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No more illegible handwriting as hospitals in Swansea and Neath Port Talbot embrace digital prescriptions

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A doctor’s handwriting has often been described as resembling that of a spider, but delays for patients in getting the right prescription due to illegible handwriting or by lost or damaged paper charts is now a thing of the past for two Swansea Bay hospitals.

New digital technology is transforming the way medicines are prescribed and given to hospital patients in Singleton and Neath Port Talbot hospitals. Something the health board says is making it safer while freeing up nurses to provide more bedside care.

Swansea Bay University Health Board is leading the way in Wales, with paper drug charts now almost entirely eradicated in 15 medical wards across Neath Port Talbot and Singleton hospitals.

These have been replaced with HEPMA, or Hospital e-Prescribing and Medicines Administration, which automates the entire process.

Gone are delays caused by illegible handwriting or by lost or damaged paper charts.

Doctors and other prescribers now complete the prescription digitally, with nurses using computers to see at a glance full details of the medication, dose, frequency and length of use.

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Christine Evans, manager of Neath Port Talbot Hospital’s Ward C. It’s one of four medical wards there to benefit from HEPMA (Image: Swansea Bay NHS)

The new system automatically flags up if the patient is allergic to a new drug being prescribed, or if the drug is not suitable for use with other medication they are already taking.

Between February and May this year, it reduced the time nurses spent on medication rounds in the four Neath Port Talbot wards by 125 hours.

In 2017, Abertawe Bro Morgannwg University Health Board – the predecessor to Swansea Bay – took its proposal for HEPMA to the Welsh Government, which then approved it as national pathfinder for Wales.

Since then the health board has been working with the system supplier, WellSky, and NHS Wales Informatics Service (now Digital Health and Care Wales) to ensure the solution is integrated with other key national solutions, such as the Welsh Clinical Portal.

The health board has also engaged with other Welsh health boards and trusts to share the learning from Swansea Bay.

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Years of planning reached fruition on 11th February 2020 when HEPMA was introduced for the first time in Wales, on the neuro-rehabilitation ward at Neath Port Talbot.

Following a successful pilot, plans were in hand to switch to HEPMA on four medical wards, with Singleton due to follow in June and July 2020.

Then the pandemic struck and those plans were put on hold.

Sharron Price, Head of Nursing for Adult Services at Neath Port Talbot and Singleton hospitals, remembers vividly what nurses went through during that very difficult time – and says HEPMA has made a huge difference.

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“The experience of the nurses doing medication rounds during the pandemic was extremely worrying,” she said.

“They were in full PPE and they were really anxious. There was this new virus and we didn’t know what we were dealing with.

“We were trying to protect ourselves and our colleagues and our patients.”

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Paper drug charts were traditionally left by the patient’s bed. However, to reduce the footfall into medical areas with Covid-positive patients, the charts were instead left outside the rooms.

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A nurse outside the room would hold the chart up to the window and the nurse inside, administering medication, would read it.

With staff fully stretched dealing with so many sick patients, using the drug chart in this way only added to already high levels of stress.

“We asked the Swansea Bay digital team if they could help us when we came to the end of the first wave,” Sharon said.

“They agreed straight away and within three weeks we started to implement HEPMA in the medical wards.”

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Extra training and precautions were taken during this time to protect the digital team working on the expansion.

Sharron praised the team’s response as immense, and said the new system had brought significant benefits.

“It transformed the pandemic response. We’re now able to have nurses in PPE administering to patients with Covid without the need to hold up paper charts.

“You just go in with the computer, and you can clean that down immediately afterwards.

“Just being able to do that has had a profound impact on the nursing team’s ability to deliver safe care. Stress levels have reduced.

“Also, previously you couldn’t always get the medication charts. A lot of nurses’ time was spent looking for them.

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“Now the charts are always where you need them. You can see what patients need medication, and when.

“Potential errors have reduced significantly and we are releasing nurses to provide bedside care because of the time saved.”

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Swansea Bay has a dedicated Digital HEPMA team, which works closely with the nursing, medical and pharmacy teams.

It has been a huge organisation-wide effort to implement and maintain the new system, but the hard work has already brought numerous benefits.

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When someone arrives in the hospital, the ward pharmacist checks their patient record to see what medication they are already on, and whether they have any known allergies.

The doctor then writes a prescription to ensure they continue receiving not just that medication but any additional drugs for whatever condition required their hospital admission.

Doing that by hand was time-consuming and mistakes could be made.

Now, as the patient’s paper records are now accessible digitally on HEPMA, the pharmacist can look up their medical history immediately.

Singleton Hospital in Swansea (Image: Swansea Bay NHS)

Some 330 drugs have been configured within the system for specific conditions such as pneumonia, to give just one example.

