INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt/Gaynor Hill
1. EXECUTIVE SUMMARY
DECISION REQUIRED
Justification Case Approval / Endorsement
INVESTMENT DRIVER(S)
GATE 1
PROPOSAL SCOPE
Patient safety / Prescription and administration error
avoidance – clear legible prescriptions for
chemotherapy with decision support and assistance
for dose calculations. Improved communication in
the pharmacy ordering process. Improved patient
waiting times for outpatient prescriptions and
continuous track of previous medications. Capture of
contracting and cancer intelligence information.
Inpatient and Outpatient prescribing of
chemotherapy by the oncology and haematology
directorate at Solihull, Heartlands and Good Hope.
Procurement and implementation over 9 months
following funding approval. Full time project
management.
BENEFITS / FIT TO STRATEGY



Improved clinical Governance
Support accurate HRG reporting
FORECAST FINANCIAL IMPACT £k*
Initial Capital to Delivery
Company set up costs
Pharmacy recurrent staffing costs
IT recurrent staffing costs
Gross Initial Investment
Grants/external funding (+ source)
Net Initial Investment
Marginal cost/savings excl dep’n
Marginal income
Total Cash Flow impact
Impact on Trust Surplus

PYE 08/09
0
Meet regional strategy (Pan Birmingham Cancer
Network)
Compliance with National Chemotherapy
Advisory Group Report
FYE 09/10
0
FYE 10/11
FYE 11/12
Total
215,640
73,320
174,216
6173,320
91,000
174,216
91,000
174,216
91,000
554,176
265,216
Proposed Funding Source
Initial Investment
Ongoing
Project Life
FYE Pay
£xk
NPV
£xk
Drivers Matrix
FYE Drugs
£xk
Payback
X mths
Delivery
Prior
approval
NA?
Cap
Rev
Page 1 of 18
xyrs
Quality Central
Business Unit
265,216
Costs to next
Gate X
£xk
xxx
£xk
£xk
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt/Gaynor Hill
Drivers for investment
The implementation of an oncology e-prescribing system will help meet challenges faced by the Trust and
will support the trust meeting the following objectives: To meet a National Cancer Standard. Without e-prescribing we will fail Peer Review for
chemotherapy.
 To utilise e-prescribing so as to make efficient use of the clinical and administrative resources.
 To use the planning and decision support tools of the system to simplify the management of clinical
complexity.
 To use electronic protocols and regimens in order to minimise clinical risk.
 To have a comprehensive audit facility to improve patient safety.
 To improve safety
 To enable NICE guidelines to become an inherent part of clinical practice.
 To meet the cancer waiting times targets and service improvement as defined by the Department of
Health.
 To utilise scheduling tools in order to allow the optimisation of resources and booking of
appointments.
 To track and report on high cost drug usage and chemotherapy contracting.
 To report the chemotherapy dataset to the NCIN.
 To reduce the risk of medication errors by nursing staff around clarity of prescriptions.
Based on the above assessment of drivers, needs and the current position, the following investment aims
have been defined for the proposed oncology prescribing investment:




