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

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

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.

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.

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

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

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

Interfacing Replicating BWPROF

Interfacing Replicating BWPROF Shared Drive

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

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

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

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

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

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

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

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

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

Problems Encountered Bypassing the System

Problems Encountered Bypassing the System

Problems Encountered Bypassing the System

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.

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.

Quality Review Savings

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.

Developments Web Output Email Trigger Events Display Screens in Stores

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.

Contact Details Daniel Mandeman Chief Pharmacy Technician Automation System Administrator. daniel.mandeman@gstt.nhs.uk 07818013755 William Pulman Senior Pharmacy Technician Deputy System Administrator. william.pulman@gstt.nhs.uk 07817738912