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Safer antibiotic prescribing for new-born babies

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An NHS trust has digitally transformed how staff safely manage complex medicines processes for two high risk antibiotics used in the treatment of new-born babies with potentially life-threatening illnesses.

North Tees and Hartlepool NHS Foundation Trust, based in the North East of England, has used InterSystems TrakCare electronic prescribing and medicines administration (EPMA) system to digitise the management of specialist antibiotics gentamicin and vancomycin for its neonatal patients. 

These antibiotics are important for treating serious infections, but failure to prescribe and administer them appropriately, at the right dose, and at the right time can lead to the risk of significant harm, especially for vulnerable patients like new-born babies.

Most hospitals rely on specialist paper charts and processes to prescribe and administer these medications, which require precise therapeutic doses that are determined by periodic blood tests. 

from January to July 2021, 15.15 per cent of the hospital’s live births resulted in neonatal patients receiving at least one dose of gentamicin and vancomycin.

Janice Atkinson, ward matron at the Special Care Baby Unit at North Tees and Hartlepool NHS Foundation Trust, said digitising the specialist medicine charts for gentamicin and vancomycin now makes it easier for clinical teams to have visibility of all the detailed information needed to make safe and timely decisions from inside or outside of the Neonatal Intensive Care Unit.

“On paper charts there is nothing to remind nursing staff to make sure everything is in place, that blood tests have been requested, and that medicines have been ordered ready to give patients the medicines at those required intervals.

“Even a slight delay to these medicines being given could result in the patient deteriorating.  Now we have the tools to make this much safer and to join up crucial information on how these two medicines are being used with the wider electronic patient record.”  

“Reviewing the chart online has given us the opportunity to ensure that the right questions are asked prior to administration, less time is spent asking/waiting for a prescription for every dose and we have a paperless audit trail of administration.”  

The adoption of this TrakCare functionality is just the latest digital advancement at the Trust, which is using TrakCare as an electronic patient record system to underpin a transformation programme that will make the Trust one of the most digitally advanced in the NHS. 

The latest innovation will mean staff can now prescribe gentamicin and vancomycin, complete required documentation, order blood tests, view the results, see the context as to why the medicine is required, and view the patient’s wider medical history all in a single system. 

Gillian Colquhoun, deputy chief information and technology officer at North Tees and Hartlepool NHS Foundation Trust, said it will help ensure staff have performed all necessary steps, that clinical processes have been followed, and will make information visible to professionals outside of the ward such as clinical pharmacists. 

“Digital transformation is less about technology, and more about transforming processes to help people.

“Removing paper from the prescribing and administration of these medicines has helped to improve the timeliness of dose administration, and help to make sure the dose is correct based on the blood result.

“This information would previously have been distributed across multiple systems, or on pieces of paper. Now it’s accessible in one place, making important information on patients visible to staff more quickly and easily. 

“This also means we have a permanent digital record, which is readily available to those who need it.” 

Following the successful implementation of this new digital medicines management process, the Trust is progressing to digitise other specialist medicines charts and processes using TrakCare.

Lessons from the deployment have been shared with trusts across the country, as digital blueprints, as part of NHS England’s Global Digital Exemplar programme. 

Gary Mooney, clinical solution executive, InterSystems said: “Many NHS hospitals still rely on paper to manage specialist medicines like gentamicin and vancomycin, including many of those that have adopted electronic prescribing and medicines administration solutions.

“This is an important step in protecting some of the most vulnerable patients in the hospital, and in continuing to advance an organisation’s digital maturity.”

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