To reduce waiting times
To improve patient safety
To reduce drug wastage
To reduce drug cost
Improve tracking and reporting of high cost drugs usage.
The following table presents a series of specific objectives that have been set against each aim.
Aim
Associated ‘SMART’ Objectives
Reduce waiting times
Meet 31 and 62 day cancer waiting time targets for 100% of
patients where first treatment is chemotherapy
Improve patient safety
To reduce prescribing errors by 5% on 2005/06 figures
Prevent avoidable deaths
Human error kept to a minimum by reducing the number of staff
involved in checking and reducing the total number of checks
required
Stop clinical staff being involved in note pulling and therefore
release their clinical time for patient care and administration
Safe prescription checking and administration of blood products
Reduce drug wastage
Improved scheduling of patients
Access to patient blood results
Page 2 of 18
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt/Gaynor Hill
Support the unit’s efficiency drives to reduce drug wastage by 0.5%
Reduce drug cost
Protocol based prescribing
Transparency of agreed protocols to enable improved contracting of
drug prices
Improve tracking and
reporting of High Cost
Drugs
Ability to monitor total spend on cancer drugs by HRG and thus
inform payment by results calculations
 There is clear need, support and commitment for the implementation of a software solution to
support electronic chemotherapy prescribing to improve patient safety and quality.
Electronic prescribing has a demonstrable impact upon prescribing errors. The recent safety data audited
by UCLH indicated a 45% reduction in the level of catastrophic and major errors after the implementation of
a specialist chemotherapy prescribing system.
Electronic prescribing is an expected standard for chemotherapy prescribing as indicated by it being a
National Cancer Standard measure which currently we fail..
The current system for chemotherapy using pre-printed prescription proformas does not provide decision
support. Although space to prompt for lab results and information to support dose calculation is provided
the system is unable to mandate their use and prescribing errors result. The system relies on an additional
manual check by pharmacy staff to intercept these errors before they reach the patient.
The electronic prescribing system in use across the rest of the Trust is not designed to deal with the
complex scheduling, infusion regimens and specific special considerations of this speciality.
Moreover it does not give the option to prescribe IV fluids and blood products which are crucial for most of
the Haematology/Oncology patients thus putting more pressure to the delivery of care to the patient
Electronic chemotherapy prescribing systems facilitate both prospective and retrospective audit at all
levels. The adoption of common, structured, disease based protocol driven prescribing ensures patients are
offered the most appropriate and equitable treatments.
Electronic chemotherapy prescribing supports Health Related Groups (HRG) reporting, providing a high
level of accuracy and thus ensures that the correct level funding is secured for the oncology service to
accurately finance the activity being provided and it also permits automatic recording of chemotherapy
activity required by the NCIN..
The purchase of an electronic chemotherapy prescribing system will improve standards of clinical
governance and facilitate risk management by providing a fully auditable record of all chemotherapy
prescribed and administered. Accurate documentation of clinical and pharmacy workload and appointment
scheduling may facilitate the achievement of performance targets, e.g. the Booked Admissions
Programme.
The implementation of an electronic chemotherapy prescribing system is viewed as part of the Pan
Birmingham Cancer Network’s overall strategy to integrate the clinical systems into a whole care record;
this option has the potential for integration into the national Integrated Care Record Service.
The proposed procurement route is via OJEU tender. Full time project management and ongoing support
would be required. A robust and maintained infrastructure (e.g. wireless network) and access to computer
Page 3 of 18
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt/Gaynor Hill
hardware (e.g. mobile computer devices) will be vital to the success of the project.
Page 4 of 18
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt/Gaynor Hill
Expected Project Benefits
The following list outlines the additional specific benefits for chemotherapy:

Eliminate the need for paper based chemotherapy protocols by establishing a central repository of protocols and
regimes accessible by all relevant staff at the point of need which reduces time writing prescriptions;

Computer printouts make the prescriptions legible; on the other hand if the EP system supports a remote tablet
form across the Haemato-oncology Unit computer printouts might not be necessary at all

An automatic interface to the patient’s hospital record. This will eliminate duplicate work to write out patient details
every time a prescription is made;

Improved retrieval of patient information;

Opportunity to audit all chemotherapy prescriptions including the audit of NICE drugs and reduce drug wastage;

Integrating working practices and support of multi-location treatment;

Improve management and audit data;

Monitor side effects and outcomes to treatments;

Reduce risk of prescription and preparation errors;

Enable Haematology and Oncology SpR trainees to increase their confidence in chemotherapy prescribing

Enable Trusts to inform commissioners of chemotherapy activity and drug costs so that effective use of resources
and accurate coding of OPCS\HRG codes as planned by the Department of Health.

