Transcript Guy’s and St.Thomas NHS Foundation Trust

Installing Medicine Smart Store Cabinets
By Bill Pulman
Deputy Pharmacy System Administrator
(Ward Automation)
Topics
 What is a cabinet
 The Vision
 From tender to go-live
 Interfacing
 Preparation
 Cabinet installation
 Restock process
 The team
 Where are we now (inc QR)
 Problems encountered
 Savings
What is a Medicine Smart Store Cabinet?
 A fully automated cabinet that provides end users with
instant information and access to stock medication
twenty four hours a day, seven days a week.
 Orders are automated and delivered by pharmacy staff
to cater for the individual ward requirements and
needs. Stock is checked weekly to monitor levels and
usage.
The Vision
 Users spend less time preparing
and dispensing medicines
enabling more time at the
patients bedside.
 Efficient timely and safe system
that protects and aids users.
Safety features like bar code
readers for high risk items like
Potassium
 Better control of inventory stock
Reports available to identify key
information.
 A cleaner environment to hold
stock and prepare 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.
From Tender to Go-Live
 Tendered 2008
 Staff needs were identified and recruited for project
 Global stock List review




Develop interface
Project plan devised with weekly follow-up meetings
Physical location of cabinets agreed
Meet with ward staff. Discuss early implementers
 Finalise ward go live order and co-ordinate work needed
on wards
Interfacing
 JAC wasn’t dm+d compliant
 No Mechanism for HL7 Interface into Pharmacy System
 Product Development path already defined until 2011 (as of 2008)
 Only solution was to replicate PDA Ward Top Up system - BWPROF
 The Interface eventually drove the Omnicell Catalogue Design
Interfacing
 JAC BWPROF - PDA Top-Up Process
 Not widely used by JAC user community.
 Involved:





Copy, Paste and Synchronise Ward profile
Count Medicines on Top-Up
Return to Pharmacy
Process Transfer of File to PC
Run BWPROF to book out medicines.
 Sample extract files (written in Hexadecimal) from Royal Liverpool Hospital
 US Omnicell Developer reversed engineered output files to develop the
interface.
 Key components of the interface drove the development of the Catalogue
Interfacing
 Replicating BWPROF
Interfacing
 Replicating BWPROF
Omnicenter Server
Shared Drive
Interfacing
 Key Interface Fields, Including Name and JAC Indexed
Field:
 Location
 Ward / Cost Centre
 Drug name
 Drugpack
 Profile
 Max Qty
 Qty
lnkdwb
lnkacb
lnkdid
lnkdpz
SectionNo.
Number
Number
Major Change on JAC is to create a section called
Cabinet, and relocate all medicines into that section
Interfacing
Any unmatched data fields can result in a processing error - Most noticeable errors
occurred during contract changes
A large number of data
mismatches arising from
changes on JAC’s ward profile
not reflected on the Omnicell
cabinet.
Booked out on JAC
Pharmacy Server
Action: Control / Remove general
access to JAC to manage changes
Omnicenter Server
Shared Drive
Pre-Go-Live Checks & Processes
 Catalogue
 Interface between Omnicell and present Pharmacy
system
 Omnicell server (and back-up server)
 Training program (no defined American training
book)
 SOP creation
 Equipment support
Cabinet Installation
 Confirm works dept completed any prep work required
(tests & certificates)
 Configure cabinet for quantity, size, location
 Liase with ward staff
 Agree re-stocking schedule with Pharmacy & Ward
 Train ward staff (min 80% before go-live)
 Deploy cabinets to ward area & transfer stock
 Carry out 100% stock check
 Remove over-stock
 Handover system to ward staff
 Trainers present to assist during shift change and
problems encountered
Restocking Process
 Cabinet talks to server through interface (24/7)
 Restock file created by cabinet server and stored on trust
server as a PDA output file
 Files processed using BWPROF (up to 12 wards daily)
 JAC picking list created
 Stock is selected and packed (at Guy’s a Robot processes
within 12 mins
 Stock delivered to the ward
 Stock put away by ATO/Pharm Tech
Our Team








Picking and putting away automated orders.
Cycle counting and expiry checking cabinet inventory.
Training all end users.
Report writing and reviewing
Stock list analysing
Buying in stock
Integrating within long standing MDT’s
System Administration
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
 Adding more safety features, Validating more “High Risk”
medications such as Heparin
 Reports and scheduling
 Setting up a specialist European training centre on site
 Undertaking Quality review
 Providing tours and information to overseas visitors and
NHS trusts across the UK
GS1 13 Barcodes
Trust used Datix reported incidents to propose list of medicines to be
validated using GS1 13 barcodes
 Potassium IV’s Initially Configured
(Now trialled for 6 months)
 Plan to include Heparins
& Insulins
 Scope to move to 2D data matrix
No “validated” catalogue to use (such as dm+d) so used a number of Pharmacy Safety
Team to triple check configuration of barcodes on Omnicell system
Encountered Problems
 Change of work practice (biggest in over 25 years)
 Nursing staff reverting to old practices
 Interface / processing problems
 Pack / drug changes (frequent)
 Training issues (understanding of ‘how to use it’)
 Equipment failure
 Jammed drawers
Problems Encountered
Bypassing the System
Problems Encountered
Bypassing the System
Problems Encountered
Bypassing the System
Quality Review
 System Admin tasks
 Training including re-fresher training and super user training
 Meeting Clinical Leads
 Looking at key performance indicators
 Ward Savings
 Meet clinical leads and ward pharmacist to explain data
analysis and stock saving recommendations
 Currently assessing data usage across 30 clinical areas to
optimise PAR levels, deliveries and possible financial savings.
Inventory Savings
We currently hold stock £127,000 worth of stock across 30
wards.
Our target from the outset would be to reduce this figure
by 20% or £25,400
We have achieved the figure of £16,027 from 12 areas so
far. So anticipate achieving that figure in the coming few
weeks of Quality Review.
Quality Review Savings
North
ICU 1
£3288.84
£560.63
Doulton
and
HDU
£1200
ICU 2
£3288.84
Luke
£617.46
Total
Saving
£16,027
Victoria
£2520.72
Hillyers
£581.40
Sarah
Swift
£1745.17
Howard
£172.40
Page
£923.83
Alan Ap
£520.92
The Future??????
 Complete phases to Guy’s ward, Evelina Children’s
hospital and Theatres
 Further savings across the stock lists
 Review metrics of quality and improvement
 Use 2D bar coding technology to track expiry dates and
batch numbers.
 Learn from other established sites that use this type of
technology around the world.
 Automate reports to include safety stock, other high risk
medications.
Developments
Omnicenter Server
Web Output
Email Trigger Events
Display Screens
in Stores
The Vision
 Users spend less time preparing
and dispensing medicines
enabling more time at the
patients bedside.
 Efficient timely and safe system
that protects and aids users.
Safety features like bar code
readers for high risk items like
Potassium
 Better control of inventory stock
Reports available to identify key
information.
 A cleaner environment to hold
stock and prepare 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.
Contact Details
 Daniel Mandeman Chief Pharmacy Technician
Automation System Administrator.
[email protected]
07818013755
 William Pulman Senior Pharmacy Technician Deputy
System Administrator. [email protected]
07817738912