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The Christie NHS Foundation Trust NHS Ward-Based Robotics June So Director of Pharmacy.

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Presentation on theme: "The Christie NHS Foundation Trust NHS Ward-Based Robotics June So Director of Pharmacy."— Presentation transcript:

1 The Christie NHS Foundation Trust NHS Ward-Based Robotics June So Director of Pharmacy

2 The Christie NHS Foundation Trust NHS Front of hospital

3 The Christie NHS Foundation Trust NHS Questions Are ward-based robotics cost-effective? How can they be made affordable?

4 The Christie NHS Foundation Trust NHS

5 The Christie NHS Foundation Trust NHS Benefits of ward-based robotics Drug savings Product recall Improved security and audit trail Staff savings for nurses, pharmacy Reduced selection/administration errors Clinical decision support Reduction in missed doses Green C, Hughes D, Baird R. Pharmaceutical Journal Oct 2009; 283: 395-398

6 The Christie NHS Foundation Trust NHS The Sheffield Northern General experience - cardiology Roberts N Rollout in 3 phases: Phase 1 4 Theatres, main stores Phase 2 Anaesthetic rooms Phase 3 ICU and recovery Source: N Roberts business case

7 The Christie NHS Foundation Trust NHS Was it cost-effective?

8 The Christie NHS Foundation Trust NHS Case studies in general theatres – one-off stock reduction HospitalPercentage stock reduction Birmingham UHB21% Countess of Chester45% Halton38% Kings College20% (over £1m) Leeds23% Sheffield Northern38% Warrington26% Source: Avantec data on file

9 The Christie NHS Foundation Trust NHS Case studies in general theatres - consumption reduction HospitalPercentage reduction Birmingham UHB16% Countess of Chester24% Halton5% Sheffield126k Kings College5% Manchester South27% Warrington16% Source: Avantec data on file

10 The Christie NHS Foundation Trust NHS Other departments Accident & Emergency eg D Child at Salford Royal Medical Admission Units eg D Ford at Dundee

11 The Christie NHS Foundation Trust NHS Oncology 1 haematology + 1 clinical oncology ward Pilot: cabinets on free loan Drugs including Controlled Drugs Parameters: stock savings, unused stock staff time savings reduction in incidents Ref: So J, Kaye D, Oldham H et al. Hospital Pharmacy Europe 2011; 054: 5-7

12 The Christie NHS Foundation Trust NHS Manchester Evening News Alert on stolen drugs October 08, 2007 DRUGS stolen from Christie Hospital could prove fatal if taken without medical supervision. Police are warning the public to be on the look- out for the morphine tablets which disappeared from the drugs store at the cancer hospital last week………………………

13 The Christie NHS Foundation Trust NHS Business case development Service managers Nurse leads Pharmacy Time/motion sheets counter-signed by Trust Scepticism of ward staff in haematology Approval from Trust to conduct a pilot IT support

14 The Christie NHS Foundation Trust NHS Savings in stock Stock issues £ Pre- installation value £ Post- installation value £ Savings in £ Total after adjustment £ Haematology5,108-1,4946,6023,118 Clinical oncology 1,461572889 Total7,4914,007 (61%)

15 The Christie NHS Foundation Trust NHS Savings in stock Stock not used in 3 months = £1,863 Total drug savings = £5,870

16 The Christie NHS Foundation Trust NHS Pharmacy time savings (top-up) WardTime saved Haematology58 minutes per visit (2x per week = 116 minutes Clinical oncology43 minutes per visit (1x per week = 43 minutes) Total time saved per week159 minutes (2.65 hours)

17 The Christie NHS Foundation Trust NHS Nurse savings CDs OrganisationPre-installationPost- installation Saving Christie Haematology 3 minutes 10 secs 45 secs2 minutes 25 secs (76%) Charing Cross8 minutes4 minutes (50%) Ref. Franklin BD, McLeod M, Miller G. Pharm Man 2009 26(2);9-14

18 The Christie NHS Foundation Trust NHS Nurse savings – non CDs OrganisationPre-installationPost- installation Saving Christie Haematology 1 minute29 seconds31 seconds (52%) Chester A&E department 3 minutes40 seconds2 minutes 20 seconds (78%) Ref. Green C, Hughes D, Baird R. Pharm J 2009;283:395-398