Automatic recording of chemotherapy delivery to the NCIN
Page 5 of 18
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
July 2011
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt
2. BENEFITS REALISATION REVIEW PLAN
Title of Business Case:
Electronic Chemotherapy Prescribing
Review Dates
Business Case Reference
No:
Business Unit:
Group 2 and 4
Operations Director
Sarah Rose
Second Review:
Directorate:
Oncology/Haematology/Pharmacy
Clinical Director:
Dr J Ewing
Subsequent Reviews:
Directorate Accountant:
Richard Barratt
Project Manager: Estates/ICT
TBC
Overall Project Lead
Agreed current prices
Initial Investment (£k)
554,176
Dr G Pratt
First Review: (after
implementation)
Due
Completed
+3 months
+9 months
Annual
Actual
Variance
Reasons for Variance
554,176
4554,176
Full funding required
Revenue Cost Base Increase (£k)
Revenue Savings Impact (£k)**
Income Impact (£k)
Contribution (£k)
Implementation Date
January 2013
Project outline scope:
*Costs savings positive, cost increases negative. Income impacts: increase positive, decrease negative **Show savings separately from impact on cost base
Ref
Critical Success Factors & link to KPI.
C1
Implementation of electronic
chemotherapy prescribing at SH, BHH
and GH (inpatient and outpatient)
C2
Link to Pathology results
C3
C4
Reduction in prescribing calculation or
regimen errors detected by pharmacy
Reduction in pathology results related
errors detected by pharmacy
Page 6 of 18
Benefit
Type
Key Measures
(KIM)
Base
Value
Target
Value
Chemotherapy
prescribed
electronically
0%
100%
Automatically
filled on
prescription
0%
100%
Reduction of
error rate
0%
100%
Reduction of
error rate
0%
100%
July 2011
Target
Date
Review Status
Comments / Actions
Agreed
INVESTMENT APPROVAL BRIEFING TO:
Group 2
July 2011
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt
Ref
A1
Additional Success Factors/Benefits to
be Achieved & link to KPI.
Automated collection of data for:
HRG costing
Cancer Minimum Data Sets
Benefit
Type
KIM
Base
Value
Reduction in
additional data
entry
0%
Target
Value
Target
Date
Review Status
100%
Overall Status Comment: Where not green or ‘grey area’ summarise issues which have defined status eg. ‘Delayed recruitment , risk to LOS’
Key Review status Key: Red – Delivery at risk and mitigating actions ineffective. Amber – Delivery at risk, mitigating actions agreed. Green Delivery not at risk.
Page 7 of 18
Comments / Actions
Agreed
July 2011
Investment Team Lead:
Name
INVESTMENT APPROVAL BRIEFING TO:
Group 2 July 2011
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt
BUSINESS CASE: CONTENTS
T*
Page No.
1.
2.
Executive Summary
Project Benefits Realisation Review Plan ‘BRRP’
1
3
3.
4.
Summary and Recommendations
The Case for Change
5
5
APPENDICES
A.
The Strategic Context
B1: Current Risk Assessment Matrix
B2: Project Drivers Matrix Score
C.
Option Appraisal Summary
D.
Option Appraisal
E.
Initial Investment Analysis
7
8
9
10
11
13
3. SUMMARY AND RECOMMENDATIONS
The other options – do nothing, employ additional resource to better maintain the paper system – do
not, or do not fully, address the risks in the current system
The approving body is asked to agree to proceed to full business case.
4. THE CASE FOR CHANGE
The current system for chemotherapy using pre-printed prescription proformas does not provide
decision support. Although space to prompt for lab results and information to support dose calculation
is provided the paper is unable to mandate their use and prescribing errors result. The system relies
on an additional manual check by pharmacy staff to catch these errors before they reach the patient.
In addition the complexity and number of cancer treatment regimens continues to increase putting
further pressure on this system and the team maintaining the pre-printed proformas.
The management of aseptic dispensing in the pharmacy aseptic unit is managed manually. The
management of this work is key to the flow of patients in the treatment areas. Delays in
communication can cause delays to treatment and clinics to overrun making patients dissatisfied
about the level of service they receive and putting additional pressure to the nursing, medical,
pharmacy and managerial staff.
Page 8 of 18
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2 July 2011
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt
The electronic prescribing system in use across the rest of the Trust is not designed to deal with the
complex scheduling, infusion regimens and specific special considerations of this speciality. In
