Clinical Documentation in AED AED Poisoning Case Management Form

Dr. Joseph Yao Health Informatics Hong Kong Hospital Authority

Poisoning incidents are common Background • According to The Hong Kong Poison Information Centre (HKPIC), there were around 4,000 poisoning cases reported in 2010 in Hong Kong

• Most of the patients were admitted via AEDs and received immediate treatment

• The Poison Form was developed to align with the enhanced features of CMS III, as well as the readiness for electronic clinical documentation in AEDs Efficiency Challenges in AED • High patient volume • Timing critical Mobility • Interacting with multiple patients and team members at any one time • Vast variety of clinical conditions • Sentinel point for the whole Knowledge community support • …..

Connect to the Community Goal ...

• Full electronic clinical documentation in AEDs

• Poisoning Case Management Form as a trial  Most cases are clinically less critical  Data items standardized  Case load not too heavy AED record

Free Text Future interface Induce frontline staff to adopt electronic documentation at AEDs

Acquisition

Institutionalization

% of User Adoption Adoption Trial Use

Understanding

Awareness

Contact

Time How do we record Poisoning Cases in AEDs?? Current situation

• Poisoning cases in A&E are manually recorded: i. Handwritten AED card ii. Locally-developed manual forms

• Wide range of non-standardized information captured among different hospitals.

Limited standardized data captured in A&D card Limitations • Difficult to retrieve information based on paper forms and AED card image • Few standardized data available and most data cannot be reused • Storage of manual forms and enquiry of previous records difficult • Difficult to analyse poisoning-related data among AEDs • Handwritten errors and potential misinterpretation of handwriting

Analysis of Poisoning Data

Number of Ketamine abuse cases? Number of Chinese herbal poisoning cases? Number of snake bites?

AED Poisoning Case Management Form workflow Clinical Workflow in using AED Poisoning Case Management Form

Clinical information retrieved in Nurse at Triage Station ward

Clinical information uploaded to ePR Clinical assessment & documentation by doctor

Clinical data captured by AED Poisoning Case Management Form Poisoning Case Management Form interface Poisoning-related information (input in Four tab pages)

1. Clinical History 2. Clinical Findings 3. Emergency Management 4. Progress and Monitoring (1) Clinical History

(1) Clinical History Poison informaton

Poisons list Source: HKPIC Alcohol Ampicillin Insulin Warfarin Sleeping pill Digoxin Carbon monoxide Ciguatoxin Amoxil Mixtard Aspirin Diazepam Nitrates Burnt charcoal Neurotoxin Amoxicillin Monotard Salicylates Midazolam TNG LPG Cannabis Cloxacilin Protaphane Panadol Ativan Nitroglycerin Towngas Cocaine Augmentin Actrapid Paracetamol Dormicum Isordil Chlorine gas Ketamine Penicillin V Metformin Panadol extra Lorazepam Isordil Tembid Potassium cyanide Methamphetamine Unasyn Diamicron Naproxen Valium Elantan Sodium cyanide MDMA Nystatin Gliclazide Naprosyn Amitriptyline Isosorbide dinitrate Cyanide Isosorbide Erythromycin Glibenclamide Indocid Imipramine Parathion Opioid mononitrate Zopiclone Clarithromycin Daonil Indomethacin Dothiepin Lasix Malathion

Other abusive substance Azithromycin Amaryl Mefenamic acid Nortriptyline Furosemide Dichlorvos Unknown abusive Tetracycline Glimepiride Ponstan Largactil Frusemide Fenthion substance Bamboo snake bite Minocycline Minidiab Brufen Chlorpromazine Allopurinol Dimethoate Cobra snake bite Doxycycline Glipizide Phenytoin Haloperidol Colchicine Chlorpyrifos King Cobra snake bite Rifampicin Glucobay Dilantin Quetiapine Dextromethorphan Adalat retard Other snake bite Cephalexin Acarbose Carbamazepine Clozapine Theophylline Amlodipine Unknown snake bite Cefuroxime Thyroxine Tegretol Risperidone Theodur Norvasc Bee or Wasp sting Zinnat Propylthiouracil Epilim Olanzapine Nueline Felodipine bite Ciprofloxacin Carbimazole Valproic acid Nitrazepam Slobid Plendil

Stonefish sting Levofloxacin Chlorpheniramine Phenobarbitone Zolpidem Aminophylline Diltiazem sting Metronidazole Piriton Luminal Zolpiclone Ethanol Herbesser Sea-urchin sting Dapsone Diphenhydramine Chloral hydrate Stilnox Methanol Verapamil sting Septrin Benadryl Loratidine Imovane Rubbing alcohol Isoptin

Unknown Bites or stings Isoniazid Phenergan Methotrexate Propranolol Isopropyl alcohol Lithium Chinese Herbal medicine Ethambutol Promethazine Vitamin A Inderal Kerosene Sulphuric acid Proprietary Chinese Nitrofurantoin Zyrtec Ferrous sulphate Flecainide Chloroform Sodium hydroxide medicine Oral contraceptive Cetirizine Iron sulphate Amiodarone Trichloromethane Caustic soda Alternative medicine pills Other herbs Clarityne Hydrochloric acid Other Poison (2) Clinical Findings

(3) Emergency Management (4) Progress and Monitoring

Benefits • Sharing of poisoning information in ePR • Retrieval of clinical guidelines and antidote regimens • Reporting and statistics • Generation of diagnosis codes Rollout Plan 1st Phase 2nd Phase (2011/12) (2012/13)

TMH

Rollout scheduleQEH

HKWC KCC NTEC HKEC KEC NTWC KWC Number of Poisoning Cases recorded via AED Poisoning Case Management Form (1/6/2011 – 31/3/2012) The way forward……

Generic electronic AED Forms

Paperless AEDs Acknowledgement

HA HI team HA IT team AED IT WG

• Dr N T Cheung • Mr Anthony Cheung • Dr M H Ng • Dr Anna Tong • Mr Tony Fung • Dr S H Tsui • Ms Karis Wong • Mr Edmund Kwong • Dr S H Ng • Mr Marcus Ng • Mr Alan Chan