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