itig presentation by dan mandeman chief pharmacy technician 11 th october 2011
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ITIG Presentation by
Dan Mandeman
Chief Pharmacy Technician
11th October 2011
TOPICS IN PRESENTATION
Background – Including Our Vision and Goals
Change Management Process
Financial Savings
Lean Working Methods
Milestones
Benefits
Future Developments
Summing Up
BACKGROUND
Aug-Dec 2009 Guy’s and St.Thomas’ install Europe’s largest deployment of e-storage for medicine and supplies cabinets.
30 individual wards for pharmacy and 100 plus locations for supplies.
Cost neutral for Pharmacy
In 2000 St.Thomas’ installed the first Robot in their dispensary in the UK.
BACKGROUND: VISION AND GOALS A clear, clean environment to hold
stock and administer medications Availability of financial reporting Improve preparing discharge medicine
on ward. Reduce cost of unused, waste and
overstocked medicine. Ability to Quality Review areas and
assess performance. A flexible, robust system that will
deliver. Decrease the need for Ad Hoc
deliveries.
BACKGROUND: VISION AND GOALS End Users spending less time preparing
and dispensing medicines enabling them to spend more time at the patients bedside.
A more efficient timely and safety controlled system that protects and aids users. Safety features such as bar code readers for high risk medications like Potassium and Heparin
Better control of inventory stock delivered and unpacked by pharmacy staff.
Reports available to identify key information
CHANGE MANAGEMENT - PHARMACY Initially train over 300 members of pharmacy staff
Explain proposed vision
Highlight benefits
Support network
Trials, early implementers
Engage as much as possible
Overcome problems in clear and timely manner
Review training and Sop’s
CHANGE MANAGEMENT - PHARMACY
Top –ups Booking out and
pick requirements Updating stock lists Deliver stock
medicines to ward Stock list reviews Ad-Hoc requests No Bank holiday
service
Pick requirements and put into cabinet.
Cycle count medications in cabinets.
Able to dispense TTO packs from cabinet
Ad-Hoc requests Provide wards a
bank holiday service
Before Omnicell (Pharmacy Tasks) Now (Pharmacy Tasks)
CHANGE MANAGEMENT- NURSE/ALL END USERS
Initially trained over 6000 nursing staff and Doctors.
Employed a lead nurse for project to liaison and communication link.
Engaged in weekly meetings, updates, forming sop’s
Biggest change at ward level in 30 years. Apprehension, anxiety, fear of the unknown,
Creating link nurses as super users. Creating extra training for nurses that
needed it. Creating workshops, monthly ward meetings
to discuss issues and performance.
INVENTORY STOCK SAVINGS: A REVIEW OF 30 WARDS USING OMNICELL REPORTING
INVENTORY SAVINGS
May 2010 we held a value of £130,000 across all Omnicell wards
All wards stock holding reviewed.
No targets set on valuation/percentage of reduction.
To achieve goals without more stock outs/ad-hoc ordering
October 2010 all stock lists reviewed.
Over £28,000 of stock removed. A percentage of 22%.
No compromise in patient care.
Reduction in ad-hoc ordering and stock outs achieved by 12% 6 months after review.
A reduction of out of hour stock enquiries achieved
6 months after installation 1 year after installation
INVENTORY SAVINGS
Lots of stock waste. High volume of
returns that couldn’t be returned in pharmacy
Irregular stock list reviews
High cost of incineration
Average £27,000 returns of medicines back into the cabinet monthly.
More control and central storage of low usage, expensive items.
Regular 3 monthly stock list reviews
Less medicines being sent for incineration
Before Omnicell Now
LEAN – EXAMPLES IN ACTION
20 hours a working day saved not doing top up
More orders delivered than before with time saved
Delivering orders to wards in same location on the same day due to hospital geography
Processes made more streamlined
No reduction in staff through automation.
More efficient in many measurable metrics and higher workload and capacity
Stock lists streamlined through advanced reporting capability.
Pharmacy Pharmacy
LEAN – EXAMPLES IN ACTION
The process of removing medicines is an average of 15 seconds at cabinet.
Nurses no longer put medicines away, done by ATO.