19 The Christie NHS Foundation Trust NHS Number of clinical incidents Incidents – no change

20 The Christie NHS Foundation Trust NHS CD incidents pre and post- installation Pre- installationPost-installation Clinical oncology ward1 major incidentNo majors; Expired drug issues HaematologyNo majorsMinor only

21 The Christie NHS Foundation Trust NHS Nurse satisfaction D Pickersgill, ward manager, clinical oncology It is very user friendly, using finger print ID, no more searching through cupboards, the drug round is a lot quicker, more time is spent with patients

22 The Christie NHS Foundation Trust NHS Other benefits Haematology – all issues to individual patient Plans to feed into the Trust Patient Level Information & Costing system (PLICS)

23 The Christie NHS Foundation Trust NHS Funding How was it funded? Not enough drug savings to pay for the cabinets Staff efficiency savings not used to fund

24 The Christie NHS Foundation Trust NHS Trust approval process Jun 2008 Capital and Workforce Planning Committee Jun 2010 Clinical Support Services Divisional Board Cancer Network Services Divisional Board Cancer Centre Services Divisional Board Aug 2010 Capital and Workforce Planning Committee

25 The Christie NHS Foundation Trust NHS Submission focus on risk/governance benefits Rejected by CWP 2 cabinets funded by the Division – and also engaging with the Christie charity

26 The Christie NHS Foundation Trust NHS Mental Health

27 The Christie NHS Foundation Trust NHS Mental Health Merseycare Trust Pre-installation Stock in £ Post- installation stock in £ Savings in £ Unwanted drugs/returns 3,0369.603,026.40 (99%) Knowles L. NW Chief Pharmacists Workshop 25 May 2011

28 The Christie NHS Foundation Trust NHS Mental Health One ward Costs£ Hardware/software15k purchase Staff costs7.5k project lead (15 months) TOTAL22.5k Savings£ Stock rationalisation, returns15k (15 months) Pharmacy assistant 0.25 WTE4.3k Pharmacist 0.1WTE4.8k TOTAL24.1k

29 The Christie NHS Foundation Trust NHS Cost of ward robotics SpecialtyPurchase cost £ Cardiac theatres25k – 30k or more Mental Health ward15k Neurology20k Oncology ward25k Opthalmology28k Radiology13k Theatres15k – 37.5k

30 The Christie NHS Foundation Trust NHS Are they cost-effective? Ward/dept type TheatresYes Accident & Emergency?Yes (if include staff efficiency savings) Medical Admissions Unit?Yes (if include staff efficiency savings) Mental health wardsYes Oncology wards?Yes if include staff efficiency savings No if exclude staff efficiency savings

31 The Christie NHS Foundation Trust NHS Governance benefits Secure audit trail for CDs/high risk medicines Less risk of diversion Safety, error prevention eg oxynorm and oxycontin

32 The Christie NHS Foundation Trust NHS

33 The Christie NHS Foundation Trust NHS Schwarz HO, Brodoury BA Significant reduction in missed doses Ref. Am J Health Syst Pharm 1995; 52: 823-828

34 The Christie NHS Foundation Trust NHS Borel JM & Rascati KL Reduction in delayed medicines and errors Pre- installation 16.9% Post installation 10.4% Statistically significant Ref: Am J Health System Pharm. 1995;52:1875-1879

35 The Christie NHS Foundation Trust NHS How can they be made affordable? Is there potential for price discounting – national or regional procurement frameworks? eg pharmacy automation in NW

36 The Christie NHS Foundation Trust NHS

37 The Christie NHS Foundation Trust NHS Potential for increased benefits – scope for more savings? Green C, Hughes D & Baird R. Wholesaler/supplier managed inventory How feasible is it? Could it be more cost-effective? Are there any tangible savings? Ref. Green C, Hughes D & Baird R. Pharm J 2009,283:395-398

38 The Christie NHS Foundation Trust NHS Wholesaler : supplier split TrustWardWholesaler: supplier split Drugs value Guys & St Thomas ICU40:60 Elderly40:60 Theatres55:45 ChristieClinical Oncology 55:45

39 The Christie NHS Foundation Trust NHS Conclusion Ward based robotics is here to stay QIPP (Quality, Innovation, Productivity, Prevention) Cost-effective – Yes in selected settings Can they be made more affordable? – procurement, Ward Order Assembly?

40 The Christie NHS Foundation Trust NHS


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