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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Launch of E-Top Up 1st September 2005

Stores Issue Transactions

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Launch of E-Top Up 1st September 2005

Weekly Telephone calls re stocks

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Launch of E-Top Up

1st September 2005

Most Frequently Requested Drugs

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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