Scan4Safety (GS1/PEPPOL)

Prof. Philip Dean FRPharmS

Head of Pharmacy & QC Lab Services

Hong Kong Pharmacy Conference Feb 2017

North Tees and Hartlepool

NHS Foundation Trust

We’re passionate about

• Putting patients first • Quality, safety and patient experience • Transforming services to meet the health

needs of future generations

Presentation plan • What is the problem?

• Systems of Medication • GS1/PEPPOL Overview

• UK Healthcare Context • GS1 coding details

• Scan4Safety initiative • North Tees story

• Benefits • Unknowns

This is a journey we have started…

but not finished.

Most of the content is about process…

not outcome

And it’s not just about medicines

• We service 400,000 people in Stockton, Hartlepool and parts of County Durham

• Have 5,500 medical, nursing, clinical and non-clinical support staff

• Services on 3 sites (600 beds)

– University Hospital of North Tees

– University Hospital of Hartlepool

– Peterlee Community Hospital

• The Pharmacy hosts a Regional Medicines Procurement Specialist Team and a Regional Quality Control Laboratory, we have 137 staff and £19m drug spend

North Tees and Hartlepool overview

What’s the problem? Generally

• Quality & safety • Patient Experience • Capacity & demand • Financial constraints

Specifically for safety • People doing the right thing • Variation in practice • Few hard systems • No commonality in IT systems • Mapping between IT systems • Different coding systems

The problem with codes

Same number, 3 entirely different products

Medicines management • The NHS spends around £6.7bn on medicines in

hospitals • Nurses spend 40% time on medicines management • Carter Report

• “The NHS could save at least £800m on pharmacy and medicines”

• 45% of Pharmacy staff time spent on supply chain activities

• Stockholding between 11 and 36 days, average 20 days • NHS trusts are holding £200m of stock at any one time • Consolidate medicines stock-holding and modernise the

supply chain • 2018 - Trusts should have systems for e-prescribing,

patient level costing, e-catalogue and inventory management, RFID systems

Solutions?

• Different ways of working • Focus on what is core work • Use of LEAN techniques to • Improve flow • Reduce waste • Re-designed pathways

• Workforce & skill mix • 7 day working • Medicines optimisation • New technologies e.g. robotics • Harder controlling systems

Medicines wheel

Secure, hard, system • Secure • Controlled storage • Bio-Metric access • Expiry date

management • Rich information &

Reports • A hard system • Patient safer • GS1 compliant • “Paradigm shift”

• Digital medicines strategy • GS1/PEPPOL • eDI (electronic data

interchange)

• ePMA (Prescribing & Medicines Administration)

• dm+d (Dictionary of medicines and devices)

• FMD (Falsified Medicines Directive EU)

• Without (globally) unique codes – different systems (Ordering,

Logistics, Clinical, Financial)

– cannot communicate

Medicines systems interfaces

GS1 Coding

Logistics System

Dispensing Robot

e-PMA

Electronic cabinets

Who or what is GS1? ...is a member led, not for profit federation (112) of global companies, whose vision is to provide a common language for Industry to identify people, places, products (and tasks...) The standards allow information to be captured at the point of use and to be shared throughout the supply chain.

Not just about barcodes…its about coding

GTIN

Global Trade Item Number

Product

GLN

Global Location Number

Place

GSRN

Global Service Relation Number

Person

Open source standards, interoperable

GSRN - person

In Healthcare this will identify the person - patients & staff A GSRN incorporates the NHS number of every patient and is held in a barcode on the patient’s wristband Can be used for traceability when identifying product recalls

GLN - place

A GLN identifies physical and functional locations, as well as legal entities.

This allows products (with GTINs) to be tracked across the supply chain from manufacture to patient

Sutures

GTIN - product GTIN, just like any product in a supermarket.

GTIN’s contain: • Unique GTIN identifier • Product expiry date • Batch/lot number • Serial number

Gloves

Dressings

Identify, capture, share

• Electronic format for transmitting Purchase Orders and Invoices between hospitals & suppliers

• Machine to machine transfer • Single purchase to payment process (P2P) • Mandated adoption for NHS providers & suppliers • Streamline processes in supply chain. • Improved cash flow, time to pay, costs

PEPPOL – (Pan European Public Procurement Online)

Political will for change • This can actually save lives for

the NHS. • Every week NHS patients died

because they had been given the wrong medicine or care.

• We also have a number of operations where the wrong implant is put into someone's body and then that has to be changed at a later date. If we use modern barcode

technology, we can deal with a lot of these problems.

• Ideally, it will avoid such errors happening in the first place. But when things do go wrong, it will be quicker and easier to figure out why and what can be done.