addition it doesn’t provide the option of IV fluids and safe blood product prescribing which is crucial for
patients receiving chemotherapy
Electronic prescribing for chemotherapy is part of the Pan Birmingham Cancer Network Strategy and
has been supported by Lord Warner’s ministerial commitment to the widespread deployment of
solutions across all cancer networks. It will also support the multidisciplinary team meet the aims of
the NHS Cancer Plan (2000).
It is assumed that the benefits realised at other Trusts can be emulated at HEFT. The primary
benefits expected to be achieved are an improvement in patient safety and improvement in the
management of treatment preparation and delivery.
The project is dependent on the Trust’s ICT infrastructure and robust network provision.
Indicative way forward
The proposed next step is to develop a detailed specification and to tender a contract through the
OJEU process for an electronic chemotherapy prescribing system.
The other options – do nothing, employ additional resource to better maintain the paper system – do
not,
or
do
not
fully,
address
the
risks
in
the
current
system.
Page 9 of 18
July 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
APPENDIX A: THE STRATEGIC CONTEXT
The implementation of electronic prescribing for chemotherapy will drive up quality of care for
patients and remove the inherent risks of dosing errors. This is clearly one of the requirements laid
out in NCAG and in the directorate strategy as a must do. The National Chemotherapy Advisory
Group Report “Chemotherapy in England: Ensuring Quality and Safety” and the Cancer Reform
Strategy have clearly identified DH expectations that competent providers of chemotherapy will
quickly move to electronic prescribing and that competent commissioners of cancer care will expect
this of their providers. There are two key drivers. The first is to improve safety in treating patients
with chemotherapy. There is good evidence that e prescribing reduces prescription errors and
provides much better, easily available, information on previous therapy and cumulative doses.
Secondly, it will become critical to have accessible information on treatment regimens. These will be
needed for accurate contracting information when chemotherapy moves into tariff and to improve the
information available to the NCIN for better quality data on clinical outcomes demanded by the
Coalition White paper.
Organisational or Departmental Overview
The current system for chemotherapy using pre-printed prescription proformas does not provide
decision support. Although space to prompt for lab results and information to support dose
calculation is provided the paper is unable to mandate their use and prescribing errors result. The
system relies on an additional manual check by pharmacy staff to catch these errors before they
reach the patient. In addition the complexity and number of cancer treatment regimens continues to
increase putting further pressure on this system and the team maintaining the pre-printed proformas.
The management of aseptic dispensing in the pharmacy aseptic unit is managed manually. The
management of this work is key to the flow of patients in the treatment areas. Delays in
communication can cause delays to treatment and clinics to overrun.
The chemotherapy prescribing system is capable of interfacing with Trust systems, especially the
PAS and Pathology systems.
Page 10 of 18
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
Oncology and Haematology Activity – April 2010 – March 2011
Inpatient Attendances
Activity - 1st April 2010 to 31st March
2011
Inpatient Activity by Patient Spells
Daycase
Elective
Emergency
Total
0
Good Hope
Clinical Haematology
2,266
8
2
2,276
Medical Oncology
3,559
6
4
3,569
Oncology
0
Heartlands
0
4,942
Clinical Haematology
359
228
5,529
1
Medical Oncology
3,962
Oncology
1
169
53
4,184
0
Solihull
Oncology
Total
240
1
14,970
543
241
287
15,800
Outpatient Activity (ward attenders excluded)
Good Hope
Heartlands Solihull
Total
First attendance
Haematology Anti-Coagulant
866
725
397
1,988
Haematology Clinical
401
1,556
224
2,181
Medical Oncology
612
263
Oncology
147
922
875
255
1,324
First telephone or telemedicine
consultation
Haematology Anti-Coagulant
1
Haematology Clinical
2
63
72
257
76
405
18,910
16,320
8,112
43,342
Haematology Clinical
3,370
8,074
30
11,474
Medical Oncology
4,532
1,341
27
4,495
Oncology
1
65
Follow-up attendance
Haematology Anti-Coagulant
Oncology
Page 11 of 18
5,873
1,732
6,254
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
Follow-up telephone or
