noel dempsey pharmacy systems manager st helens & knowsley teaching hospitals nhs trust 4th june...
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Noel DempseyPharmacy Systems Manager
St Helens & Knowsley Teaching Hospitals NHS Trust
4th June 2008
Background
Problem identified when stocked drugs are required by wards between “top up” visits from pharmacy staff
• Procedure
• Security / Efficiency
How do wards request additional drugs?
Which drugs can they have?
Which section within the pharmacy do they need to contact? - Stores or Dispensary
Who can request additional stocks?
Who is requesting additional stocks? Is the drug available?
Solutions?1. Telephone requests
No security No Audit Trail
4. Fax requests Little or no security Legibility of request (hand written) Incomplete forms
Drug limitations (Profiles)
Drug limitations (Profiles)
2. Requisition Books Legibility of request (hand written)
Drug limitations (Profiles)
Time and distance (remote sites)
3. Ward Access to Pharmacy Computer System (JAC) Loss of pharmacy budgetary controls Potential exceeding User Licence limits
Interruption to work
Which Which Ward?Ward?
Authorised Authorised staff?staff?
Stocked Drug?Stocked Drug?
1. Web based application (Trust Intranet)
2. Fully secure and auditable
Available from any networked PC
Available to any authorised nurse
Only drugs stocked on their own ward can be ordered
Records name of person ordering
ADVANTAGES
Stops telephone requests for additional drugs
ADVANTAGES
3. Evidential support for:
C.N.S.T. (Clinical Negligence Scheme for Trusts)
• Medicine Management Standards
Criteria 7.1.6
Criteria 7.2.5
Standards for Better Health
• Safe and Secure Handling of Medicines
Assurance marker C4d
Duthie Report (New Edition March 2005)
•Safe and Secure Handling of Medicines
4. Time Efficient
Reduces time to create an order
ADVANTAGES
Improves legibility of the order
Stops requests for non stocked drugs
Improves communication between wards
and the Pharmacy department
5. Stock Efficiency
Reduces duplication of work
Identifies items where the stock level on the ward needs to be addressed
Reduces telephone calls
ADVANTAGES
1. The user must register themselves on the Trust Intranet Staff Directory and know their username and password (Nursing staff reluctance regarding new computer procedures)
2. Being Web based, it will not be available in the event of a network failure
3. The user must be set up and activated by the system administrator before they can access the application
DISADVANTAGES
1. The value of issues to wards will increase drastically!
2. The number of issues will increase if nursing staff have an easier route to order stocks
3. Pharmacy staff will not have enough time to process the requests, and assemble and……and…
CONCERNS RAISED
Bulk Issue Value
£200,000
£220,000
£240,000
£260,000
£280,000
£300,000
£320,000
£340,000
£360,000
£380,000A
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month
Launch of E-Top Up 1st September 2005
Stores Issue Transactions
5000
7000
9000
11000
13000
15000
17000
19000A
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Launch of E-Top Up 1st September 2005
Weekly Telephone calls re stocks
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20
40
60
80
100
120
140
160
180
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May
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Jun
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Oct
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Dec
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Launch of E-Top Up
1st September 2005
Most Frequently Requested Drugs
0 20
40
60
80
10
0
12
0
14
0
16
0
18
0
AMET HOCAINE Gel 4 %
BET AMET HASONE SODIUM PHOSPHAT E Inject ion 4 mg in 1mL
ENOXAPARIN Inject ion 20 mg
GAST ROGRAFIN 100ml Solut ion no st rength
GENT AMICIN Inject ion 80 mg in 2mL
GOSERELIN ACET AT E Inject ion 3.6 mg
JELONET 10CM X 10CM Dressing (no st rength)
LIDOCAINE 'LIGNOCAINE' T opical Solut ion 4 %
LORAZEPAM T ablets 1 mg
MET HYLPREDNISOLONE ACET AT E Inject ion 80 mg in 2mL
ONDANSET RON Inject ion 4 mg in 2mL
PARACET AMOL Infusion 1 g in 100mL
PROCYCLIDINE T ablets 5 mg
PROPOFOL (20ml) Inject ion 1 %
PROXYMET ACAINE 0.5% FLUORESCEIN 0.25% Minims (no st rength)
T ROPICAMIDE Minims 1 %
WAT ER FOR IRRIGAT ION 'POUR' (1000ml) Irrigat ion (no st rength)
WAT ER FOR IRRIGAT ION 'POUR' (1000ml) Irrigat ion (no st rength)
Top 20 Ward Activity
0 100 200 300 400 500 600
X-RAY WHISTON STOCKTAYLOR STOCK (ExT5)
T3 STOCKT2 STOCKT1 STOCK
STEWART ASSESSMENT STOCKRENNIE STOCK
MATERNITY THEATRE STOCKMAGNETIC RESONANCE IMAGING STOCK
HULME STOCKGARTON STOCK
G THEATRE EXTERNALS STOCKG DRESSING CLINIC STOCKENDOSCOPY UNIT STOCK
E1 STOCKDUFFY SUITE
DIABETES NURSE SPECIALIST STOCK WHISTONCORONARY CARE UNIT STOCK
ANTE-NATAL CLINIC STOCK WHISTONG THEATRE 3 PLASTICS STOCK
Pharmacy Top Up Service Ow n Top Up
Garton Ward Drug Ordering Frequency
0 5 10 15 20 25 30 35 40 45 50
CEFUROXIME Injection 750 mg
CO-CODAMOL Tablets 30/500
CODEINE PHOSPHATE Tablets 30 mg
CYCLIZINE Injection 50 mg in 1mL
DICLOFENAC SODIUM Enteric Coated Tablets 50 mg
DICLOFENAC Suppositories 100 mg
ENOXAPARIN Injection 20 mg
ENOXAPARIN Injection 40 mg in 0.4mL
FERROUS SULPHATE Tablets 200 mg
HARTMANS SOLUTION (COMPOUND SODIUM LACTATE)'B2324G' (1000ml) Infusion (no strength)
LACTULOSE Liquid (no strength)
MORPHINE SULPHATE Oral Solution 10 mg in 5mL
MOVICOL Oral Powder (no strength)
PARACETAMOL Tablets 500 mg
SODIUM CHLORIDE 'B1324G' (1000ml) Infusion 0.9 %
SODIUM CHLORIDE FLOWFUSOR (2000ml) Irrigation 0.9 %
TRAMADOL HYDROCHLORIDE Capsules 50 mg
WATER (10ml) MINI-PLASCO Injection (no strength)
WATER (5ml) MINI-PLASCO Injection (no strength)
•Number of Wards / Departments able to use:
•Number of Authorised users:
186
1748
Noel DempseyPharmacy Systems Manager
St Helens & Knowsley Hospitals NHS Trust
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