UHB is being held up as a leading example as the Government today announces a £260 million investment to improve patient safety.
Responding to the Francis report, which called on the NHS to make better use of technology to improve safe, effective care, Health Secretary Jeremy Hunt was today due to unveil the new fund for hospitals.
Last year at least 11 people died in the NHS because they were given the wrong prescriptions. This fund will be used to increase the use of technology which will help stop drugs being prescribed incorrectly because patients notes have been lost.
UHB is already using an in-house developed system that provides a blueprint for other trusts looking to invest in technology through the new fund.
A recent evaluation of the electronic prescribing system showed: a 66% reduction in prescription errors (400-450 each day); total annual savings of £43k (9.5%) in the Critical Care drug budget (£11,681.46 on sedation and £31,549.14 other medications); more than 90% compliance with risk assessment rules for venous thromboembolism for inpatients.
Errors in prescriptions are present in as many as 8% of hospital prescriptions and studies have shown that the use of technology can cut these errors by half.
The new fund will help protect patients by ensuring that doctors and nurses are able to access accurate details about the care of a patient. And it will make a patient’s journey through different parts of the NHS much safer, because their records can follow them electronically wherever they go.
Health Secretary Jeremy Hunt said: “This fund will allow doctors and nurses to make the NHS safer by harnessing the very latest technology.
“In many places, right now, a paramedic picking up a frail elderly woman who has had a fall will not always know she has dementia, because he or she cannot access her notes. Or a doctor is prescribing the wrong drugs, because they don’t know what drugs their patient is already on.
“If we are to improve patient safety then we must allow the NHS to have access to the best tools available and this fund will help them achieve that.”
The fund will be used by hospitals to replace outdated paper based systems for patient notes and prescriptions, and is a critical stepping-stone in helping the NHS go digital by 2018.
It will be primarily used for ‘electronic prescribing’ – which means computer generated prescriptions sent by doctors directly to pharmacies, linked to barcodes unique to each patient. This kind of technology plays a huge part in cutting errors and improving safety.
The fund will also be used for creating electronic systems linked to patient records that talk to each other right across hospitals.
Another example showcased by the DH today is the myhealth@QEHB system developed by UHB where an online ‘portal’ allows patients to view and update their own medical records so doctors can get instant, real-time updates.
Professor Sir Bruce Keogh, Medical Director of NHS England said: “This new fund will help patients get better and safer care by giving doctors access to the right information when they need it most.
“Supporting hospitals to replace outdated paper systems for notes and prescriptions will help stop patients having to repeat their medical history over and over again, often in the same hospital, because their records can’t be found or doctors don’t have access to them.
“Expanding the use of electronic prescribing by doctors and nurses in hospitals will help the NHS saves lives and save money.”
NHS hospitals can bid for the money to fund projects but in order to be eligible they must demonstrate that these will lead to better, safer care.
Case study 1
e-prescribing PICS (Prescribing Information and Communications System)
An electronic prescribing system pioneered by University Hospitals Birmingham NHS Foundation Trust is preventing 146,000 potential medication errors every year.
A recent evaluation of the e-prescribing tool showed that it saved 100 lives in a year at UHB alone. The Trust saw a 17% drop in deaths of emergency patients over 12 months after it introduced the system.
The research could not pinpoint who had been saved, although there was clear evidence that giving antibiotics to emergency patients with severe infections within an hour of admission halved their risk of dying.
Other results include: a 66% reduction in prescription errors (400–450 each day); total annual savings of £43k (9.5%) in the Critical Care drug budget (£11,681.46 on sedation and £31,549.14 other medications); more than 90% compliance with risk assessment rules for venous thromboembolism for inpatients.
An audit within Critical Care at UHB before the system was introduced discovered an average of four charts per patient, of which; 17% were illegible to an independent eye; 28% had altered times and doses; 3.5% posed a potentially significant cause of error; 22% of patients were not in the bed space relating to the notes.
“Medication errors are one of the major preventable sources of harm in healthcare,” says UHB Medical Director Dr Dave Rosser. “And as medicines are the commonest form of treatment and the most expensive part of healthcare after staff costs, there is huge scope to significantly reduce risk and cost.
“Our rules-based system guides or controls behaviour at the point of decision, giving clinicians access to detailed and timely information to allow them to improve the quality of care and the Trust to improve efficiency of care.”
The Trust’s e-prescribing system is just one of the information applications within the in-house developed PICS.
PICS works on the basis of collating patients’ laboratory results, received directly from laboratory systems, diagnoses and co-morbidities which drive real-time electronic decision support for prescribing in terms of drug interactions, contra-indications, dose limits and in a wide range of other clinical areas.
Case study 2:
A system that allows patients to view and update their own medical records online has signed up more than 1500 users in the nine months since it was rolled out across the Trust.
myhealth@QEHB was launched on July 31 2012 and by the end of April this year 1528 people receiving long-term had registered to use the portal.
It was originally trialled by liver patients at the Queen Elizabeth Hospital Birmingham but is now available across 13 specialties within the Trust.
Patients are encouraged to give feedback and the system is now being enhanced to give them even more access and flexibility in how they use information to monitor and help manage their care.
Letters from GPs and other Trusts will soon be made available to patients registered on the system and there will be on-going integration with other healthcare monitoring technology, such as medication monitoring devices. In addition, consultants will be able to directly contact patients within their specialty to share relevant information with them.
One patient signed up to myhealth@QEHB said that the system gave her “more power and control of my health and lets me be involved”. She added “it makes me happier and able to cope…it instils trust”.
myhealth@QEHB was developed in-house by University Hospitals Birmingham NHS Foundation Trust. It reflects the ‘No decision about me, without me’ principle to give patients high-quality information and support to allow informed choice and shared decision-making.
Daniel Ray, UHB’s Director of Informatics, said: “We’re pleased that the response to the system has been so positive and that so many patients feel that they benefit from using it.
“Feedback from both consultants and patients has proved invaluable in developing myhealth. Hopefully more and more people will sign up to use it to give themselves more control and understanding of their condition and to support the Trust in delivering the best care to suit their individual needs.”