ePrescribing Lessons Learned from Other Implementations

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ePrescribing Lessons Learned from Other Implementations by Mind Map: ePrescribing Lessons Learned from Other Implementations

1. Giving Meds

1.1. Admin record editable & not closed

1.2. ADmin dose typos

1.3. How to admin TTAs

1.4. Meds given as not deleted

1.5. Incomplete administrations

1.5.1. Nurses view

1.5.1.1. Fragmentation

1.5.1.1.1. Mabs

1.5.1.1.2. Chemo

1.5.1.1.3. Chemist pickups

2. Planning DOSE

2.1. Dose changes problematic

2.1.1. e.g. where pharmacy make cheap products in advance of order

2.2. Check dose banding

2.2.1. ?rounding

2.3. Wrong dose reduction/capping

2.3.1. Dose increase not documented

2.4. Quantities

2.4.1. 1 month instead of 3

2.5. Prescribing

3. Documentation

3.1. Document reasons

3.1.1. For change in action

3.2. High workload initially

3.2.1. No predefined prescriptions

3.3. No documentation by Dr

3.3.1. Delays verification

4. Protocols

4.1. Whats the reference point?

4.2. Validation

4.2.1. ClinPharm

4.2.2. Nurse

4.2.3. Consultant

4.3. Protocol maintenance

4.3.1. Dedicated resource

4.3.1.1. If national remit

4.3.1.1.1. NCCP?

4.4. Regimen blindness

4.4.1. Just rely on system

4.5. Supportive care

4.6. Wrong regimen

5. Errors

5.1. Reduction in errors

5.1.1. 12 months 2006/2007

5.1.1.1. 103

5.1.2. Pro.rata 6/12 in 2011

5.1.2.1. 58

5.1.2.2. also 30% increase in activity

5.2. Error potential

5.2.1. at every step

5.2.2. Selection error

5.2.2.1. >2500 order sets

5.2.3. Regimen name

5.2.3.1. Wrong regimen selection error

5.2.4. Knock-on effects (also exist with paper)

5.3. New errors

5.3.1. Dosing errors

5.3.1.1. Check notes

5.3.1.2. Previous cycle

5.3.1.2.1. Check if given

5.3.1.3. Cycle cancellation

5.3.1.3.1. If patients stops treatment

5.3.2. Increased drug OMISSION errors

5.3.2.1. Failure to notice

5.3.2.1.1. Drugs not given

5.3.2.1.2. Drugs discontinued

5.3.3. Wrong selection

5.3.3.1. Naming/nomenclature

5.3.3.2. Sheer volume for selection

6. Systems

6.1. Keep it simple

6.2. No pharmacy system interface

6.3. Overdependence on technology

6.4. Legacy paper risk

6.4.1. 2 sources

6.4.2. Partial printing of prescriptions-->fragmentation

6.4.3. Paper persistence

6.4.4. Mixed paper-ePrescribing

6.5. Training required

6.5.1. Develop more productive process

6.5.2. How

6.5.2.1. 1:1

6.5.2.2. Small group

6.5.2.3. Competency based

6.6. Inflexibility of use

6.7. Improvements needed

6.7.1. Hands on project manager

6.7.2. Weekly meetings required

6.8. Significant process change

6.8.1. Different process?

6.8.1.1. > interpretation risk

6.8.1.2. less consensus driven

6.8.1.3. Less interrogated/reproducible

7. Evidence base

7.1. Published data

7.1.1. UK x 3

7.1.1.1. As per BOPA conference

7.1.2. Ireland x 1

7.1.2.1. Mater