So when the hospital clinician writes up the prescription, they not only access the appropriate drugs, the computer displays the recommended dose, how many times a day it should be given and for how many days.

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If a patient is allergic to that specific drug, or it should not be taken with other medication they are on, this is also displayed. Previously, doctors and other prescribers would have had to check all this manually.

When nurses administer the medication, that is also recorded on the system, avoiding the risk of doses being missed.

Pharmacists too have the opportunity to discuss any medication queries with the prescriber before it is dispensed. HEPMA is also used to monitor medicine usage and stock levels on the ward.

Another benefit is that details of the patient’s medication, including any new drugs given during their hospital stay, are automatically added to the discharge letter sent to their GP when they leave.

Pre-HEPMA this had to be compiled by a pharmacy technician.

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Feedback from staff in the medical wards at Neath Port Talbot and Singleton – where HEPMA went live this March – has been extremely positive. One junior doctor said it had become second nature in less than a day.

There are financial benefits too, as the health board’s spending on drugs and stationery is expected to reduce.

Once additional funds are available the health board will extend HEPMA into Morriston and Gorseinon hospitals

In the longer term it will become commonplace in hospitals and other clinical areas across Wales.

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Matt John, Swansea Bay’s Director of Digital, said: “It is an amazing example of the difference digital working can make.

“It isn’t just replicating the paper process, there are so many safety checks too.

“I would like to thank health board colleagues, WellSky and Digital Health and Care Wales for their commitment and desire to make this a success, and the Welsh Government for its support.

“This has been an intense piece of work for a number of years and a great collaboration nationally.

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“We have already achieved so much and we still have a lot more we can do.”


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Charity

Mayor of Llandovery raises over £2k for air ambulance after surviving freak cycling accident

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The Mayor of Llandovery in Carmarthenshire has raised over £2,000 for Wales Air Ambulance after surviving a freak cycling accident that left him unconscious at the side of the road and saw TWO air ambulances sent to his aid.

Mayor Handel Davies and his wife Margaret raised £2,280 during the annual Mayors Charity Ball.

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The successful ball, which included an auction of rugby related paraphernalia and a raffle, also raised funds for Llandovery Hospital League of Friends.

Over 110 guests enjoyed an evening of entertainment, which included ‘an excellent address’ from Wales Air Ambulance chair of trustees David Gilbert. Over £4,500 was raised during the evening for the two good causes.

The Mayor and Mayoress presented the cheque to David Gilbert at a recent base visit at the Wales Air Ambulance’s headquarters in Llanelli.

The mayor has had personal experience of the essential service the Wales Air Ambulance provides after the Charity’s medics were called out to him during the pandemic.

Handel was involved in a freak accident when a dog ran out in front of him whilst out cycling. He was knocked unconscious for 15 minutes and despite two air ambulances being called out to him, luckily for Handel he didn’t need to be airlifted to hospital.

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Mr Davies said: “A sheepdog literally appeared from nowhere at full speed in the blink of an eye hitting the front wheel of my bike at right angles causing me to fall immediately. It happened so quickly I do not remember hitting the road, but the eyewitness commented that had I not been wearing a helmet I would not have survived. The shattered interior of the helmet is evidence of this.

“It took 6-9 months to really recover and get over the impact, which following another serious cycling accident when I was 18, has led me to decide to ‘hang up’ my bicycle and instead attend ‘spin classes’ at the local leisure centre.”

A cheque for £2,280 was presented to Wales Air Ambulance by Mayor of Llandovery, Cllr Handel Davies

The Wales Air Ambulance Charity needs to raise £8 million every year to keep its emergency helicopters in the air and its rapid response vehicles on the road.

The 24/7 emergency service offers advanced critical care and is often described as a ‘Flying ED’. The on-board consultants and critical care practitioners are highly skilled and carry some of the most pioneering medical equipment in the world. They can deliver blood transfusions, administer anaesthesia, and undertake emergency operations at the scene of the incident, before flying the patient directly to specialist care. 

Reflecting on why the 24/7 Charity was chosen to benefit from the Mayor’s charity Ball, he added: “I have the utmost respect for the incredible and invaluable work the Wales Air Ambulance undertake and as we live in a beautiful part of north Carmarthenshire next to road which is very popular with both cyclists and motor bikers, over the last 25 years we have seen many accidents along this stretch of the A4069 particularly at weekends.

“It seems that almost every weekend during the summer months a Wales Air Ambulance flies overhead to attend to an incident.”

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Jane Griffiths Wales Air Ambulance’s Community Fundraising Manager said: “It was lovely to meet the Mayor and Mayoress of Llandovery during their recent base visit. They’ve raised a fantastic amount for two important causes and we’re extremely grateful for them choosing the Wales Air Ambulance as one of the charities to benefit from the Mayors Charity Ball.

