Dr Keith Hughes

1
Three Cs for Spinach A Local Model for
improving Safety in Medicines Management

• Dr Keith Hughes
• General Practitioner, Pengorof Surgery,
  Ystradgynlais. Clinical lead, Ystradgynlais
  Community Hospital.
• 11th Powys Research Innovation Conference
•  7th December 2006

2
BACKGROUND

• COMPUTERS
• Community Hospitals are served by local General
  Practices
• All GP practices fully computerised
• GP computers use READ CODES, and use systems,
  mainly EMIS in Powys, which are excellent
  clinical systems
• GP computer systems have A Full BNF DRUG
  DATABASE
• drug interactions
• allergy warnings
• interactions between drugs and medical conditions

3
THE MODEL OF CARE

• Continuum of care
• GP practice/Community/Minor injuries/Secondary
  Care
• Inpatient
• Day Hospital
• Practice Community

With local GP practices involved at all stages of
patient journey
4
PROBLEMS

• COMPLICATED Too much risk/chance
• Patients generally elderly - multiple medical
  conditions
• multiple medications/polypharmacy
• unclear/confused re medication
• what on? / what for?
• From DGH
• Lack of clarity
• Unsure of drug/medical condition interaction
• Multiple prescription of medication during
  patient journey
• -paper form
• -manually
• -doctors handwriting
• Delay
• -dispatch to GP
• -within GP data input system

5
CUTTING RISK

• Solution -marry model of care with GP
  computerisation to reduce complexity in
  prescribing to GP and patient, cutting risk
• How -add GP computer link Community
  Hospital
• In YCH -care if elderly ward
• -day hospital
• -minor injury unit

6

• PRE COMPUTER LINK
• Hand write history and medication sheet for
  admission
• Hand write history and medication onto hospital
  record
• On discharge hand write - discharge
  notification
• - discharge summary
  - TTOs
• In Day Hospital handwrite medication change
  note and forward to GP
• In GP Practice - enter clinical and TTO
  information onto GP computer

7
POST COMPUTER LINK

• On discharge- still have to handwrite for
  hospital record Day hospital
• But - enter medication directly onto GP system
  contemporaneously as doing TTOs
• Consequently reducing - risk
• - error
• - delay
• and -reviewing interactions/allergies
• -medication review done
• -updating review dates all contemporaneously
• also -reducing doctor time by cutting
  duplication when TTOs/DN processed In GP
  surgery

8
BARRIERS

• Barriers to comprehensive system for safer
  prescribing -
• Hospital vs GP computer codes system
• Access to other GP Practices computer system
• Access to local pharmacy computer system
• Ownership/maintenance of softwear in community
  hospitals
• Secondary care.

9
OTHER POSSIBILITIES

• GP Lab links - reducing duplication/duplication
  of testing
• - cost savings
• - QOF
• Computerised/coded (EMIS) discharge summary
• Computerised production of TTOs
• Limited access to other GP computer systems, e.g.
  medications
• Access to local pharmacy computer
• Secondary care a step too far?

10

• CONCLUSION
• 3Cs - computer
• - contemporaneousness
• - cutting completifs
• or - computer, computer, computer to
  cut the risk