Able to use technology to locate out of stock medicines 24 hours a day
Less journeys to pharmacy to collect medicines
Less calls made to pharmacy for stock medicines
Developing new 21st century skills.
Nurses/End Users Nurses/End Users
MILESTONES-WHERE WE ARE NOW
30 wards successfully installed with Medicine Smart Store at Guy’s and St. Thomas NHS Foundation trust
Ongoing training of pharmacy users and all end users. Over 10,000 users have been trained to date.
Adding more safety features, Validating more “High Risk” medications such as Potassium's, Heparins, Insulin's and penicillin's.
Trust used Datix reported incidents to propose list of medicines to be validated using GS1 13 barcodes
Potassium IV’s Initially Configured with removal using bar code reader.This has been in place 18 months withNo reported picking errors
we are trailing all Heparins kept atTrust.
After Stepping Hill incident – ongoing talks regarding Insulin’s
High Risk Medicines - High Risk Medicines - BarcodingBarcoding
MILESTONES-WHERE WE ARE NOW Live reports for better financial control and round the
clock review
Have set up a specialist European training centre on site
Weekly key performance indicator meetings to assess performance
In the past 18 months have been visited by over 40 NHS Trusts. Many going out for tender. Lots of International visitors.
BENEFITS
TTO Medicines dispensed from cabinets traditionally done in dispensary
Reduce Ad Hoc deliveries
More frequent deliveries to all 30 wards. Achieved with no additional staff.
Better financial and inventory stock control
BENEFITS Released many hours of nursing time to care
22% stock inventory saving in first year of go live
A safer system for patients and nursing staff
A clean, tidy environment for medicine storage
Before Omnicell
With Omnicell
Medicine Smart Store Cabinet Stock Take Break Down and Figures May 2011
WardItems in cabinet Percentage of items
correctImprovement on last quarter
How many discrepancies
Amount of items expired
Improvement on last quarter
Alan Apley 131 79% Yes 28 1 Yes
Albert 187 45% Yes 102 4 Yes
Henry 190 59% No 78 2 No
Becket 219 52% Yes 106 5 No
Sarah Swift Figures still to review
ICU 1 208 61% No 81 1 Yes
ICU 2 208 57% No 89 0 Yes
Victoria Figures still to review
NICU 105 65% No 37 3 No
SCBU 85 47% No 45 3 No
Page 186 77% Yes 43 0 Yes
Page HDU 98 86% New cabinet 14 2 New cabinet
Post Natal 95 69% No 29 2 No
Luke 156 65% Yes 54 4 No
Northumberland 171 68% Yes 55 7 No
Nightingale 150 61% No 58 5 Yes
George Perkins 112 77% Yes 26 1 Yes
Ante Natal 95 75% Yes 24 2 Yes
Doulton and HDU 310 50% No 151 10 No
Hillyers 180 58% Yes 75 7 No
Medicine Smart Store Cabinet Stock Take Break Down and Figures 2011
Measure Feb 2011 May 2011 Comments
Average percentage of items correct 62.5% 64.5% 14 wards percentages higher than last months average. 10 wards below. One new ward. 2 wards figures not compiled yet.
Least amount of discrepancies SCBU 10 Page HDU 14 Slightly better overall
Highest percentage of items correct SCBU 88% Page HDU 86% Slightly better overall
Least amount of expired items 11 ward with 0 3 ward with 0 Not as good
Highest amount of expired items Gynae 8 Doulton and HDU 10 Not as good
Average amount of expired items in cabinet
2.5 3.4 Overall average slightly higher than last month.
Lowest percentage of items correct Hillyers 32% Albert 45% Better all round figures reflected with improvement of lowest percentage.
Most Null Transactions (Month)
Cost of discrepancies £52,500 £49,700 Slight improvement
THE FUTURE Electronic prescribing
More safety features to be installed
Trials in PCT areas
Improving cabinet compliance
Training: At Trust Induction
Hand held devices with up to the minute info. App for Iphone being designed.
Dashboard style screens with live ward feeds
Developing hospital in your pocket.
SUMMING UP Many lessons learned along the way.
Success in change management is tough yet rewarding!!!
Clear project management and planning.
Listening
Understanding and engaging.
Always highlighting potential benefits and rewards
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