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.

Special requirements in UCV theatres.

Graeme Hall FIHEEM, MIET, managing director of Brandon Medical, considers in detail the particular requirements and criteria for operating lights used in ultraclean ventilation (UCV) theatres, and explains how the recent establishment of a standard for testing of lighting's suitability for such theatre environments will help designers and manufacturers, as well as those specifying UCV theatre illumination, going forward.

Managing plantation forests to provide short- to long-term supplies of wood to streams: a simulation study using New Zealand's pine plantations.

Riparian functions such as the recruitment of wood to streams take decades to recover after a clear-fell harvest to the stream edge. The implications of two sets of riparian management scenarios on the short- and long-term recruitment of wood to a hypothetical stream (central North Island, New Zealand) were compared through simulation modeling. In the first set (native forest buffer), a designated tree-less riparian buffer was colonized by native forest species after a pine crop (Pinus radiata) had been harvested to the stream bank. In the second set (pine to native forest buffer), native forest species were allowed to establish under the pine canopy in a designated riparian buffer. In general, the volume of wood was greater in streams with wider buffers (5-m to 50-m) and this effect increased with forest age (800 years). The pine to native forest buffer supplied more wood to the stream more quickly, and matched the long-term supply to the stream from the native forest buffer. For the native forest buffer, total wood volume was minimal for the first 70 years and then increased uniformly for the remainder of the simulation. In contrast, the pine to native forest buffer produced a bimodal response in total wood volume with the initial sharp peak at year 100 attributed to pine recruitment and a second more gradual peak lasting for the rest of the simulation, which was similar to levels in the native forest simulations. These results suggest that existing plantations could be an important source of wood to the stream during the first 100+ years of native forest development.

Air flow disruption must be minimised.

Operating theatre lights are known to affect the air flow in ultra clean ventilation systems and it is important that specialist luminaires are designed to minimise the disruption of air flow. This paper explains the results of tests carried out during actual surgical interventions using reticulated operating theatre lights and examines the implications of new NHS recommendations on the future use of UCV ceilings.

Analysis of the growth of rimu (Dacrydium cupressinum) in South Westland, New Zealand, using process-based simulation models.

Two process-based models were used to identify the environmental variables limiting productivity in a pristine, mature forest dominated by rimu (Dacrydium cupressinum Sol. ex Lamb.) trees in South Westland, New Zealand. A model of canopy net carbon uptake, incorporating routines for radiation interception, photosynthesis and water balance was used to determine a value for quantum efficiency when climate variables were not limiting. The annual net carbon uptake by the canopy was estimated to be 1.1 kg C m(-2) and the quantum efficiency 22.6 mmol mol quanta(-1). This value of quantum efficiency, combined with other parameters obtainable from the literature, was then used in a model of forest productivity (3-PG), to simulate changes in net productivity and the allocation of carbon to tree components. The model was adjusted to match a measured stem increment of 10.6 Mg ha(-1) over a period of 13 years. To achieve this while maintaining a low, but stable value for leaf area index, it was necessary to set the site fertility rating very low and select high values for the parameters describing the proportional allocation of total carbon to roots. This approach highlighted nutrient availability as the principal constraint on productivity for the ecosystem and identified critical measurements that will be necessary for using the model to predict the effects of climate change on carbon sequestration. The low rates of carbon uptake and productivity are consistent with the low nutrient supply available from the highly leached, acid soils, most likely attributable to frequent saturation and a very shallow aerobic zone.