telemedicine consultation
Haematology Anti-Coagulant
Haematology Clinical
Medical Oncology
Oncology
Total
2
1
3
36
136
172
2
2
134
1,426
185
1,745
29,114
35,579
11,011
75,704
Daycase
Specialty
Haematology Clinical
Haematology Clinical
Medical Oncology
Medical Oncology
Oncology
Oncology
Site
Good Hope
Heartlands
Good Hope
Heartlands
Heartlands
Solihull
Daycases
2266
4942
3559
1
3962
240
Business Strategies
The purchase of the chemotherapy prescribing system will improve standards of clinical governance
and facilitate risk management by providing a fully auditable record of all chemotherapy prescribed
and administered. Accurate documentation of clinical and pharmacy workload and appointment
scheduling may facilitate the achievement of performance targets, e.g. the Booked Admissions
Programme. Furthermore, the data stored by the system may, in the future, allow improved
documentation of chemotherapy costs to defined purchasing organisations, and hence be of
considerable benefit to the Cancer Network.
Page 12 of 18
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
Other Organisational Strategies
The benefits of implementing electronic chemotherapy prescribing have been long understood and
have been supported by Lord Warner’s ministerial commitment to the widespread deployment of
solutions across all cancer networks.
The cancer action team (CAT), in collaboration with NHS Connecting for Health (CfH) and Professor
Mike Richards has been keen to ensure that cancer networks implement appropriate and compliant
electronic systems.
The implementation of a chemotherapy prescribing system is viewed as part of the Pan Birmingham
Cancer Network’s overall strategy; this option has the potential for integration into the national
Integrated Care Record Service.
Page 13 of 18
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
APPENDIX B1: CURRENT RISK ASSESSMENT MATRIX
Table 1 – MEASUREMENT OF LIKELIHOOD
Description
Level
Descriptor
0
Never
The event cannot happen under any circumstances
1
Rare
2
3
Unlikely
Possible
The incident may occur only in exceptional circumstances
The incident is not expected to happen but may occur in some circumstances
4
5
Likely
Almost Certain
The incident may happen occasionally
The incident is likely to occur, but is not a persistent issue
The incident will probably occur on many occasions and is a persistent issue
Table 2 – MEASUREMENT OF CONSEQUENCE
Level
Descriptor
0
1
None
Insignificant
2
Minor
3
Moderate
4
Major
5
Catastrophic
Description
No injury or adverse outcome. Low financial loss
No injury or adverse outcome; First aid treatment; Low financial loss
Short term injury/damage (e.g. resolves in a month); a number of people are
involved
Semi permanent injury (e.g. takes up to year to resolve)
Permanent injury; major defects in plant, equipment, drugs or devises; the
incident or individual involved may have a high media profile
Death
Table 3 - ASSESSMENT MATRIX THE RISK FACTOR = LIKELIHOOD X CONSEQUENCE
CONSEQUENCE
LIKELIHOOD
0 Never
1 Rare
2 Unlikely
3 Possible
4 Likely
5 Almost Certain
None
0
0
0
0
0
0
0
Insignificant
1
0
1
2
3
4
5
Minor
2
0
2
4
6
8
10
Moderate
3
0
3
6
9
12
15
Major
4
0
4
8
12
16
20
Catastrophic
5
0
5
10
15
20
25
By using the matrix above the risk score can be calculated to determine risk category. This ranges ranging
from 1 (low severity and unlikely to happen) to 25 (just waiting to happen with disastrous and widespread
consequences). The risk score can now form a basis upon which to determine the urgency of any actions.
*Risks which have a priority score of 9 or more should be reviewed by the Directorate Management Team
immediately. Green status denotes low risk. Yellow can denote moderate to Significant risk. Red risks
which score 15 or more must be notified to the Risk Register Officer.
Page 14 of 18
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
APPENDIX B2: PROJECT DRIVERS SCORE MATRIX
SCORE
RISK
AVOIDANCE
(i.e. CURRENT
RISK OF DOING
NOTHING) (25%)
IMPROVEMENT
TO PATIENT
CARE (25%)
5
Very high risk
score (> 20) as
per Trust’s Risk
Assessment
Matrix
Clear evidence
that the case
delivers a
specific &
tangible
improvement to
patient care
4
High risk score
(15 to 19) as per
Trust’s Risk
Assessment
Matrix
3
Medium risk
score (9 to 14) as
per Trust’s Risk
Assessment
Matrix
2
Moderate risk
score (4 to 8) as
per Trust’s Risk
Assessment
Matrix
1
Low risk score (1
to 3) as per
Trust’s Risk
Assessment
Matrix
0
No risk, score 0
SCORE
Eg. 4
Eg. 3
Eg. 3
Eg. 1
Eg.2
WEIGHTING
4 x 25 = 100
3 x 25 = 75
3 x 25 = 75
1 x 10 = 10
2 x 15 = 30
WEIGHTED
SCORE
290

