*Full name of the hospital: Chelsea and Westminster Healthcare NHS Trust
*Location: London, UK
*Type: Integrated acute care teaching hospital
*Year of foundation: 1993
*Number of beds: 522
*Number of employees: 2,200
*Income in last financial year: £190 million (~280 million euros)(2004-2005)
*Area from which patients are drawn: Mainly central and West London
Chelsea and Westminster Healthcare Trust is an acute care hospital in West London. Its
pharmacy department was modernized during 2002 and 2003, including the introduction
of an electronic prescription system, a new dispensary, a computer-controlled dispensing
robot and pneumatic tubes to distribute medications to the ward or unit where they are
required. The new dispensary was designed to meet the needs of new pharmacy
processes using electronic prescriptions. The electronic medication management system
encompasses the whole chain of an electronic pharmacy system, that can be described
as e-prescribing, e-dispensing, e-distribution, e-stock-management, and e-procurement.
The new system led to more accurate prescriptions, more accurate dispensing, reduced
stock holding, reduced waiting times for patients, reduced workload in the dispensary,
and fewer visits to pharmacy by nursing staff, allowing more time to be spent with
patients.
In 1993, C&W started planning to introduce electronic patient records (EPRs). In 1999 the
hospital introduced its EPR using a software system called Lastword. It was produced by
the IDX Systems Corporation1 to replace the old patient administration system. After a
period of piloting and development, Lastword was also used from 2001 for e-prescribing
for the hospital’s outpatients and discharged inpatients. The general view was that e-prescriptions
were easier to read than hand written ones and the Lastword system
provided useful electronic records of medication for particular patients. This reinforced a
parallel development in the hospital pharmacy that aimed to modernize its services. A
driving force was the long patient waiting times for both outpatients and discharged
inpatients. There had been an increasing number of formal complaints regarding these
waits. There was also a need to reduce the number of dispensing errors, increase the
number of pharmacists working directly with patients as part of the healthcare
professional teams, improve stock control, and improve the generally low staff morale
caused mainly by hectic working days and late hours when on late duty.
In May 2003, C&W installed the Rowa dispensing robot, constructed by ARX Ltd.
The robot screens show stock orders from prescriptions that have been prepared by the
robot, but not released by the pharmacy staff. This ensures that prescriptions can be
prepared by the robot, but not executed until the system is explicitly told to do so by the
pharmacy staff.
The new system improved dispensing accuracy, reduced stock holding, reduced waiting
times for processing and dispensing outpatient and discharged inpatient prescriptions,
enabled earlier finishing times for late duties, reduced workload in the dispensary, and
reduced the number of visits to the pharmacy by nursing staff, allowing more time to be
spent with patients on the ward. The impact has been evaluated using the methodology
of the EU’s eHealth Impact project.
Lessons learned:
*C&W has the following lessons to offer by introducing ICT into its prescribing, dispensing
and stock management chain:
*Investing in ICT across the whole chain from e-prescribing to e-procurement offers
significant net benefits to patients, healthcare professionals and the organization.
Access rights to robot programs should be restricted according to job roles to
prevent miscoordination errors and misuse.
*Stock levels should be reduced several weeks before the system’s “go live” date in
order to facilitate the task of capturing all stock records in electronic form, as well
as physically “feeding” the system with articles.
*At an early stage of planning, the managers involved should investigate existing
solutions by visiting sites where similar systems are already running, as C&W
managers did. Managers should seek support from people and teams who have
experience in implementing such systems.
*Training curricula should be tailor-made to the needs of particular professionals,
especially physicians, nurses and pharmacists. This is vital for motivating and
ensuring the support of all staff members. The success of implementing a
medication management system that requires a thorough re-organization of
workflows depends on the willingness of staff members to accept and use the
system.
*The C&W experience has already been successfully utilized by other NHS hospitals in
the London area, with more sites in the process of implementing similar systems
