FIXING THE MISSING LINK Connecting e P to

FIXING THE MISSING LINK Connecting e. P to e. Cupboards – l Lessons Learnt Gillian Honeywell Chief Pharmacist July 2015 NHS Technology Fund: Safer Wards Safer Hospitals

The Isle of Wight Population: 140, 000, 2 m visitors pa One unique organisation: �Acute hospital �Community �Ambulance �Mental Health �‘One front door’ GP and ED �Vanguard site

Right Drug, Right Patient, Right Time Safety, effectiveness, patient experience � Minimise duplication of data entry � Paperless from prescribing to administration � Rationalise and amalgamate ward stock � Improve access to medicines � Audit trail from prescribing to patient � Reduced delays � Improve efficiency � Knowledge at the press of a button

Not the Only Why: Legibility – Semtex!

Electronic prescribing 7 day working Access to Vision 360

Missed doses Trust Quality Report

RRISK CHANGE

RISK CHANGE

DOES SAFETY & QUALITY = SAVINGS? • ADE cost £ 713 - £ 1, 484 – CALL IT £ 1 k: • Medicines Reconciliation: increase by 10%: • Increased saving ~£ 10 k pa • Missed Doses: Assume 10% are avoidable. Pre EPMA? ? ? 10% reduction: 250, 000 pa 25, 000 avoidable, reduce by 10% = 2500 avoided, assume 10% cause ADE = 250 • = £ 250 k pa • Category 4 warnings: 170 pa heeded, assume 10% cause ADE • = £ 17 k pa

Does safety = savings? • Conservative identified quality / safety benefits >£ 270 k pa • What is the cost of antibiotic resistance? • What is the cost of VTE? • What is the cost of readmissions when the GP gets poor information?

Duplication of data entry Ward stock order Prescription Dose Prescription Dispense JAC Select drug

What’s Missing? �Medicines vs prescription �Supply to ward vs used by ward �Medicine matches prescription �Stock availability �Closed loop

Technology Pathway �Pharmacy system 1980’s �Robot 2006 �Vertical carousel 2007 �Keyless patients own drugs lockers 2011 �EPMA 2012 �Automated storage on wards 2014 NHSE Technology Fund

Storyboard: • 15 areas covered by 12 cupboards • One shared clinic room for neighbouring wards • Rationalise stock • Interface Omnicell with JAC stock and EPMA • Select medicine by patient

Interface Map EPMA Prescribed drugs supplier OMNICELL Select drug by patient JAC STOCK SYSTEM STOCK Omnicell top up PAS / PORTAL patient ROBOT/ CAROUSEL Issues stock JAC STOCK Top up list

Interfacing Interface EPMA with Omnicell, prescription appears on cupboard

Interfacing Details of current medicines

Interfacing Order arrives in JAC, goes to Robot and Vertical Carousels

Experience: Clare Barton, Staff Nurse on Colwell Ward, said: “The biggest difference it has made is that we don’t have to hunt around for keys anymore because it’s all finger coded. It makes you more aware of the drugs you’re handling—rather than routing through cupboards, a specific cupboard opens for a specific drug. The machine will only offer you what you’re asking, which is a way of it being checked. This system is time-saving and I think it is great! “

Experience: Jackie Harry on NICU Ward, said: “After very few hiccups I really like it, we have much better stock control and expiry date management, it’s really easy to use even in an emergency. We have saved time hunting for keys and searching in cupboards – we know we have the stock and the cupboard takes us to it. Invaluable. Really time efficient and safe“

Safety BEFORE AFTER

BEFORE AFTER

Efficiency Caution note: based on 6 -12 month data �> 10 hours a week Pharmacy time �> 35 hours a week nursing time � 6% reduction in stockholding value (£ 6 k) � 11% reduction in supplies to wards (£ 140 k pa)

Efficiency �Vision to all Omnicells for restricted meds �Stock usage vs stock supply �No manual transfer of information �Information entered once – prescribing �Staff time released to care

LESSONS LEARNT: • Clear vision and strategy • Maximise benefits from each step • Gain understanding & ownership from users • Demonstrate and celebrate success • Long term monitoring of benefits

Installing: �INNOVATION WITH TECHNOLOGY

gillian. honeywell@iow. nhs. uk www. iow. nhs. uk