Weeknotes #2

On-Screen medication display : NICU : CRRT : Paxlovid

NPSA_OnScreenDisplayOfMedicinesInformation_Feb2010 (1)

Does anybody recognise the above NPSA “Guidelines for safe on-screen display of medication information” from 2010?

Over the last 12 years this has certainly been my most referred to guide. As far as I am aware, it has not been replaced / updated by any of the NHS digital platforms but is still used today. With our legacy EPR system (LastWord), the ePMA team were responsible for full compliance. We had control over the build of all meds related fields e.g. dose ‘units of measure’, ‘route’ and ‘frequency’. When the NPSA released the above guidance, we updated all naming conventions on LastWord to conform with ‘Appendix 1 — Units of Measure and how to display them on-screen’.

NPSA_OnScreenDisplayOfMedicinesInformation_Feb2010 (1)

Since joining Cerner and onto an established domain of another NHS Trust, we have come to notice some small discrepancies in ‘naming’. For example, our ‘unit of measure’ code set in Cerner uses the full word ‘hour’ instead of the abbreviated ‘hr’ as per the NPSA “Guideline for safe on-screen display of medication information”.

Further exploration needed— Does SNOWMED-CT naming use ‘hour / hr’? Historically on our domain, were these fields built as ‘freetext’ or system uploaded? I have recently been introduced to the term ‘technical debt’ which I have heard referenced before but never fully understood until my manager Kevin (Head of IT Applications, Deputy Director of IT) spent time explaining the terminology.

These are important points, not only because of the new ISN published in October 2021 for Medicines Interoperability which will mean hospital systems are required to be fully dm+d, SNOWMED-CT and FHIR UK Core R4 compliant by March 2023 but also to raise awareness of not introducing any additional custom naming for ‘route’, ‘units of measure’, ‘frequency’ thereby adding to our ‘technical debt’.

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Highlights this week

1. NICU ePMA was our main focus. We had a collaborative meeting with Neonatal consultants, pharmacists and ePMA teams from both CWFT, ICHT and NWL (THH and LNWH). Building a NICU drug formulary is not an easy task and some fantastic discussions resulted from working through our existing drug catalogue for adults, where paediatric order sentences have been added and identifying gaps that exist for NICU. Presenting a Request for Change (RfC) to our joint Cerner Change Board for a new ‘unit of measure’ for milliunits/kg/minute for the use of vasopressin continuous variable rate infusion and requesting a list from the Neonatal team of all ‘sites’ used in premature babies for ‘IV’ and ‘IV Central’ to ensure nurse administration can be correctly completed.
2. NWL meeting — Exploring CRRT and AICU PowerPlans with my colleague, Lead Pharmacist ePMA (THH and LNWH). An area neither of us have clinically covered as pharmacists, vastly complicated due to the question of what should be prescribed on the drug chart — only drugs entering the human body or to include those via the filtration device? With CRRT, we will thus be guided by our AICU colleagues to introduce increased safety measures on Cerner for the nurse and prescribing workflows by the use of a CRRT PowerPlan. However, over the years we have had some interesting requests for prescribing on electronic drug charts — ‘surgical drains’ and ‘flushes’, ‘dialysis fluids’, ‘dressings’, ‘drinking water’, ‘milk’ and even a ‘full English breakfast’ bundle! Our guidance has remained the same, to reduce noise and minimise medication related errors, ideally only ‘drugs’ should be prescribed on the ‘drug chart’.
3. Paxlovid — On Thursday, we were the first site in the country to roll out the UK’s second antiviral treatment for COVID-19, Pfizer’s Paxlovid. The drug has been proven to reduce the risk of hospitalisation or death from the disease by 88% in clinical trials, for those who received treatment within five days of symptoms appearing. For the purposes of the Cerner build, we have kept things simple, with just 2 order sentences rather than a PowerPlan:

• 3 tablet(s), oral, twice a day, for 5 day(s), Take TWO PF-07321332 150mg tablets (pink) and ONE ritonavir 100mg tablet (white), for COVID-19 treatment
• 2 tablet(s), oral, twice a day, for 5 day(s), Take ONE PF-07321332 150mg tablets (pink) and ONE ritonavir 100mg tablet (white), for COVID-19 treatment
• Monitoring reminder placeholder — since Paxlovid is a new Covid treatment, our consultant antimicrobial pharmacists requested a placeholder for inpatients as a reminder to the GP, when the patient received a course of treatment and for this to be documented on the discharge summary under the medication section (similar to our workflow for tocilizumab and sarilumab)

Challenges this week

Learning when is important to have a room filled with brains to decide on intricate drug detail or whether to start small, reduce the size of the initial team providing the detailed input and later bringing differences to the table for further discussion.

What am I looking forward to next week?

A well-deserved break! It is half term — a time to enjoy being a tourist in my own city and visit as many London museums as possible. Always a highlight, the Science Museum and one I haven’t frequented since I helped out in the early days of the Science Museum Vaccine Centre. An experience I will forever hold dear to my heart — nothing comes close to walking through the huge turbine entrance hall, completely alone in the early hours before the lights have even been switched on!