Shared medications chart for GPs, pharmacy and aged care
New Zealand's MidCentral District Health Board (DHB) has agreed to fund some of the set-up costs to enable a full roll out of the Medi-Map electronic medications chart in all of the area's aged care facilities and their supplying pharmacies.
Medi-Map has been designed by Christchurch-based pharmacist Greg Garratt to give GPs, pharmacists and aged care nurses access to a shared interface for residents' medications charts, which can be updated in real time and are accessible from any device.
The idea is to overcome the common problem of multiple changes being made to residents' medication charts, which are still predominantly paper based, and which then have to be faxed between nursing home, pharmacy and GP.
Medi-Map has received a waiver from the NZ Ministry of Health to allow GPs to chart medications through the system, and the prescription will be able to be sent electronically to the pharmacy when integration with the New Zealand ePrescribing Service (NZePS) is finalised in the next month or so.
NZePS integration will also mean that items charted become automatically scripted and sent to the dispensing pharmacy.
Mr Garratt first came up with the idea for Medi-Map about three years ago following a near miss with a medication order in his own pharmacy, which works with a number of aged care facilities.
“We had a near miss which potentially could have resulted in serious harm and we made the decision on the spot that we need to do something about this,” Mr Garratt said.
“I found a developer whose mother ran a whole lot of rest homes so that gave good context. That fixed our local problem but it turns out our problem is everyone's problem.”
Mr Garratt described Medi-Map as a cloud-hosted medication charting system with a shared interface that can be accessed on any internet-enabled device. Unlike paper systems, any changes or updates to the chart are available to other clinicians in real time. “Everyone is looking at the same data so there is only one source of truth,” he said.
The GP can prescribe a new medication or change or stop an existing one through the chart. When the GP charts in Medi-Map, it will generate an appropriate prescription electronically, via the NZePS integration when available, to the pharmacy and which is also directed back into the GP's practice management system.
Medi-Map has integrated with one pharmacy dispensing system so far, which means changes and new orders automatically appear in that system. It also automatically maps to the medications administration module used in the aged care facility, meaning there is absolutely no transcribing of orders in any link in the chain.
Mr Garratt, who has an interest in robotics, said the company is also building a separate function so the pharmacy can create a batch file out of Medi-Map and send it automatically into the pharmacy's robotic packing machine.
From the aged care facility's end, the system not only provides an electronic chart of all of their residents' regular medications, but PRNs and non-packed medications as well.
“When they give the medication, it shows them the available dose, it knows what is packed and it knows what’s not packed,” Mr Garratt said. “It knows that there's also an eye drop to give them or an inhaler to give them, so if they forget the non-packed stuff it prompts them and reminds them.
“It closes that loop with the administration of the drug and with the PRNs as well as it knows the number of doses given to any resident in a 24-hour period. If you are giving paracetamol three times a day, it marks the first dose and then says you are allowed to give them two more doses over the next 24 hours, so it controls and stops things like paracetamol overdoses in care facilities.”
The system also stores the medications history, showing ceased and short-term medications such as antibiotics, and from the GP's end, they can click on any drug in the chart and view the administration record so they know that the drug has actually been given and if not, why not.
There is also a re-supply function that has proved invaluable in terms of minimising waste, Mr Garratt said. All users can see what the pharmacy's supply cycle is, allowing GPs for instance to start or stop a medication in the next supply cycle if it is not urgent.
“What we've found is over 20 per cent reduction in wastage of medications, because it gives the prescriber the ability to make the call if this is acute or can it just be part of the pharmacy's normal supply,” Mr Garratt said. “That gives a massive reduction in waste, which is why the DHBs like it.”
If the facility is running low on a medication, the nurse can use the re-supply function with an order sent automatically to the pharmacy. “And when the pharmacy actions it, it sends a notification back into the rest home interface to say that it has been actioned and it's on its way,” Mr Garratt said. “It closes that loop.”
There is also a section on the chart for test results such as blood sugar levels, and a notes section so doctor, pharmacist and nurse can leave instructions or explanations. Medi-Map uses the New Zealand Universal List of Medicines and drugs are colour-coded for those that are subsidised by the government and those that are private scripts.
While Medi-Map has been used in a number of aged care facilities throughout New Zealand, the recent agreement with MidCentral DHB (MDHB) is the first time that a whole DHB has come on board. Mr Garratt is in discussions with three other DHBs, and has also fielded calls from Australia about the system.
He said one reason it has had such good take-up is that it was designed by a pharmacist who spent a lot of time observing doctors and nurses and their workflow for nursing home residents.
“We didn't build it based on what we thought was good but based on what they do,” he said.
MDHB's manager for older people's health, Jo Smith, said the DHB had contributed toward the set-up costs to help support community facilities in improving their medicine management systems.
“This new system is unlike anything we’ve had in the district before,” Ms Smith said in a statement. “After talking with aged care providers, pharmacists, and general practitioners, it is apparent that the current paper chart system has created significant safety risks.
“I have heard many facilities express their interest in this sort of system, but for some the initial cost was a hurdle. At MDHB we aim to improve patient safety in all areas of care, and that is why we have decided to contribute toward implementation costs.”
The clinical director for the Central PHO, Feilding GP Bruce Stewart, said there were significant advances the system would bring.
“Medi-Map has been a major advance in simplifying the management of medicines between general practice, pharmacy and rest homes,” Dr Stewart said. “It has removed the confusion and inaccuracy associated with multiple faxed drug charts and so greatly improved patient safety around medicines.
“Once the system fully integrates with our IT, it will be even more powerful as a quality improvement tool, and also a time saver in the practice.”
Posted in New Zealand eHealth