Use of the JAC electronic prescribing system to facilitate audit data collection

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Use of the JAC electronic prescribing system to
facilitate audit data collection

• Dr. Richard Hughes, Anaesthetic Research Fellow
• Dr. Nicola Edwards, Anaesthetic SHO
• Dr. Niall Poole, Pharmacist and EPS manager
• Birmingham Heartlands Hospital

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Overview

• Two audits performed eight months apart
• One manual data collection
• One electronic data collection
• Methods of electronic data collection using
  electronic prescribing

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Clinical Problem

• Thromboprophylaxis in high risk surgical patients

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Audit 1

• Routine audit of thromboprophylaxis amongst
  thoracic surgical patients completed January
  2003.
• Data collected on paper forms by reviewing notes
  and drug charts.

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Audit 1 - Manual data collection
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Efficiency Audit 1

• Manual audit collection
• 20 minutes per patient
• 114 patients
• 38 hours
• i.e. SLOW

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Interpretation problems
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Results Audit 1

• N114
• Only 42 patients had full compliance with
  protocol
• Majority of failure due to prescription timing
  errors.

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Completing the audit cycle

• Action taken
• Correspondence to all SHOs and Ward Nurses
  highlighting problem
• Increased flexibility of drug dosing agreed
• Repeat audit planned.
• Electronic prescribing system introduced.

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Manual data collection
Data stored in caché Name PID Age Admission
date Admission time TEDS Enoxaparin prescription
time Prescriber Time of first dose If not before
theatre why not? Date enoxaparin discontinued
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Manual data collection
Data stored in caché Name PID Age Admission
date Admission time TEDS Enoxaparin prescription
time Prescriber Time of first dose If not before
theatre why not? Date enoxaparin discontinued
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Manual data collection

• Outstanding Data
• Operation date and time
• Procedure

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JAC prescribing system

• EPS to be mandatory in acute hospitals by 2005.
• JAC (John, Andy,?)
• Supplying pharmacy software for 20 years.

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JAC prescribing system
JAC electronic prescribing
1. Prescribing record 2. Administration record 3.
Dispensing record
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Manual data collection

• Outstanding Data
• Operation date and time
• Procedure

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Operation Code Format
Procedure Date Time . ABCD 131103
1130
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Operation Codes
Operation Code Lobectomy LOBE Pneumonectomy
PNEU Wedge resection WEDG Open
Biopsy OPBI Oesophagectomy OESO Decortication
DECO VATS VATS Mediastinoscopy MEDI Bronchos
copy only BRON Oesophagoscopy OSCP Other
major OTMA Other minor OTMI
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Manual data collection
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JAC prescribing system
JAC electronic prescribing
1. Prescribing record 2. Administration record 3.
Dispensing record
Crystal reports
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Crystal reports

• READ ONLY access to caché
• Generates report of pre-selected values
• Enables full control over accessed data

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Select required tables

1. Active patients
2. Patient basic
3. Clinical notes
4. General users

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LOBE 131103 1100
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Efficiency

• Manual data collection
• 20 minutes per patient
• 114 patients
• 38 hours

• Electronic data collection
• 2 minutes per patient
• 114 patients
• 4 hours

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Results Audit 2
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Strengths of electronic audit

• Fast, efficient assimilation of data
• Benefit increases as size of audit increases
• Allows viewing of additional variables at a later
  date

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Other potential uses

• Countless other uses in clinical audit
• Pain audit
• Reviewing analgesic prescribing and
  administration

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Weaknesses

• Only as accurate as the data already in caché
• Relies on accurate input of coded information
• Manually inputted reasons for non-administration
  not analysed

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Summary

• Golden Ideal - universally compatible IT system
  throughout NHS
• Avoidance of duplication of data input
• Principle of utilising existing electronic data
• Doors open to a powerful tool for clinical audit

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Questions?
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Thank You!