Introduction

The Royal Cornwall Hospitals NHS Trust (RCHT) is responsible for the provision of acute care services across three hospital sites comprising approximately 650 beds. The trust serves a population of 450,000 people, a figure often doubled by holidaymakers during the busiest times of year.

 

To enable real time access to detailed primary care patient records to assist in the accurate reconciliation of patients’ medications on admission, the Pharmacy Department at RCHT chose to deploy Microtest’s Guru. Working with 31 practices the project has been declared a major success and is now being rolled out across other Microtest GP practices in Cornwall.

 

Microtest is one of the UK’s top four GP system suppliers and has been providing clinical systems to the primary care sector for over 30 years. Guru is a secure, virtual, interoperable, web-based clinical data-sharing solution that allows two-way remote access to GP patient records held within Microtest’s Evolution system and can be used on mobile devices and laptops.

 

Background

The reconciliation of patients’ medications on admission to hospital is a recognized area of error and patient risk with published evidence estimating a 30-70% unintentional discrepancy rate between what a patient is prescribed on admission and what they take in primary care.

 

Iain Davidson, Chief Pharmacist & Controlled Drug Accountable Officer Royal At RCHT says: “Before Guru was deployed, finding out what medications a patient was taking in primary care often required the Pharmacy Department phoning the GP practice to request a copy of the patient’s medication record. The GP practice had to manually create detailed reports and fax them to the hospital, all of which created a significant amount of work for hospital and practice staff alike, delayed good patient care and was only possible during surgery hours.”

 

Guru – a web based, clinical data-sharing solution

Guru is the result of a lengthy consultation and development period and the resulting solution is secure, fully encrypted and allows healthcare professionals to deliver a live and detailed patient record to the point of care, exactly when needed.

 

Guru can be used in any clinical situation when the clinician is not at the surgery and an internet connection is available (e.g. via mobile/3G network). It can be used to share patient records with other healthcare workers or to extend the boundaries of clinical care delivered by the patient’s practice. In addition to surgeries and hospitals/pharmacies, other out-of-hours providers have the ability to view full patient records (with the practice’s and patient’s consent), helping to improve diagnosis, and can electronically submit patient notes detailing diagnosis and medication back to the surgery.

 

On this particular project, Guru has enabled accurate and up to date clinical medication history information to be available within seconds to pharmacy clinical staff at RCHT, 24 hours a day and 365 days a year, thus providing faster intervention by healthcare workers and less delays for the patient. Guru also provides a pre-populated medicines history template at the click of a button, reducing the possibility of human error during transcription.

 

Staff and patient benefits

Iain  explains “The benefits reported at RCHT speak for themselves. The proportion of medicines reconciled within 20 minutes increased from 63% to 71% overall and notably those where solely Guru was used, this figure rose to 89%.”

 

The working lives of staff have been improved in many ways:

 

  • Being better informed means staff are more efficient and the risk of clinical error is reduced
  • Provision of patient information is faster – no need for lengthy calls back to the surgery to verify recent information that may not have been on the print out
  • RCHT pharmacy clinical team has been freed up to spend more face to face time with patients/patient care rather than on paperwork
  • For the pilot alone it is estimated that a saving of over 10 hours of GP receptionists’ time per practice per month has been achieved.

 

Most important of all are the direct benefits to patients:

 

  • The increase in percentage medicines reconciliation within 24 hours of admission
  • Level of successful medicines reconciliations outside of GP opening hours
  • Major patient safety interventions made as a result of access to Guru by having vital information quickly

 

Following the success of the pilot project, Guru is now being rolled out across all consenting Microtest GP practices in Cornwall.

 

Multiple applications

Since the system can be used via any device that supports a web browser and an encrypted link to NHS.net, the applications are virtually limitless.

 

Organisations running drugs trials across multiple GP surgeries are currently using Guru (with consent) to access patient records in real time from participating surgeries. Mobile Clinics (eg Diabetes and COPD) can view patients from any participating surgery in the area – showing the user required information at a touch of the screen. Federating practices, working together to share the delivery of patient care, now have the facility they have required to delivered focused care to patients with the patient being able to attend whichever practice is convenient for him safe in the knowledge that the clinician is fully informed.

 

Future plans include Guru providing patient access to their own notes and blood results via the Internet, giving more power to patients as outlined in DOH’s “The Power of information” strategy.