Clear evidence
that the case
directly drives a
specific &
tangible
improvement in
patient care
Clear evidence
that the case
directly drives
the Strategy on
improving patient
care
Evidence that
the case
influences a
specific part of
the Strategy on
improving patient
care
FIT WITH
MISSION/STRATEGY
(25%)
Clear evidence that
the case delivers a
specific & tangible
element of the Trust’s
Strategy
Clear evidence that
the case directly
drives a specific &
tangible element of
the Trust’s Strategy
Clear evidence that
the case directly
drives the delivery of
the Trust’s Strategy &
Mission
IMPACT ON
MARKET
SHARE (10%)
Growth in Market
share is real,
sustainable,
increases
income & is
agreed with the
Trust’s key
stakeholders
Case identifies
real potential for
future
sustainable
increases in
income & Market
share
Case directly
influences other
opportunities for
future growth in
income & Market
share
FINANCIAL
VIABILITY (15%)
Revenue Surplus/
Prevention of Lost
Revenue > £500k
&/or Pay back period
< 3 years AND NPV
+ve
Revenue surplus
£251k to £500k &/or
Pay Back period < 4
years AND NPV +ve
Revenue surplus
£101k to £250k &/or
Pay Back period < 5
years AND NPV +ve
Evidence that the case
influences a specific
part of supports the
wider delivery of the
Trust’s Strategy &
Mission
Case is needed
to maintain our
current market
share & income
Revenue surplus £0
to £100k &/or Pay
back period < 5 years
AND NPV +ve
Evidence that
the case
influences
improvements in
patient care
Evidence that the case
influences the
delivery of the Trust’s
Strategy & Mission
No impact on
market share &
income
No revenue
implications – cost
neutral AND NPV
+ve
No impact on
patient care
improvements
No impact on
delivering the Trust’s
Strategy & Mission
Reduces market
share & income
Net revenue loss
and/or NPV –ve
.
Page 15 of 18
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
Option Appraisal
Baseline Option – Do nothing
The current system of prescription proformas for individual treatment regimens fails to deliver a
sufficiently consistent safe service to patients. The forms are able to prompt clinicians to check
the appropriate results and make the appropriate dose calculations – but these actions must be
manually completed and cannot be mandated which introduces the possibility for human error.
Current staff resources have not allowed the prescription proformas to be kept up to date and this
further exacerbates the risks presented by this option. In some cases prescribers using out of
date proformas are required to make manual amendments to the prescription and, as such, the
benefits of the proforma are negated.
Baseline Option Risk Assessment
Description of risk:
Possible consequence:
Likelyhood:
Score:
Inappropriate dose or scheduling of dose is
prescribed due to miscalculation by the
prescriber, omission of lab results check, or
poorly laid out proforma.
Major/Catastrophic (4/5)
Possible (3)
12 - 15
Project Drivers Score
No change – not applicable
The baseline option IS NOT the preferred option.
Option 1 – Invest in current system – Paper based prescribing
An additional junior pharmacist to release more senior pharmacist time would allow the current
system to be properly maintained. This would eliminate the risks associated with manual
amendments to the pre-printed prescription forms.
Suggested resource: 1.0 WTE x Band 6 pharmacist
The problems associated with manual calculations and results checks would still persist.
Option 1 Risk Assessment
Description of risk:
Possible consequence:
Likelihood:
Score:
Page 16 of 18
Inappropriate dose or scheduling of dose is
prescribed due to miscalculation by the
prescriber or omission of lab results check.
Major/Catastrophic (4/5)
Unlikely (2)
8 - 10
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
July 2011
P. Lead: Dr Guy Pratt
Project Drivers Score
Risk:
Improvement to patient care:
Fit with mission / strategy:
Impact on market:
Financial viability:
Score
3
2
2
2
2
Weight
25
25
25
10
15
Total
Weighted Score
75
50
50
20
30
225
Option 1 IS NOT the preferred option.
Option 2 – Electronic chemotherapy prescribing
The purchase of an electronic chemotherapy prescribing system will improve standards of clinical
governance and facilitate risk management by providing a fully auditable record of all
chemotherapy prescribed and administered. Accurate documentation of clinical and pharmacy
workload and appointment scheduling may facilitate the achievement of performance targets, e.g.
the Booked Admissions Programme.
The system will integrate with the Trusts existing results reporting and PAS systems to provide
process and clinical decision support (e.g. no go ahead without blood results as well as dose
reduction recommendations).
Option 2 Risk Assessment
Description of risk:
Inappropriate dose or scheduling of dose is
prescribed due to miscalculation by the
prescriber or omission of lab results check.
Major/Catastrophic (4/5)
Never/Rare (0/1)
0-5
Possible consequence:
Likelihood:
Score:
Project Drivers Score
Risk:
Improvement to patient care:
Fit with mission / strategy:
Impact on market:
Financial viability:
Score
2
5
5
5
0
Weight
25
25
25
10
15
Total
Weighted Score
50
125
125
50
0
350
Option 2 IS the preferred optio
Page 17 of 18
October 2011
INVESTMENT APPROVAL BRIEFING TO:
Group 2
July 2011
Directorate: Oncology/Haematology/Pharmacy
Project Ref:
P.Sponsor:
P. Lead: Dr Guy Pratt
Page 18 of 18
October 2011