Medicines Storage Audit – A Live Solution Neil Carvell Pharmacy Supply Manager & Debbie Brenton Deputy Director of Pharmacy (Operational Manager)

Overview BackgroundBackground Case for ChangeCase for Change The SolutionThe Solution Benefits of MeridianBenefits of Meridian ImplementationImplementation Meridian in UseMeridian in Use Lessons LearntLessons Learnt The FutureThe Future

Introduction Plymouth Hospitals NHS TrustPlymouth Hospitals NHS Trust -900 bed Teaching Hospital -Secondary & tertiary care provider for Plymouth, North & East Cornwall and South & West Devon -Population of 450,000

Background Annual audit undertakenAnnual audit undertaken –Limitation Manual data collection and analysisManual data collection and analysis Time lag between data entry and reportTime lag between data entry and report Undertaken by clinical staffUndertaken by clinical staff Lack of engagement from clinical areas with action planLack of engagement from clinical areas with action plan Stepping Hill incidentStepping Hill incident –DH audit requirements –CQC involvement Improved internal focusImproved internal focus

Case for Change To provide assurance of compliance with the Medicines Management PolicyTo provide assurance of compliance with the Medicines Management Policy To provide assurance that storage conditions are met.To provide assurance that storage conditions are met. Reduce the risk of medicines wastage due to incorrect storage.Reduce the risk of medicines wastage due to incorrect storage. To raise the profile of medicines security and storage within the Trust.To raise the profile of medicines security and storage within the Trust. To develop a governance framework for the storage of medicines at a ward and department level.To develop a governance framework for the storage of medicines at a ward and department level. To drive improvements in practiceTo drive improvements in practice

The Solution - Meridian Technology platform for patient/stakeholder feedback and auditTechnology platform for patient/stakeholder feedback and audit Fully hosted secure web based solutionFully hosted secure web based solution License includes ability to build and adapt surveys/audits and deploy instantly to any internet enabled deviceLicense includes ability to build and adapt surveys/audits and deploy instantly to any internet enabled device -No limit to number of surveys or users -Licence also covers use of kiosks, or SMS Text surveys Supports Equality and Diversity programme – different languages, graphics, audio and videoSupports Equality and Diversity programme – different languages, graphics, audio and video

Benefits of Meridian Provide a platform for clinical care feedback and audit solutions via one provider and within one annual license fee of £30kProvide a platform for clinical care feedback and audit solutions via one provider and within one annual license fee of £30k Reduce time wasted on input of manual data into spreadsheetsReduce time wasted on input of manual data into spreadsheets Provide real time quantitative dataProvide real time quantitative data Provide KPI analysis from Directorate to Board level in standardised formatProvide KPI analysis from Directorate to Board level in standardised format

Implementation of Meridian Initial trial in one Directorate and two auditsInitial trial in one Directorate and two audits Trial extendedTrial extended -Orthopaedics – delayed discharge reasons -GI & Renal – Ward managers audit -Pharmacy – Missed doses & Medicines Storage

Medicines Storage Historically Carried out paper based audit yearly in 38 clinical areasCarried out paper based audit yearly in 38 clinical areas Carried out by ward pharmacistCarried out by ward pharmacist Clinical areas not auditedClinical areas not audited Significant drain on limited pharmacist resourceSignificant drain on limited pharmacist resource Delay before results knownDelay before results known - Actions difficult to push through

Objectives Improve frequency of auditsImprove frequency of audits Increase number of clinical areas auditedIncrease number of clinical areas audited Decrease time taken to complete auditDecrease time taken to complete audit Decrease time taken to input dataDecrease time taken to input data Provide real time feedback from auditsProvide real time feedback from audits -Allowing immediate corrective and preventative actions Carry out Estates work to enable clinical areas to correctly store medicinesCarry out Estates work to enable clinical areas to correctly store medicines Pharmacy ATOs to carry out audit as part of routine top-up processPharmacy ATOs to carry out audit as part of routine top-up process

Implementation Costs Licence Fee £30kLicence Fee £30k 2 iPads purchased for Pharmacy 2 iPads purchased for Pharmacy £399 per unit £399 per unit £100 set up cost£100 set up cost £50 annual service contract£50 annual service contract

Other uses of Meridian Patient Experience Surveys:Patient Experience Surveys: -Dermatology -Day Case -Hip/Knee Patients -Inpatient Quality and Safety Audits: -Cannula Audit -Catheter Care Audit -Hand Hygiene -Re-Admission Audit -Theatre Audit -C.Diff Audit -Safer Surgery Audit

Meridian in use Audit is now built in to the routine for ATOs carrying out top-upsAudit is now built in to the routine for ATOs carrying out top-ups Results are monitored weeklyResults are monitored weekly Clinical areas not achieving required standard undergo repeat audits on an increased basisClinical areas not achieving required standard undergo repeat audits on an increased basis Reason for not achieving standard passed to ward manager and matron immediately for actions to be takenReason for not achieving standard passed to ward manager and matron immediately for actions to be taken

Results Average monthly audit resultsAverage monthly audit results

Example of a report from MeridianExample of a report from Meridian

Security Meridian software and Trusts wireless network only available from Trust assetted devices.Meridian software and Trusts wireless network only available from Trust assetted devices. This prevents personal devices connecting to the networkThis prevents personal devices connecting to the network Devices added to Trust device directoryDevices added to Trust device directory Firewall to prevent unknown devices/users accessFirewall to prevent unknown devices/users access

Lessons Learnt Ensure process complianceEnsure process compliance Engage ward staffEngage ward staff Pharmacy staff trainingPharmacy staff training Escalation process of resultsEscalation process of results

Other uses of Meridian Patient Experience SurveysPatient Experience Surveys -Your Maternity Care -Dermatology Feedback -Day Case Feedback -Hip/Knee Patient Feedback -Inpatient Survey

Further development for Meridian use within Pharmacy -CD storage audit -Missed dose audit -Continuous out- Patient Satisfaction survey with on site partnership (Lloyds Pharmacy)