“What’s wrong with a piece of paper?”

The Electronic Transfer of CarePrincess of Wales Hospital

Rowena Lewis

Electronic Transfer of Care (e-TOC) Clinical information Medication information Sent electronically to GP

10 medical wards over two sites 2 mental health wards 2 orthopaedic wards

The situation that had to change “Mind the gap!” Carbon copy paper take-home prescription Patient had to transfer information

Varying clinical summary sent or not sent at all

GPs asked for better communication

Aims of e-TOC project Improve discharge communication from

hospital to primary care. Improve patient safety and reduce clinical risk

by providing better medication information to GPs.

GPs to receive in a timely manner with a target of 80% discharge summaries within 5 working days.

Objectives Carbon copy → typed medication list Transfer electronically to GP immediately Reasons why medicines are started and

stopped - NICE/NPSA medicines reconciliation

Provide GP with full clinical details in uniform format

Method Designed by clinicians Produced by our IT

department Accessed via PIMS+ Hospital wide wireless

network

Ward Process Junior doctor enters initial information Updated during patient stay Doctor marks “ready for discharge” Pharmacist verifies medication list Junior doctor completes clinical info Consultant approves it for GP

Implementation One ward pilot Many improvements made initially

Dosage codes taken from the pharmacy system Colours and symbols distinguish between new,

changed and stopped medicines Format of printed list of medication to improve

clarity Screen icons to aid communication between staff Laminated crib sheets Helpful hints boxes

Key Success Factors Gradual roll out Dedicated project manager Multidisciplinary training sessions Regular feedback from all users

Key Success Factors Frequent updates to system Regular audits of doctors input On site IT support Determination to succeed

Training within Pharmacy Pharmacist users

Entering medication Verifying medication Signing off medication Trouble shooting Regular updates Listening to feedback

Ward Technicians Marking drug chart Dispensing from drug

chart Dispensary staff

New format of discharge prescriptions

Printing medication orders

Benefits of e-TOC Patient Pharmacist Doctor Nurse GP

96% of patients have verified medication sections sent to their GP on day of discharge – includes diagnosis and follow up arrangements

Time taken and percentage of discharge summaries received by GPs

0%10%20%30%40%50%60%70%80%90%

100%

Paper system Average of eTOC w ards Best performing eTOCw ard

0510152025303540

Percentage of discharge summaries received by GP

Time taken to receive summary (days)

5.7%

70%

89%

How much have we achieved? Increased number of summaries sent to GPs Improved timeliness of communication to

primary care

Gradual implementation helped acceptance of system in hospital

Have targets been reached? Not achieved on all wards yet! Average is 70% in 9 days Much better than 5.7% in 37 days

Changes to practice have been challenging Sharing workload has helped

Benefits to Pharmacists Medication on e-TOC system prior to

discharge Order function linked to dispensary Access to previous e-TOCs Legible list to give patient at discharge

Lessons learned Thorough training

required Need modern

computers Helpful IT staff

available to assist Regular updates to

system Enthusiasm and

determination

The future Finish implementation across hospital Electronic learning package for users Medication reminder cards Pharmaceutical care plan

Summary Clear communication Greater detail of medication changes Transfer of information to GP is guaranteed