Transitioning EPMA applications in a large multisite teaching hospital.

INTRODUCTION: University Hospitals of Leicester (UHL) has co-developed and deployed a novel Electronic Prescribing and Medicines Administration (EPMA) application as part of the trust electronic patient record (EPR) programme that meets specific clinical demands and interoperability standards of the National Health Service (NHS) despite clinical pressures from the COVID-19 pandemic. METHODS: Following an initial limited pilot deployment, a big-bang whole site-based approach allowed transition of 1844 acute adult inpatients beds from an existing standalone EMPA to the new system. This project used a frontline driven and agile management strategy. Clinical risk was managed using a combination of standard risk logs, robust clinical prototyping and robust disaster recovery plans. Early engagement with clinical teams allowed for advanced product configuration before live deployment and reduced the need for sustained transition support for clinical staff. RESULTS: An iterative, well-governed approach, led by a combination of information technology (IT) and clinical staff with a responsive vendor, enabled a complex new EPMA system in a large acute NHS trust to be deployed with limited resources despite the ongoing COVID-19 pandemic. DISCUSSION: The development and deployment of EMPA and EPR systems across NHS trusts is a key enabler for better healthcare delivery. This case study shows it is possible to deploy a new clinical IT system at scale without interruption of clinical services and with a relatively modest deployment team. Sustainability of the project was also ensured through a clear clinically led governance structure to manage risk quickly and carry lessons learnt onto new developments.

Codeveloping an effective EMPA to maturity in an acute NHS Trust: an implementer report.

INTRODUCTION: University Hospitals Leicester has codeveloped, with Nervecentre, an Electronic Prescribing and Medicines Administration System that meets specific clinical and interoperability demands of the National Health Service (NHS). METHODS: The system was developed through a frontline-led and agile approach with a project team consisting of clinicians, Information Technology (IT) specialists and the vendor's representatives over an 18-month period. RESULTS: The system was deployed successfully with more than a thousand transcriptions during roll-out. Despite the high caseload and novelty of the system, there was no increase in error rates within the first 3 months of roll-out. Healthcare professionals perceived the new system as efficient with improved clinical workflow, and safe through an integrated medication alert system. DISCUSSION: This case study demonstrates how NHS trusts can successfully co-develop, with vendors, new IT systems which meet interoperability standards such as Fast Healthcare Interoperability Resources, while improving front line clinical experience. CONCLUSION: Alternative methods to the 'big bang' deployment of IT projects, such as 'gradual implementation', must be demonstrated and evaluated for their ability to deliver digital transformation projects in the NHS successfully.

Constructing high-quality rest facilities to maximise performance and ensure patient safety.

INTRODUCTION: Junior doctors are working in an increasingly overstretched National Health Service. In 2018, Kettering General Hospital (KGH) was awarded £60 800 of government funds to create high-quality rest facilities and improve junior doctor well-being. METHODS: An audit and survey in KGH identified the structural and functional improvements needed. From November 2019 to June 2020, £47 841.24 was spent on creating new rest facilities. On completion, a postaction review assessed how the changes impacted morale, well-being and quality of patient care. RESULTS: The majority of doctors were happy with the new rest areas (60%), a majority felt that they would use the on-call room area (63%) and the renovation improved morale and well-being. There was an increased ability to take breaks. However, the majority of doctors are not exception-reporting missing breaks: 79% (2019), 74% (2020). CONCLUSIONS AND IMPLICATIONS: This report recommends the maintenance of increased staffing levels and rest facilities during the recovery phase of COVID-19. The remaining £12 958.76 should be directed at sustaining the quality of KGH rest facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities ensures workforce well-being and translates into patient safety.

Fatigue & facilities at kettering general hospital the importance of high-quality rest to maximise the performance of junior doctors and ensure patient safety

IntroductionJunior doctors are increasingly working in an overstretched NHS. In 2018 Kettering General Hospital (KGH) was awarded £60,800 of government funds to create high-quality rest facilities and improve junior doctor wellbeing.MethodsThrough auditing doctors working at KGH, alongside consulting senior management, a project initiation document was constructed to spend this money. From November 2019 to June 2020 £46,275 was spent on creating new rest facilities, including separate sleeping and working areas. Furthermore, the purchase of modern furniture and equipment met the functional needs of busy junior doctors. One month after the completion of the project, the team conducted a post-action review by re-auditing how the changes impacted morale, wellbeing and quality of patient care.ResultsNow, the majority of doctors are happy with the current rest areas on offer at KGH (60%), and a majority feel that they will use the on-call room area (63%). Overall, the feedback from both interviews and the JDF was positive and, the renovation improved morale and wellbeing. There was an increased ability to take breaks. However, the majority of doctors are still not exception-reporting missing breaks: 79% (2019), 74% (2020).Lessons LearntWhilst improved rest facilities were welcomed, this report recommends the maintenance of increased staffing levels and fatigue facilities during the recovery phase of COVID-19. The remaining £14,524.38 should be directed at creating shower facilities, upgrading computer hardware and sustaining the quality of KGH fatigue facilities. Lastly, the rate of exception-reporting must be increased through improving awareness, exploring alternative methods and supporting the action when necessary. The continual investment into rest facilities not only ensure workforce wellbeing but undoubtedly translates into the safety of our patients.