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CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS

Pr Pascal BONNABRYHead of pharmacy

Global GS1 Healthcare ConferenceDubai, April 18, 2016

Introduction

A full traceability of the medication process is the final objective to reachThe implementation should be progressive, as a puzzleTo make the proof of concept, it is important to select

Pilot processes

Pilot products

Pilot persons (patients, healthcare workers)

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High-risk process, with potentially dramaticconsequences for patients in case of errorCritical and costly drugs, a full traceability has a clear added valueLast check at bedside complex and time consumingProduct preparation centralized at the pharmacy, with a possibility to identify the final containerComputerized prescription already implemented

Why cytotoxic as pilot process ?

10 points to check before the administration

Control complexity

Balbaaki R, HUG, 2006

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Failure during verification and administration

Prakash V, BMJ Qual Saf 2014;23:884

Simulation study

IT in the cytotoxic process

Electronicprescription

Bedsidescanning

Preparation withgravimetric control

+ Dose-banding

(2016)

Automatedpreparations

(2015)

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Bedside scanningOrganisation

Database

Cytotoxic

Patient

Nurse

Physician

Safety firstEfficiency

Documenting

Invoicing

…

TraceabilityTracing

Tracking

Traceability as a side effect

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Actors identificationPatient

Caregiver Drug

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Patient identification

8018 7613167 80009627382

GSRN (with hospital ID encapsulated)

HUG IDGCP

Product identification (cytotoxic)

01 07613167000009 7003 1103161400 21 cyt-11198499

GTIN - cytos EXP (date and time) Serial # HUG

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Need to have a standardized system to identifyobjects, persons and placesGS1 is an international standard, recognized in the fields of logistic and healthGS1 is the dominant standard for drugidentification around the worldIncreasing interoperability needs in and betweenhospitals, important to abandon proprietarysystems

Why GS1?

DatamatrixSimple to print and to readRobustNeed a service to calculate the image from the alphanumerical sequence

RFID (initial choice)Scan at distance, under bed sheet, …More costlyNeed specific labels and printersEncoding problems (suboptimal reliability)Practical problems (syringes, liquids)

Data carrier (drug and patient)

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Computer on wheel (COW) and scannerPlatform already working for physicians

Full access to the electronic patient record

Can manage all nurses activities

Cumbersome at bedside

PDA (initial choice)

Mobile and accessible (in the pocket)

Specific to a single/few task(s)

Connectivity problems (Wi-Fi deconnexion)

Readers

Electronic traceability of a cytotoxic

Who?What ?When ?

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Tracking of cytotoxics

Follow the implementation

Scanning rates during the first months

Fleury M, HUG, 2012

Outpatient medical oncology

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31h observation (onco-gynaecology, outpatient clinic)

89 stressors (2.7/h), 27 unplanned movements24% related to the bedside scanning software

Fleury M, HUG, 2012

Consider environment

Advices

Use standard identification systemInvolve specialists of standardsUse robust technologies (data carrier, readers…)Have a strategy, but…Start small and scale-up (selected processesand areas)Involve the users and identify the workaroundsDo not re-invent the wheel

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Next steps

Blood transfusionDrugs, starting with

Biologicals (traceability)

High-risk drugs (safety)

Implantable medical devicesPatient transportation…

Thank you for your attention

Tom Thumb - Traceability by Charles Perrault

Pascal.Bonnabry@hcuge.chThe presentation can be downloadedhttp://pharmacie.hug-ge.ch/ens/conferences.html