Improving Patient Safety using e-cabinets

1. Improving Patient Safety using e-cabinets Daniel Mandeman Chief Pharmacy Technician Ward Automation Guy’s and St.Thomas NHS Foundation Trust 16th October 2012 ITIG Birmingham

2. Content of Presentation • Brief introduction and background • History and timeline of introducing e-cabinets to Guy’s and St.Thomas • Safety devices/tools. • Results • Effects, benefits and user feedback • Future developments • Your questions?

3. History and timeline of introducing e-cabinets to Guy’s and St.Thomas • Jan 2009 Omnicell (Avantec) awarded tender for GSTT. • Sep-Dec 2009 Rolled out Europe’s largest e-cabinet project and installation. • Over 33 areas live to date with Pharmacy stock and many more for supplies. • Extension of e-cabinet Service to complete Guys site and Evelina paediatric hospital in 2013 and 14. • E-prescribing to be introduced late 2013

4. Safety Devices/Tools-Configuration- • Sounds obvious – but a lot of people liked the cabinets and worked in the same way for years so had to sell the idea of separating medicines to avoid administration errors. • Configuration – Criteria discussed to maximise cabinet’s potential. Consultation between Pharmacy and nurse users. • Sound and look a like medicine separated. Only one strength of medicine in one drawer/shelf location. • Groups of medicines spread to eliminate potential picking errors. • Setting up a guide to keep system standardised. See next slide) • Regularly checking all new products and pack sizes to maintain system.

5. Configuration Guide For Cabinet Building • Not more than one strength of the same medicine to be stored in a single matrix drawer or open shelving section. Lockable bins are fine due to being hidden but sensible to avoid being next to each other for issue and returning of medicines. • Not more than one PENICILLIN or CEPHLASPORIN in a matrix drawer, however if space is an issue keep a different form from that of the first placed item. Same applies to shelving sections. • Check that similar sounding medicines names are configured in different matrix drawers. Also make sure there isn’t too many medicines starting with the same letter. We produced our own list of medicines to be parted. Same applies for medicines with same colour schemes or boxes as other products. • Bulkier products including intravenous fluid bags should be configured in lower shelving spaces to avoid health and safety risks. • High risk considered preparations should be stored in lockable bins for heightened security and access.

6. Configuration Guide For Cabinet Building • Potassium fluid bags separated to only ever allow access to one strength that is required. • Never place liquids above the computers circuit board section of the cabinet for obvious reasons!!!!! • Load capacity on a shelf should not exceed 32 litres of IV fluid. • Configure enough space to allow nurses to return part packs into the medicines section. Also aid the system admin time required if pack size/manufacturer changes. Never have more than 13 products inside one matrix drawer. • A second person should double check configuration is satisfactory. Usually lead nurse for ward and a second person from Pharmacy. • All standard operating procedures should be attached to cabinet, along with keys for emergency access and all contact details of ward automation team.

7. System Warnings, Prompts and questions • Monthly meetings to add further user safety features. • Penicillins • Gentamicin dosing • Potassium, Heparin and other high risk medicines. • Paracetamol dosing • All of the above feature with user information/prompts/questions to answer before accessing the medicines. • All information is fully auditable

9. Live reporting with any transaction able to be monitored. Compliance reports used and monthly meetings held with each directorate. Each ward receives a 3 monthly KPI review and stock list optimisation report. Both financial and operational. Reports

10. Results • Incidents with high risk medications classified as Heparin, Potassium, Warfarin have reduced year on year since installing the cabinets in 2009. • Compliance of user and accuracy of picking data showed a significant improvement after 2 weeks post go live. • Fewer Penicillin administration errors. Although a new allergy sticker along with warning introduced. • Overall near misses, incorrect administration of stock medications reported lower year on year. • In time study surveys performed the average transaction to remove medicine from cabinet using biometrics averaged 15 seconds. • Ability to review stock accuracy.

11. Effects, Benefits and User Feedback

12. Effects, Benefits and User Feedback • A shift in the way we work on the ward. Biggest change at ward level for nearly 30 years. Huge change management process and not everybody keen on the idea. • Working in a closer MDT. • Job roles and responsibilities. • Change of culture at medicine rounds. Drug trolleys etc. • Released many hours of nursing time to care • 22% stock inventory saving in first year of go live • A safer system for patients and nursing staff • A clean, tidy environment for medicine storage

13. Effects, Benefits and User Feedback • TTO Medicines dispensed from cabinets traditionally done in dispensary • Reduce Ad Hoc deliveries • More frequent deliveries to all 30 wards. Achieved with no additional staff. • Better financial and inventory stock control • Good lean methods used. • A compatible system for now and the future.

14. Effects, Benefits and User Feedback • An annoymous survey in 2011 showed. • 81% of nurses preferred the cabinets to the old traditional way of working. • 67% of nurses claimed that the cabinets saved time doing medicine rounds. • 70% of nurses stated that they received good quality training. • 66% nurses knew who to contact in an emergency and where keys kept on ward. • 69% of nurses thought that the after care after installation was excellent or good. • 72% of nurses stated the cabinets impacted on their day in a positive way. • One Nurse added: “The cabinets aid all aspects of giving patients their medicines. They look clean and tidy. Are regularly topped up by Pharmacy. These cabinets have released a lot of time for nurses to care for their patients”.

15. Future Ideas and improvements • Electronic prescribing • More safety features to be installed • Trials in PCT areas • Improving cabinet compliance • Training: At trust induction • Hand held devices with up to the minute info. Apps for Smart phone/tablets etc