Singapore Electronic Medicines Management Experience

Transcription

1 Singapore Electronic Medicines Management Experience Angelina Tan Senior Principal Pharmacist, Singapore General Hospital 17 th October 2014 WAMSG Symposium

2 Singapore General Hospital (SGH) World s 2nd largest teaching hospital to achieve JCI accreditation in 2005; Asia s 1st hospital to achieve MAGNET recognition in 2010 Oldest hospital in Singapore 1782 Inpatient Beds 33 Ward 36 Clinical Specialties

3 Medication Use Process Before 2010 Manual processes Medication charts and records Ward imprest Non-ward imprest are supplied through pharmacy medication charts sent down Pharmacists will review medication orders either on the ward or when the charts comes to pharmacy

4 Medication Use Process Implementation of Closed Loop Medication Management From 2010 Implemented electronic prescribing no more medication charts! Minimizes transcription errors and errors arising from illegible handwriting Packing errors Pharmacists and doctors have remote access to medication orders

5 Closed Loop Medication Management From 2010 Doctor s Order Pharmacist s Verification Pharmacist s Supply Medication Cabinet/cart Computer On wheels Identify Patient Electronic Electronic Manual Manual Manual Manual

6 Closed Loop Medication Management closing the gaps Doctor s Order Pharmacist s Verification Pharmacist s Supply Medication Cabinet/cart Computer On wheels Identify Patient Electronic Electronic Manual Manual Manual Manual

7 I2M SAFE Project 2012 Inpatient Medication Management Safe, Accurate, Fast and Efficient (I2MSAFE) Involved Pharmacy, Nursing Informatics (NI) & Integrated Health Information Systems (IHIS) Objectives: Improving safety and quality of medication management process incorporating: o Automated unit dose packaging machines o Electronically secured automated medication cabinets o A bedside barcode medication administration system

8 Closed Loop Medication Management I 2 M SAFE Project Doctor s Order Pharmacist s Verification Automated Supply/Unit dosing Automated Medication Cabinet Automated Medication Cart Identify Patient Electronic Electronic Electronic Electronic Electronic Electronic Solutions IPAS/ Robot AMC Automated Medication Cart/scanner SCM Wireless scanner RFID KBMA

9 Model of Care Hybrid drug distribution model o Automated drug supply from pharmacy o Automated Medication Cabinet (AMC) in the ward Stat/initial doses for the first 24h and injections from decentralised AMC ward stocks

10 Model of Care Subsequent supply of routine doses from central pharmacy Knowledge-based medication administration o Nurses perform bedside barcode scanning before drug administration

11 Advantages of the Hybrid Model Combined advantages of the centralised and decentralised model o Improves accessibility & availability of drugs o Reduce nursing time queuing at AMC to obtain medications for administration The only institution using this model to date

12 I 2 M SAFE: Components of Inpatient Pharmacy Automation System (IPAS) Swisslog for automated unit dose packaging, storage and dispensing Pyxis AMC for storage and dispensing of wardstocks Smart Electronic Med cart with auto bin assignment Blispack machine for unit dose bar code packaging for paracetamol tablets Outsource barcoding of high volume medications that Swisslog is unable to manage 100% barcoding of formulary drugs 98% of formulary tablets/ capsules/ injections are repackaged and supplied as unit doses

13 Inpatient Pharmacy Automation System (IPAS) Robotic pack/dispense system Packs unit doses into drug nest Rings up patient specific bundle Daily supply - cartfill Also supplies stock to AMC

14 IPAS Key Features Swisslog Swisslog handles a wide range of dosage forms, including loose tablets/capsules, blister strips, ampoules and vials o re-packages drugs into barcoded unit doses o stores unit doses in its drug nest o assembles and dispenses patient-specific unit doses bound in rings o accepts returned medication back into the drug nest via barcode scanning

15 IPAS Key Features Swisslog 3 Swisslog units supply 20,000 unit doses a day

16 Key Features Automated Medication Cabinet Better drug accessibility and availability (up to 85% of drug range) Timely drug administration Improved security (bio ID access) Manages inventory and expiry date monitoring Controlled drugs recording and tracking Patient profiling Medication replenishment using barcode scanning Fridge temperature monitoring Billing AMC stock replenishment is autotriggered to Swisslog for packaging

17 Knowledge Based Medication Administration Previous workflow with Old Medication Cart Big, bulky and takes up space Nurses do not push the cart to patient s bedside for medication administration Needs to be manually locked Multiple drawers open at a time

18 Knowledge Based Medication Administration New Automated Medication Cart Small footprint Long battery life 13 hours Nurse login to use med cart Two scanners One tethered and one wireless Tethered scanner keeps both the nurse s hands free Wireless scanner scans patient s RFID wrist tag to open the drawer Only allows one drawer to be open at a time

19 Knowledge Based Medication Administration Radio Frequency Identification Tag (RFID) Assigned to patient during admission Worn together with the identification wristband Embedded active and passive chip o Active used for Bed Management System o Passive used for KBMA o Only wireless Scanner can read the passive chip to identify patient

20 I2M SAFE Project - CLMM 5 6 Delivery of medication to Bedside Bedside Verification using RFID 2 Verification of Medication Order 1 Inpatient Medication Order 4 Patient medication with (bar-coded label) delivered Pharmacy load unit doses directly into Automated Medication Cabinets 3 Unit Dose Medication Packed By Robotic System

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22 Graph shows medication events reported for errors in manual pack, machine pack, loading and interface issues Undefined trend of error during the period of system stabilisation and machine optimisation which coincides with hospital wide roll out Since May 2014, there have been reduction in errors and is expected to decrease as the system stabilised

23 Challenges of I2MSAFE project Availability of barcodes on medications that are not packed by Swisslog Swisslog may not be able to process some blister packs due to packaging Space constraints in AMC

24 Timeline of I2MSAFE Oct 2012 Inpatient Pharmacy Renovation Mar 2013 Implementation of AMC Nov 2014 Hospital-wide implementation Jan 2013 Ward Renovation Sep 2013 Pilot Unit dose drug supply and bedside barcode administration Mar 2014 Completion of hospital-wide CLMM implementation

25 Thank You