“It’s lovely to hear that the mayor has recovered from his freak accident, and we wish him well for the future. Your support of our lifesaving Charity is much appreciated and will help us to continue to be there for the people of Wales when they need us most.”

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Swansea Bay NHS

£2.5m investment aims to help tackle hospital waiting lists in Swansea Bay by expanding care after surgery

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photo of woman lying in hospital bed

Swansea Bay University Health Board say a £2.5million investment in a new service that provides enhanced recovery support for patients following some types of complex surgery, will open the way for Singleton and Neath Port Talbot hospitals to do even more to tackle waiting lists.

In the wake of the two-year+ pandemic, pressure on waiting lists is higher than ever. Changes to how Swansea Bay University Health Board delivers services; and investment in staff and equipment, are aimed at bringing those waits down the health board says.

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One of the key investments is focused on expanding enhanced post-operative care facilities, which offer a step up from general ward care for patients who need extra support immediately after their operation.

This includes offering patients advanced pain relief, blood pressure monitoring and oxygen support in the immediate 24-48 hour post-operative period.

These facilities and services are not as intensive as high dependency or intensive care units. However, this additional layer of care will offer Swansea Bay hospitals greater flexibility over where that surgery can be carried out.

Opening these services in Singleton and Neath Port Talbot hospitals mean they will soon be able to offer a wider range of certain surgeries which are currently only carried out in Morriston Hospital.

Pankaj Kumar, Deputy Group Medical Director, Morriston Hospital and the project lead said: “In providing these enhanced post-operative care facilities, the health board is providing right-sized, fit for purpose, post-operative care that is responsive to every patients’ needs and is efficient in its delivery of care.

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“It will lead to improved patient care and better clinical outcomes for patients, and will also reduce the time they spend in hospital.”

The health board says that expanding these services will also ease the pressure on critical care units located on the Morriston site, and reduce the risk of a scheduled operation being cancelled at the last minute because an emergency patient needed the bed.

Singleton Hospital, which already carries out some complex surgery, will benefit from four enhanced post-operative recovery beds to begin with (eventual plan is for six beds) offering the enhanced post-operative recovery facilities particularly for colorectal and gynaecology patients.

Neath Port Talbot’s plan to become the Orthopaedic Centre of Excellence will be supported by enhanced recovery unit beds being introduced in phase two, with the commissioning of three beds. This development will also help urology surgical patients.

Morriston Hospital already has advanced post-operative care beds as part of post-anaesthetic care unit services to complement its higher level of critical care beds.

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Coronavirus

Wales extends COVID-19 testing throughout July

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Welsh Health Minister, Eluned Morgan has confirmed that access to free LFD tests will be extended in Wales until July 31st 2022.

Tests will be available to the public that are showing symptoms of coronavirus (high temperature a new, continuous cough, a loss or change to your sense of smell or taste), alongside free access for people visiting someone eligible for new COVID-19 treatments.

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The announcement comes following a rise in cases, with The Office for National Statistics recent survey reporting an increase in cases across the UK. An estimated 1 in 45 people in Wales currently have COVID-19.

The emergence of the BA.4 and BA.5 sub-variants are also contributing to this increase as they become more dominant across the UK.

The health minister has also announced the following testing will continue to be in place –

  • LFD and PCR testing for those eligible for COVID-19 treatments.
  • PCR testing for COVID-19 and other respiratory viruses for symptomatic care home residents and prisoners.
  • PCR and LFD testing under the patient testing framework and when clinically advised including pre-operative hospital patients and care home residents returning from inpatient hospital stays
  • LFD testing for symptomatic health and social care staff.
  • Twice weekly LFD tests for asymptomatic testing for health and social care staff
  • Those visiting people in care homes should continue to test using tests provided by the care home they are visiting.

Self-isolation payments of £500 will end on 30th June 2022, whilst the COVID-19 Statutory Sick Pay Enhancement scheme will be extended until 31st August 2022 to support social care staff to stay away from work due to testing positive.

Minister for Health and Social Services, Eluned Morgan, said: “Testing has been an effective tool in breaking the chain of transmission and with an increase in cases its vital that we keep testing in place to protect the most vulnerable in our society. As we have seen before, Covid can quickly change, I am announcing this extension in response to the changing picture and new variants of concern.

“I would also ask people to take protective measures to protect the more vulnerable in the community, wear masks in health and care settings, stay at home if you test positive, and take up the offer for the vaccine. We know that the vaccine is the best way to protect yourself, I would urge those eligible to have their spring booster if they have not already had it, the booster is available until June 30.

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“Covid has not gone away, whilst we are learning to live safely with it, we will continue to monitor the situation and as we have done for the last two years, we will work together to Keep Wales Safe.”

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