Authors (including presenting author) :
Lui CT (1)(2), Tse CF (1), Ng WS (1), Chiu YK (2), Lai SO (2), Mak KH (2), Lai YM (1), Yip CS (1), Yu KM (1), Wong CF(1), Tam KY (1), Cheung LM (2), Chan WL (2), Cheung CY (2), Tang H (2), Ha PK (1), Chan YW (1), Tsang MY (1), Chan AY (1), Hong CK (1), Chan CC (1), Wu A (3), Chan L (3), Tse E (3), Yung J (3), Chu P (3), Chung M (4), Auyeung KL (4), Leung C (4), Law CH (4), Lo E (4), Poon KM(2), Lai CH(2), Lau CL (1)(2)
Affiliation :
(1) Department of Accident & Emergency, Tuen Mun Hospital (2) Department of Accident & Emergency, Tin Shui Wai Hospital (3) Pharmacy Department, New Territories West Cluster (4) IT Department, New Territories West Cluster
Introduction :
Conventional workflow in resuscitation room of AED relies on manual charting of patient vitals and activities. There are inherited shortcomings of inefficiency, suboptimal accuracy and lack of decision support. AED resuscitation room had been demonstrated to be the clinical area with highest risk of medication incidents. There is imminent need to transform the workflow model in resuscitation room to enhance quality and efficiency.
Objectives :
To digital-transform the workflow and documentation in resuscitation room with process automation. To integrate decision support features to enhance patient care quality and safety.
Methodology :
The eResus project, the first co-development product between NTWC and HAHO IT under smart hospital was initiated in 2018. The core of the eResus system is an iOS app under corporate MCAF framework (mobile CMS suite), integrated with drug label printer and two dashboards in the resuscitation room – the medication dashboard for drug workflow and the all-in-one patient monitoring dashboard. All patient activities, including vitals, medications and procedures were digitally transformed. The major change of medication workflow is switch from predominantly verbal order to prescription-preparation-administration workflow and central standardized regimen handled by pharmacist. More than 20 decision support features, including drug allergy checking, were added in the system to enhance patient safety. An impact analysis was conducted in December 2021 as interim analysis, covering domains in documentation integrity, medication safety and staff acceptance survey.
Result & Outcome :
The system was first piloted in TMH A&E in January-2021 and further rolled out to TSWH A&E in September-2021. Intended scope are triage category-2 cases. The compliance was around 80-90%. The documentation integrity and accuracy were optimized. After implementation of series of medication decision support and allergy checking, the types of medication incidents were reduced with observation of elimination of drug allergy incidents, incorrect drug preparation and missed drug doses. There was observed improved accuracy in drug preparation and dilution. However, not all medication incidents were eliminated with residual case of drug route / drug identification. Staff survey reviewed most frontline staffs agreed the direction of digital transformation would improve documentation integrity and medication safety, with area of improvement in efficiency. eResus will be rolled out to POH, RH and NLTH in 2022-23. In the upcoming development, will integrate auto-capture of team member, vitals auto-charting and other efficiency gaining measures as priority, followed by big data analytic and protocol-driven resuscitation.
