1. Guy’s and St. Thomas NHS Foundation Trust
Installing Medicine Smart Store Cabinets
By Bill Pulman
Deputy Pharmacy System Administrator
(Ward Automation)

2. 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

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. Interfacing
Replicating BWPROF

9. Interfacing
Replicating BWPROF
Shared Drive

10. Interfacing
Key Interface Fields, Including Name and JAC Indexed Field:
Location lnkdwb
Ward / Cost Centre lnkacb
Drug name lnkdid
Drugpack lnkdpz
Profile SectionNo.
Max Qty Number
Qty Number
Major Change on JAC is to create a section called Cabinet, and relocate all medicines into that section

11. 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
Action: Control / Remove general
access to JAC to manage changes
Shared Drive

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Problems Encountered
Bypassing the System

20. Problems Encountered
Bypassing the System

21. Problems Encountered
Bypassing the System

22. 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.

23. 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.

24. Quality Review Savings

25. 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.

26. Developments
Web Output
Trigger Events
Display Screens
in Stores

27. 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.

28. Contact Details
Daniel Mandeman Chief Pharmacy Technician Automation System Administrator.
William Pulman Senior Pharmacy Technician Deputy System Administrator