Right Medicine, right patient, right time: Challenges and innovation in medicines logistics in hospitals

Transcription

1 Right Medicine, right patient, right time: Challenges and innovation in medicines logistics in hospitals Graeme Hall Deputy Chief Pharmacist, University Hospitals of Leicester

2 What I will cover Some figures about medicines use and activity levels Prescribing safety Administration safety How well are medicines administration system designed? Re-designing the in patient medicines process The project set up Benefits to be tested The centralised plant concept

3 What we know Medicines management is central to the quality of healthcare. Nearly all patients are given medication as a result of a visit to hospital on a typical day in a typical hospital there are 7000 individual medicines activities. Approx. 40 per cent of a Nurses day is spent either administering medicines or on some medicines related activity. 10,000 hospital patients each year have serious adverse reactions to medicines, and one-fifth of clinical negligence litigation stems from hospital medication errors. The Chief Medical Officer has set trusts a target to reduce serious medication errors by 40 per cent by 2005.

4 Safety of Prescribing Studies report prescribing errors in 8.9 to 14.7% of inpatient and discharge medications in English hospitals. Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP Study. London: General Medical Council, Franklin BD, Reynolds M, Shebl NA, Burnett S, Jacklin A. Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes. Postgrad Med J 2011;87: Seden K, Kirkham JJ, Kennedy T, Lloyd M, James S, Mcmanus A, et al. Crosssectional study of prescribing errors in patients admitted to nine hospitals across North West England. BMJ Open 2013;3:1 e doi: /bmjopen Electronic prescribing expected to deliver improvements

5 Safety of Administration Studies report administration error rates in adult patients in 5.6% of inpatient administrations in English hospitals. Monsey Chan McLeod, Bryony Dean Franklin & Nick Barber. Methodological variations and their effects on reported medication administration error rates. BMJ QualSaf. 10; ,482 medication incidents reported to National Reporting & Learning System Jan-Dec 2007 Of which approx 50% administration/supply Of which 3 types account for 71% of fatal or serious harm Wrong dose / frequency Wrong medicine Omitted or delayed

6 How well designed are current medicines administration systems? Path of travel by one nurse during a morning drug round showing travel to several locations other than patients bedside at site A McLeod M Medication administration processes and systems exploring the effects of systems-based variation on the safety of medication administration in NHS hospitals. PhD thesis, UCL School of Pharmacy, London

7 A typical drug stock cupboard

8 Redesigning the in patient medicines use process Optimising medicines using individualised doses (Optimed ID) is a project between UHL and IBSL SpA. It links electronic prescribing to unit dose packing robots and logistics software This allows complete control of medicines prescribing, supply and administration. There is bar code recognition of medicines including traceability and accountability for each dose given.

9 OptiMed in a bit more detail

10 Project set up Joint between UHL Medical, Nursing and Pharmacy staff and IBSL. Set up the unit dose laboratory (cutting and repackaging robots) in the a section of pharmacy department on the Leicester General site. Across 4 ward areas within the renal specialty on the Leicester General site. Train Medical, Nursing and Pharmacy Staff in the use of the software and process map changes to processes. Full evaluation to take place jointly with UHL, IBSL and Loughborough University Prof. Nick Medcalf at the:- ( Centre for Innovative Manufacturing in Regenerative Medicine.)

11 Benefits to be tested Reduction in costs through waste elimination and overall consumption of medicines Reduction in value of stockholding on ward Improved patient safety through reduction in medication errors Reduction in Nursing time spent on medicines supply related work releasing time for care Increase in Clinical Pharmacist time spent on patient care rather that supply tasks. Reduction in pharmacy time spent dispensing to in patients

12 Benefits continued Bar code verification of right patient / right medicines Medicines collated for drug round automatically. Reduction in duplicated dispensing Ability to more accurately cost medicine treatment to individual patient level Improved storage and retrieval leading to reduction in missed medications due to stock out or location problems Improved compliance with CQC standards for medicines security Improvements in traceability and logistics and ability to cost accurately to patient level

13 The centralised plant concept Piacenza province Purpose built facility repackages medicines into unit doses for multiple commissioning hospitals Supply requirements received via electronic prescribing system and logistics software patient ready doses are prepared, as well as historical usage allowing predictive supply.

14 The centralised plant concept Piacenza province This provides a cost efficient method of manipulation of medicines into patient ready form linked directly to supply requirements and patterns. We feel this might be a future model to improve medicines safety and reduce wastage in NHS Trusts. Has the potential to be a standardised platform for distributive manufacturing in advanced therapies.

15 Thank You. Questions? Acknowledgements:- I would like to thank Prof. Ann Jacklin for assistance with background information.