancing the system, but that this would take at least six months to a year to complete. The finished project actually took only three weeks, thanks to the hard work of the EPMA team and the team at System C.  Helen Dillon, who heads up the EPMA team at NNUHFT and explains: “We were really keen to reduce medication errors and to protect our patients – and so we started work straightaway. We were not expecting to carry out the project during a pandemic, but we were able to complete our project despite the intense and unexpected pressure from COVID-19.”

The ED at NNUHFT was one of the few areas in the hospital not using System C’s EPMA and the team there were having issues with patients receiving medicines that they were allergic to – sometimes leading to serious incidents. Helen explains: “The team were relying on paper in a heavily pressurised and extremely busy environment. We were trying to solve a problem, as some of our patients were receiving medicines that they were allergic to and there were also issues around the documentation of medicines. With the paper system, if a medicine was given in the ED, it might also be replicated and given again when the patient was moved to a ward. Or conversely, patients would not receive the medicine they needed and would move on to their next location. There were incidences of double doses and missing doses: patients were meant to have antibiotics within the hour and were not receiving them within this timeframe. We needed to sort out duplication and allergies and reduce medication errors in order to enhance the safety of our patients. Deploying System C’s EPMA – with integrated clinical decision support from FDB – seemed like the obvious answer.”

New ways of working – developing and deploying successful solutions during the COVID-19 pandemic

When COVID-19 hit the UK in March 2020, the hospital had to create a whole new way of working. With some staff shielding, appointments were now being carried out by phone and virtually and it was of utmost importance to keep patients as safe and as protected as possible. The hospital wanted to minimise paper transfer, both from a health and safety point of view and in order to enhance and speed up patient care. This would seem like the most unlikely time to develop solutions and deploy them in new areas, but this is exactly what happened at NNUHFT.

New recommendation forms – from concept to reality in three weeks!

Helen Dillon says: “After we had explained to System C the pressing need for electronic recommendation forms from our clinics to GPs, the team there helped us to set up three different types of template: hospital prescriptions, a recommendation template and an FP10HP template. We were really impressed with the team at System C who helped us with the training and creation of the templates.

We then worked out how to use our tracking system to provide access and interfaced the Outpatients department with the tracker – which would flag up new recommendations to staff. We developed training, user guides and ‘how to’ guides, and put out communications to our new users along with a training script. We also carried out virtual training sessions for health and safety reasons. The new solution was adopted really quickly.

We also organised training and information for the Pharmacy Department so they would know how to process. The Pharmacy department would then deliver medication to patients’ homes.

From a patient safety point of view, people were aware of being prescribed to within four hours and it meant the GP recommendations were no longer hand-written. This was tested with GPs and the feedback was excellent!”

Helen continues: “It was quite extraordinary how easy the clinicians found using the new solution – they all said that the outpatient module was so easy to use. Before, consultants had always been reluctant to engage – but they all fed back that the solution was a lot more intuitive than they had expected.”

Successful go-live with System C’s EPMA in the Emergency Department

Helen says: “We initially wanted to roll out EPMA over two years ago – but this had been delayed amid concerns that it would slow down consultants in this pressurised environment – as our emergency department is constantly under pressure. We began work on interoperability with the GP clinical systems, starting with a simple scope then expanding. Now, using HL7 messages[1] we can admit and discharge patients electronically to the ED and this is sent to CareFlow EPMA – enabling users to admit the patient in ED and later discharge them.

The Go Live went amazingly well! We got such good feedback from medical teams that it was simple and intuitive. The clinical decision support within the EPMA solution was excellent, and the feedback from our teams showed they were very impressed.”


The benefits to the hospital for both deployments have been quite clear. Helen Dillon explains: “It’s changed our way of working and has enhanced patient safety, without a doubt. There are far fewer dispensing errors and dispensers and nurses can now read the prescriptions. Before, it was very easy to make a mistake – for example with dermatology drugs. Durations are now much easier as well, as well as being able to see who actually prescribed the medication.  In the ED, patient safety incidents have also decreased hugely.

It has removed a huge amount of duplicated paperwork and means that the patients’ medications are all logged and clinically checked – so no missed doses, duplicated doses or interactions, because of the clinical decision support.

System C’s latest version is web-based and everyone has seen the benefits. Feedback from nurses from prescribing their Patient Group Directions in the ED, is that it helped them with which prescription to choose from. The latest version of EPMA is so good and we had lots of feedback about how intuitive it was.

Before deploying the solution in both ED and for referrals, we would spend a lot of time on the phone to clarify prescribing – this is no longer the case. The team at System C has been excellent at supporting our improvement work and we are delighted with the depth of clinical decision support within the EPMA solution provided by Multilex.”


[1] HL7 Messages are used to transfer electronic data between disparate healthcare systems. Each HL7 message sends information about a particular event such as a patient admission.


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