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1 Sue Ladds & Mark Pepperrell Chief Pharmacist & Deputy Chief Pharmacist University Hospital Southampton NHS Foundation Trust

2 Medicines and Technology Medicines are the most common intervention in healthcare The NHS spends 14b on medicines every year. Medicines are cures & poisons balance of benefit and harm >17,000 medicine doses are administered to inpatients in this hospital alone every day. To err is human - technology is an essential tool for the safe and secure management of medicines in the modern NHS.

3 Medication safety issues The evidence: Medicines are the third most common cause of patient safety incidents in hospitals, accounting for around 12%. Hospital prescribing error rate 7%. Hospital dispensing error rate %. Administration errors 3-8%. Annual cost of medicines related admissions to the NHS estimated at 466 million. Over a 6 year period 525,186 medication incidents reported to NRLS of which 822 resulted in severe harm or death.

4 Existing technology at UHS Electronic prescribing and medicines administration (EPMA) Electronic discharge information to GPs (edischarge) Pharmacy stock management & reporting system Pharmacy reporting tool (Aintree)

5 Existing technology at UHS Drug Chart View program Automated dispensing robot imdsoft MetaVision eprescribing system for Intensive Care Units (in development.)

6 Existing technology at UHS Electronic prescription tracking in dispensaries Ward ibins Antimicrobial HAPPI audit tool Antimicrobial prescribing guidance App developed by UHS with a commercial partner and sold to over 30 NHS trusts

7 Partnership working for solutions Oncology Pharmacy project Produces 30,000 IV chemotherapy doses every year Highly toxic medicines and very sick patients fine balance between benefit and harm individualised dosing Hazardous to staff Environment, equipment & processes designed to protect the product and the operators SOCP picture here

8 Oncology Pharmacy project The problems: Inefficient paper-based systems with multiple transcription processes Reliance on human accuracy and checking Increasing workload year on year Increasingly cramped working environment Increasing pressure on staff Increasing error rate

9 Oncology Pharmacy project The solution: Electronic management system: Reduced reliance on humans through in-built controls and checks Efficient scheduling of workload increased capacity Reduced physical space needed for paperwork Improved staff well-being Management reporting tools Virtually zero error rate

10 Oncology Pharmacy project The approach: 1. Market review no system available to meet our needs. 2. Approach existing pharmacy IT providers re product development. 3. Partnership agreement with Promatica Healthcare Ltd.

11 Partnership objectives Development phase: Well-designed system which meets the needs of UHS and is applicable to other NHS units. Minimise the risks for each organisation Flexible approach to changes Work together to minimise delays Joint approach to design and testing Use of independent expert knowledge Innovate UK Technology Strategy Board grant awarded Contract and commercial agreement

12 Partnership objectives Implementation & post-implementation phase: Shared project plan and project board UHS providing evaluation of benefits for the NHS UHS to publish evaluation findings in journals and at conferences UHS to act as reference site and host visits Recognition of UHS input within commercial agreement

13 Other problems and ideas Paediatric chemotherapy prescribing - Accelerator Fund bid shortlisted for enablement of an existing system Development of user friendly reporting tools Transfer of care communication to community pharmacists Follow-up medicines advice for patients post-discharge Reminders and support to help patients adhere to medicines