• Should save the NHS time and money - an estimated £1bn over the next seven years.

Health Secretary, Jeremy Hunt

The journey so far…

National sites

Project timescales

• The project is to be fully implemented in 21 months • The project is segmented into 4 phases

• We have completed phase 1 & 2

Clinical Practice Standardisation • Patient level costing capability

• Enables meaningful dialogue between clinicians,

procurement and finance

Improved patient outcomes at a lower cost

Mandated by the

Department of Health

• Mandated in eProcurement Strategy 2014

• Both providers and suppliers • NHS Terms and conditions updated

Patient Safety Improvements • Faster product re-call response times

• Reduced adverse drug effects

• Faster incident investigations

• Lower NHS LA contribution

Procurement

Efficiencies • Machine-to-machine

POs

• Machine-to-machine

invoices

• Reduced manual

intervention

• Upstream supplier

efficiencies

• Greater product

benchmarking

visibility

£

Inventory

Management

• Reduced wastage

• Lower stock levels

• Automated ordering

• Releasing clinical

time to care

The Department of Health expects

demonstrator sites to ‘showcase’ adoption:

Reporting back on metrics Mini case studies Sharing learnings with the wider NHS

What has the Trust done?

• Senior Board and management support

• IT systems stocktake (180+) – gaps established

• Key IT systems fields identified for GS1 codes

• GLNs assigned – entered into systems

• Scan4Safety training room

• 4x supplier engagement days

• 4 x 100+ industry attendees

• Wide variation in supplier awareness

• Presented within the Trust and Region & nationally on the project

• Engagement with IT system suppliers

• Upgrading IT systems

• Part of a wider team approach

• Mapped our systems (duplicates)

• Mapped our Processes & Activities

• Upgraded existing Systems

• ASCribe/EMIS v10.14

• Decision Support System (background task)

• National Medicines contracts Upload

• GHX PowerGate eDI (PEPPOL) installed

• Started eDI

• Robot tender (next generation)

• Omnicell v20.0 (includes Active Directory support)

• Additional interfaces

• EMIS to Omnicell

• Bar Code Scanners

• InterSystems TrakCare as e-PMA

Pharmacy activity

Faster product recall response

times

Reduced number of

adverse drug effects

Released clinical time to

care

Improved product

traceability

Improved patient

experience

Benefits

A nurse is attending to patients on a ward

Pre GS1 implementation

Post GS1 Implementation

A nurse is attending to patients on a ward

A patient requires urgent attention

A patient requires urgent attention

The nurse looks in stores to locate specialist

tubing

The nurse requires help to locate the product

15 minutes later – the product is found

The nurse looks up the location of specialist

tubing

The nurse locates the product immediately

The product is administered to the

patient

Clinical time released to care

Metal-on- Metal

Patient arrives at hospital

Patient given a GS1 barcoded wristband

upon admission

Patient is given medication

The medication taken by the patient have a GS1 barcode

on the packaging

Patient goes to theatre and has a hip

replacement. All products used contain a GS1

barcode.

Patient returns home

Patient reads about a national product

recall

Patient is worried that they may be

effected & phones the hospital

Hospital staff are easily able to look up the patient &

analyse all products used

Staff are able to confirm to the

patient that they are unaffected the same

day

Patient journey benefits

Financial benefits

Lower NHS LA

contribution

Reduced stock

wastage and

obsolescence

Reduced stock

levels

Operational

efficiencies

£

• Allow product use and pricing to be visible across systems, between organisations, supporting analytics/big data held at national level

• Supplier adoption

• Product compliance

• GMP quality system needed for GS1 use

• IT Systems Supplier variation & Integration?

• Best of breed or top down?

• Flow of GS1 enablers around systems & duplication of data collection

• When do we scan?

Still in progress

• A programme for every NHS hospital in England • Any Product or Service that results in any invoice to

the NHS will need to have a GTIN and GLN

• The national plan will cost £312 million ($400m USD) • Will take seven years to complete • Savings generated amount to £1.04 billion ($1.3bn) • Ongoing annual savings of £370m ($465m) annually

• But the real benefits are in Patient safety and clinical

productivity

The National Plan

• More than halfway through the pilot project to test usefulness of a commonality of global coding

• To integrate these codes into our systems and everyday working

• To measure the effect • To make what we do, safer, easier, quicker

and cheaper

Summary

Pharmacy Team:

•Stephen Ashton/Stuart Fullerton, Principal Technicians

•Helen Jones, Associate Chief Pharmacist

•Angela Kielly, Chief Technician

•Katerina Davidson, Accenture

•GS1 UK and GS1 Hong Kong

Thanks for listening…philip.dean@nth.nhs.uk

Acknowledgments

The Hospital Scan4Safety Team