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ITIG Presentation by Dan Mandeman Chief Pharmacy Technician 11 th October 2011.

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Presentation on theme: "ITIG Presentation by Dan Mandeman Chief Pharmacy Technician 11 th October 2011."— Presentation transcript:

1 ITIG Presentation by Dan Mandeman Chief Pharmacy Technician 11 th October 2011

2 T OPICS IN PRESENTATION  Background – Including Our Vision and Goals  Change Management Process  Financial Savings  Lean Working Methods  Milestones  Benefits  Future Developments  Summing Up

3 B ACKGROUND  Aug-Dec 2009 Guy’s and St.Thomas’ install Europe’s largest deployment of e-storage for medicine and supplies cabinets.  30 individual wards for pharmacy and 100 plus locations for supplies.  Cost neutral for Pharmacy  In 2000 St.Thomas’ installed the first Robot in their dispensary in the UK.

4 B ACKGROUND : V ISION AND G OALS A clear, clean environment to hold stock and administer 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 B ACKGROUND : V ISION AND G OALS End Users spending less time preparing and dispensing medicines enabling them to spend more time at the patients bedside. A more efficient timely and safety controlled system that protects and aids users. Safety features such as bar code readers for high risk medications like Potassium and Heparin Better control of inventory stock delivered and unpacked by pharmacy staff. Reports available to identify key information

6 C HANGE MANAGEMENT - PHARMACY  Initially train over 300 members of pharmacy staff  Explain proposed vision  Highlight benefits  Support network  Trials, early implementers  Engage as much as possible  Overcome problems in clear and timely manner  Review training and Sop’s

7 C HANGE MANAGEMENT - PHARMACY  Top –ups  Booking out and pick requirements  Updating stock lists  Deliver stock medicines to ward  Stock list reviews  Ad-Hoc requests  No Bank holiday service  Pick requirements and put into cabinet.  Cycle count medications in cabinets.  Able to dispense TTO packs from cabinet  Ad-Hoc requests  Provide wards a bank holiday service Before Omnicell (Pharmacy Tasks) Now (Pharmacy Tasks)

8 C HANGE MANAGEMENT - NURSE / ALL END USERS  Initially trained over 6000 nursing staff and Doctors.  Employed a lead nurse for project to liaison and communication link.  Engaged in weekly meetings, updates, forming sop’s  Biggest change at ward level in 30 years. Apprehension, anxiety, fear of the unknown,  Creating link nurses as super users.  Creating extra training for nurses that needed it.  Creating workshops, monthly ward meetings to discuss issues and performance.


10 INVENTORY SAVINGS  May 2010 we held a value of £130,000 across all Omnicell wards  All wards stock holding reviewed.  No targets set on valuation/percentage of reduction.  To achieve goals without more stock outs/ad-hoc ordering October 2010 all stock lists reviewed. Over £28,000 of stock removed. A percentage of 22%. No compromise in patient care. Reduction in ad-hoc ordering and stock outs achieved by 12% 6 months after review. A reduction of out of hour stock enquiries achieved 6 months after installation 1 year after installation

11 INVENTORY SAVINGS  Lots of stock waste.  High volume of returns that couldn’t be returned in pharmacy  Irregular stock list reviews  High cost of incineration  Average £27,000 returns of medicines back into the cabinet monthly.  More control and central storage of low usage, expensive items.  Regular 3 monthly stock list reviews  Less medicines being sent for incineration Before OmnicellNow

12 L EAN – E XAMPLES IN ACTION  20 hours a working day saved not doing top up  More orders delivered than before with time saved  Delivering orders to wards in same location on the same day due to hospital geography Processes made more streamlined No reduction in staff through automation. More efficient in many measurable metrics and higher workload and capacity Stock lists streamlined through advanced reporting capability. Pharmacy

13 L EAN – E XAMPLES IN ACTION  The process of removing medicines is an average of 15 seconds at cabinet.  Nurses no longer put medicines away, done by ATO.  Able to use technology to locate out of stock medicines 24 hours a day Less journeys to pharmacy to collect medicines Less calls made to pharmacy for stock medicines Developing new 21 st century skills. Nurses/End Users

14 M ILESTONES -W HERE 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. Over 10,000 users have been trained to date. Adding more safety features, Validating more “High Risk” medications such as Potassium's, Heparins, Insulin's and penicillin's.

15 Trust used Datix reported incidents to propose list of medicines to be validated using GS1 13 barcodes Potassium IV’s Initially Configured with removal using bar code reader. This has been in place 18 months with No reported picking errors we are trailing all Heparins kept at Trust. After Stepping Hill incident – ongoing talks regarding Insulin’s High Risk Medicines - Barcoding

16 M ILESTONES -W HERE WE ARE NOW Live reports for better financial control and round the clock review Have set up a specialist European training centre on site Weekly key performance indicator meetings to assess performance In the past 18 months have been visited by over 40 NHS Trusts. Many going out for tender. Lots of International visitors.


18 B ENEFITS TTO Medicines dispensed from cabinets traditionally done in dispensary Reduce Ad Hoc deliveries More frequent deliveries to all 30 wards. Achieved with no additional staff. Better financial and inventory stock control


20 B ENEFITS Released many hours of nursing time to care 22% stock inventory saving in first year of go live A safer system for patients and nursing staff A clean, tidy environment for medicine storage

21 Before Omnicell

22 With Omnicell

23 Medicine Smart Store Cabinet Stock Take Break Down and Figures May 2011 Ward Items in cabinetPercentage of items correct Improvement on last quarter How many discrepancies Amount of items expired Improvement on last quarter Alan Apley13179%Yes281Yes Albert18745%Yes1024Yes Henry19059%No782No Becket21952%Yes1065No Sarah Swift Figures still to review ICU 120861%No811Yes ICU 220857%No890Yes Victoria Figures still to review NICU10565%No373No SCBU8547%No453No Page18677%Yes430Yes Page HDU9886%New cabinet142New cabinet Post Natal9569%No292No Luke15665%Yes544No Northumberland17168%Yes557No Nightingale15061%No585Yes George Perkins11277%Yes261Yes Ante Natal9575%Yes242Yes Doulton and HDU31050%No15110No Hillyers18058%Yes757No

24 Medicine Smart Store Cabinet Stock Take Break Down and Figures 2011 MeasureFeb 2011May 2011Comments Average percentage of items correct62.5%64.5%14 wards percentages higher than last months average. 10 wards below. One new ward. 2 wards figures not compiled yet. Least amount of discrepanciesSCBU 10Page HDU 14Slightly better overall Highest percentage of items correctSCBU 88%Page HDU 86%Slightly better overall Least amount of expired items11 ward with 03 ward with 0Not as good Highest amount of expired itemsGynae 8Doulton and HDU 10Not as good Average amount of expired items in cabinet 2.53.4Overall average slightly higher than last month. Lowest percentage of items correctHillyers 32%Albert 45%Better all round figures reflected with improvement of lowest percentage. Most Null Transactions (Month) Cost of discrepancies £ 52,500 £ 49,700 Slight improvement

25 T HE F UTURE Electronic prescribing More safety features to be installed Trials in PCT areas Improving cabinet compliance Training: At Trust Induction Hand held devices with up to the minute info. App for Iphone being designed. Dashboard style screens with live ward feeds Developing hospital in your pocket.

26 S UMMING UP Many lessons learned along the way. Success in change management is tough yet rewarding!!! Clear project management and planning. Listening Understanding and engaging. Always highlighting potential benefits and rewards


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