2 results
Long admission waiting list at the Orchard clinic-why?
- Hannah Sayeed, Johanna Brown, Fionnbar Lenihan
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S287
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- Article
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Aims
The Orchard clinic is one of the three medium secure units in Scotland. This project was completed:
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To gain an understanding of the causes of the Orchard clinic's long admission waiting list.
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To use this information to improve current clinical pathways, service development and further research and development.
MethodTo study the longitudinal traffic flow through the clinic from January 2017 to December 2019, data were collected for this time retrospectively from electronic minutes of fortnightly bed management meetings at the Orchard clinic.
This was cross checked with the Orchard clinic's record of admissions and discharges during this time and approved by the Forensic Research and Audit Group, NHS Lothian.
ResultNovember 2018 onwards, a surge of 90% was observed in the admission waiting list.
Looking at the trends of traffic flow through the clinic during this time, the following observations were made:
1. More admissions than discharges, especially November 2018 onwards.
2. New referrals for medium secure care at the Orchard clinic peaked twice during this time.
3. Delayed discharges peaked in July 2018 and further in January 2019 running parallel to the surge in admission waiting list thereafter.
4. 42% patients on the delayed discharge list belonged to other health boards awaiting local low secure/community placements.
ConclusionDelayed discharges were identified as a constant parallel to the long waiting list and hence identified as the main factor contributing to it. Out of area (non-NHS Lothian) admissions were noted to be linked to these delayed discharges.
Regular peaks in new referrals was also noted to be contributory.
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The introduction of electronic prescribing in the Orchard clinic-a QI project
- Hannah Sayeed, Fionnbar Lenihan
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S218
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- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Hospital Electronic Prescribing and Medicines Administration (HEPMA) system successfully rolled out in July, 2020 at the Orchard clinic as the first site in NHS Lothian. The initial aim was to collect some “pre-HEPMA” and “post-HEPMA” data to look at “staff's attitudes to a new IT system, and does that change with successful implementation of it?” in the form of a survey. In the light of the findings of the pre-HEPMA staff survey, it became the QI project (as above).
This aimed to look at both qualitative data; in the form of a staff attitudes survey towards a new IT system and quantitative data; to measure benefits of its implementation and to address issues raised by staff in the survey in the form of an audit in both pre and post HEPMA cycles.
MethodTwo cycles were completed as follows:
1. Pre-HEPMA cycle in March, 2020:
Survey: Questionnaires asking question re- own IT skills, preparation and expectations of outcome of its implementation.
Audit: Measured time taken to write and re-write paper prescriptions. Proforma filled by staff to measure time taken to log on and other IT related issues.
2. Post-HEPMA cycle in October, 2020:
Survey: Replicated above questions re-own IT skills, support during and after launch, disaster recovery and views about actual outcome of its implementation.
Audit: Replicated to measure time taken to complete electronic prescriptions.
Result24 staff questionnaires returned in both cycles. Staff felt more confident in their own IT skills, training and hence competence to use HEPMA; more supported, more confident about contingency plans and HEPMA to be more beneficial than initially anticipated. Overall, actual perceived success of (91%) compared to anticipated success (71%).
The majority issues raised via the first survey were felt to be addressed. Time to log was on average
The audit showed a clear benefit in terms of clinical time saving, e.g. daily clinical time spent writing prescription reduced from an average 45 to 6 minutes with HEPMA.
The quality of documentation on the prescriptions remained unchanged.
ConclusionStaff's attitude towards IT does change after successful implementation of a new IT system. But IT issues make the whole process laborious.
There was evident benefits realization with an electronic prescribing system compared to paper prescriptions.
I was awarded “Employee of the month” for this project which I also presented at the NHS Lothian grand round (>150 attendees) for dissemination and future replication.