Nurse Stefan Siekerski has implemented five different EPMA systems within six NHS trusts – most recently at Wye Valley NHS Trust (WVT). He shares his learnings, best practice tips and reveals how WVT achieved implementation of Better Meds in just six months.
The decision to switch to electronic prescribing and medicine administration at WVT was easy, as it was a priority within our wider digital strategy to make efficiency savings and reduce the risks associated with paper-based systems. Following a competitive tender, Better Meds scored highest in terms of functionality and received the best score from staff demonstrations for usability, while also being comparable on costs. The hard part was the implementation, with the first wave of COVID–19 pandemic forcing us to pause the project and led to ongoing problems. Even so, we went live on our pilot ward in October 2020 — just six months after the system was made accessible — and, within nine months, Better Meds had been rolled out across 95% of the trust’s sites, including three community hospitals.
So, how did we achieve such a fast and effective EPMA roll out? The secret is to plan for the unexpected, be adaptable and reach out to the influencers and networkers.
Plan for bumps in the road
When we began planning our EPMA roll-out, we could never have foreseen the global pandemic which stopped all non-essential work including implementation of new IT systems. But the challenges didn’t stop there – there were many. A new hospital building opened, wards merged to increase bed capacity by 50%, and we were unable to launch as planned. All this had the potential to derail our go-live targets and cause costly delays – something that we couldn’t afford when dealing with medicine management and prescribing.
Fortunately, we didn’t have just one go-live scenario and we were prepared to adapt. For example, when we wanted to start the rollout, another IT project was due to go live. This meant that we couldn’t take nurses off the ward for an hour for EPMA training, and so we agreed to delay the EPMA rollout by two weeks and shorten them to keep on schedule without impacting other rollouts.
Build your network
I joined the EPMA project with experience of working at five trusts and implementing several different systems, so I had a ready-made network of colleagues that I went to for advice. I also reached out to Taunton and Somerset NHS Foundation Trust and University Hospitals Plymouth NHS Trust, who were both implementing Better systems. Their advice, as well as that from internal networks within the trust, proved invaluable.
As with all digital transformation, resistance to change can be an issue so we involved the end users – our doctors, nurses, pharmacists and anaesthetists – from the start. We asked them what their pain-points were, their day-to-day challenges, and addressed their concerns. By doing so, we fostered a rollout by consent, creating an atmosphere of ownership and partnership. We had a team of people unified against challenges, rather than a battle against internal resistance.
We made sure that we were present and created in-person encounters (as much as Covid procedures allowed), joining ward rounds and giving end-users a laptop so they could practice using the system. We also organised a roadshow in the canteen, where people could ask us anything and stood at the staff entrance from 7am to speak with workers as they arrived to start their shifts.
Just as important is top-level buy-in. At Wye Valley, the project board had been created before I joined the team and fortunately it is one of the best I’ve worked with. With the clinical director of pharmacy, financial director, medical director, and nursing director all on the board, if we encountered problems within medical or surgical divisions we could go back to them for advice. Even if the board level was unable to help us, the individuals on the board could take those issues up to the next level – the executive board.
Be realistic and stick to deadlines
Two crucial aspects of achieving implementation at pace is sticking to your deadline and being realistic. While it is ill-advised to be inflexible when leading a project, I am not flexible with go-live deadlines because delays can lead to safety concerns if you begin operating with a mixed economy of paper and digital wards. So, once you have decided on your deadline, you need to figure out the minimum requirements of the go-live so that even in a worst-case scenario, the date doesn’t need to be delayed. To do this, you will need to manage the expectations of your end-users. Put simply, your ePMA won’t be able to do everything immediately.
At Wye Valley, we didn’t go live with VTE assessment; we didn’t have full integration with laboratory systems. It would have been brilliant, but a paper chart doesn’t have those functionalities either — it has a patient’s name, their clinical details, their allergies, and the medication which has been prescribed. And the chart lies beside the bed that the patient is in. For us, having clinical decision-support in the background of the EPMA was already much better than the original piece of paper we had been using. Managing expectations is crucial.
Incentivise
Another COVID-related challenge was that in-person training was not an option, and increased workloads meant that staff had less time to engage. We had to move training online, which gave staff the autonomy and flexibility to learn about the system at a time convenient to them, but reduced the likelihood of them completing the training ahead of implementation on their wards. To tackle this, we incentivised engagement by getting the training course accredited with the Royal College of Nursing, which gave nurses a nudge to complete it as they knew they would have a certificate for revalidation.
In addition, we also paid for a Saturday shift of a junior doctor, who helped with transcriptions and supported the on-call rotation, while on-call doctors did their training. He was then able to show colleagues how to use the system effectively.
Be present and available
During roll-out, as an implementation team, we were on hand to assist with any additional training or troubleshooting. We were available from 7am until 10.30pm – the core hours that the wards needed our support. We were then available outside these hours through an on-call system, which ensured that staff felt supported and reassured that help was available if they needed it. In addition, we put steps in place so that staff from wards that had gone live could support others, particularly if requests were clinical, and we adapted our training based on issues that arose, resulting in fewer support calls as the rollout progressed. To be available 24/7 is tiring, but the trust welcomed the support, which gave them confidence in us, the system and the ability to proceed.
Find success
We wouldn’t have been successful in our implementation if we were discouraged by the challenges that came our way. We all work in clinical environments, and unexpected events do happen. So, when they arrive, don’t just put your blinders up. Use your team and the skills that you’ve learned from going to site visits – from having a clear target and stakeholder management and having a good team structure. Look for a workaround to any issues that arise and reach out to your network for advice and whether they have encountered similar challenges. It may require more work, but the satisfaction is so much higher when you hit the targets in the end.
Find out further tips from Stefan’s YouTube presentation and Better’s EPMA Guide “6 Success Factors For a Speedy Rollout of a Hospital Electronic Prescribing and Medication Management System (EPMA)”