An electronic controlled drugs register is the latest first-of-type solution at a health trust already brimming with digital innovation.
It is currently being rolled out at the two West Yorkshire hospitals run by the Calderdale and Huddersfield NHS Foundation Trust (CHFT) – Huddersfield Royal Infirmary and Calderdale Royal Hospital in Halifax.
Known as the eCDR-PRO, it is the culmination of a three-year collaboration between CHFT’s medication safety team and a London-based software company called Solidsoft Reply, which specialises in developing digital healthcare solutions for patient safety and closed-loop medicine management.
The electronic register replaces the conventional handwritten controlled drug (CD) requisition books and registers used to record what CDs have been ordered, supplied and administered, and to provide a legally binding process to ensure accurate information is recorded and retained.
Documentation in CD registers requires great attention to detail.
It is illegal to cross out or use correction-type products, but in clinical areas, where multiple doses are administered by staff working in very busy environments, it was understandable that documentation errors might happen.
Recognising that any handwritten process was open to human error, crossings out or miscalculations – and to avoid such errors – CHFT sought a digital solution to mitigate the issues and offer time-saving benefits.
Penny Daynes, CHFT’s Lead Pharmacist for Operations – Medicines Management and Procurement, says: “We’ve been fortunate to find the right software development partner to work with.
“It is new and unique, and we don’t think any other trust has managed to implement what we have done.”
Essential element of modern clinical care
CDs are an essential element of modern clinical care.
They include medications such as morphine and oxycodone that are used in a wide variety of clinical treatments, such as the relief of acute and chronic pain, end-of-life treatments or as part of the treatment for substance misuse.
Other medicines such as anxiolytics to relieve anxiety, sleeping pills, steroids and growth hormones are also designated as CDs.
Clear oversight of CD supply and administration is a legislative requirement that all NHS organisations must abide by.
Robust documentation and recording for every dose supplied and administered is subject to strict documentation rules that are not merely good practice, but necessary for the legalities of controlled drug usage.
Good practice combined with legal compliance
Using the eCDR-PRO now allows for real time auditing for stock reconciliation and reduces the time required by ward and pharmacy staff to audit stock quantities.
It is also being used as a stock management tool in times of drug shortages, allowing an overview of stock on all wards where previously the EMIS system only showed stock available in pharmacy, not on the wards or in theatres.
With only registered healthcare professionals allowed to order CD stock, and with approximately 50 requisitions processed each day, it meant 50 delivery visits to pharmacy.
If each trip took approximately five minutes, that equated to more than four hours of nursing time daily, totalling 1,400 hours a year of non-nursing time.
Other benefits of the eCDR-PRO include:
- Orders are sent overnight and are ready as soon as pharmacy opens – saving 10 to 15 minutes each time an order is placed.
- Orders are accurate – this saves pharmacy time resolving unclear requests and also stops orders from unapproved staff.
- Order processing and receipt back to the ward is quicker – reducing delayed or omitted doses.
- Actual stock balance is checked at every administration and the second check is recorded as a mandatory field where appropriate.
- The system instantly highlights discrepancies.
- Audit completion is now quicker.
- Time taken to stock check has also reduced.
- Automatically reports if there are deviations from the stock balance in the CD register.
- Automatically flags concerns to appropriate staff so they can act immediately on any anomalies.
Lis Street, CHFT’s Clinical Director of Pharmacy and CDAO (Controlled Drugs Accountable Officer) says: “Originally, we hoped there would be an off-the-shelf product to meet our needs.
“As we worked with Solidsoft we could see the potential for an acute trust system that would in addition to meeting the legalities of controlled drugs recording, could also save our staff time, have better audit functionality and also be used for on-call pharmacist queries.”
Both CHFT and Solidsoft Reply see the eCDR-PRO as a system that could easily be rolled out in other NHS trusts to replace the traditional register, and indeed, other trusts have made enquiries about it already.
The project has also garnered interest at the West Yorkshire controlled drugs intelligence network attended by CD accountable officers from the region’s hospitals, hospices and community trust providers and representatives from the CQC and the police.
CHFT is the host trust of The Health Informatics Service (THIS), which is project managing this latest innovation, and which has been instrumental in the trust’s other digital developments such as the first-of-type integration of its Oracle Millennium EPR and EMIS hospital pharmacy stock control system, the introduction of voice recognition technology and predictive analytics to monitor mortality ratios.
Other projects have used digital solutions to tackle health inequalities and reduce waiting times for elective surgery.