Colin WardLead Pharmacist – Cancer Services

&Duane McLean

Clinical Effectiveness Pharmacist

Wireless Drug Ordering- Pilot project

Background (1)

Royal Derby Hospital comprises 4 satellite pharmacies undertaking aseptic and tablet dispensing– each with own dispensary

stock holding stock checks stock top-ups

– potential for economy of scale Main dispensary houses a robot

– capacity to increase use

Background (2)

Traditional method of ordering named patient medicines appears cumbersome– Delays getting orders from ward pharmacy team to

dispensary– Legibility of orders

• Further delays• Risk

– Fixed delivery times to wards from satellite dispensaries

More background

Chemotherapy satellite pharmacy has competing pressures related to day case chemotherapy– Oral dispensing– Aseptic dispensing

“Releasing Time to Care: The Productive Ward” project showed that drug rounds were often extended as medicines not in bedside lockers– Medicines were on ward but had not been unpacked

• Does not help support self administration• “Right drug in the right place at the right time”

– May result in repeat dispensing activity• ££ • Time• Pressure on OOH

service

The Idea

Order named patient medicines using JAC at ward level via laptop & wireless network

Orders dispensed by robot Ward trained pharmacy team

– deliver to ward– “reconcile” against in-patient chart– place directly in bedside locker – counsel patient (if appropriate)

Aims

1. To better understand flow of “traditional” method of ordering named patient medicines

2. To test an alternative model of ordering named patient medicines

3. To test the concept of remote ordering pre-EPMA

4. To test the concept of using the robot to dispense more of the in-patient workload

“Traditional” Workflow (PTS)

Flow of Named Patient Orders During the Day

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Time of receipt

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Items received (satellite) Items ready for delivery (satellite)

Time of Porters vs. Dispensing

Time to Undertake Activity

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% Orders Received (Satellite) % Ready for Delivery (Satellite)

Time of porter (traditional model)

Time of porter (traditional model)

Wireless Pilot

Items dispensed (robot)

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Orders arrive in dispensary earlier & dispensing is instant

Comparison of Approaches

Comparative Time to Undertake Activity

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% Ready for Delivery (Satellite) % Ready for Delivery (Robot)

Time of porter (traditional model)

Time of porter (traditional model)

“Issues” during pilot

1. As only a pilot, staff unable to “reconcile” urgent orders late in the day

2. Competing workload/staffing pressures could cause delays in distribution

3. Pilot only one ward, so chemo satellite still functioning as a dispensary for other wards

4. Robot in-line labelling 5. Wireless black-spots6. Need for a trolley for the laptop7. Can’t dispense specials remotely (need BN)

Pharmacy Staff Satisfaction

Do you find the new system easy to use?

50%50%

0%

0%

Very easy to use Quite easy to use

Quite difficult to use Very difficult to use

Do you feel it made a difference to your work?

29%

71%

0%

Major contribution Minor contribution No contribution

Is the system easier to use than the old system?

14%

57%

29%

0%

A lot easier A little easier A little more difficult Very difficult

Which statement do you feel is true when comparing the old system with the new system:

57%

43%

0%

New system is better No difference Previous system was better

Summary

Medication was dispensed by the robot by the time that order cards would arrive in the satellite dispensary under the traditional approach

When other members of the team were asked whether we should revert back to the traditional model there was a resounding response of “No” which would imply that the pilot was successful

Pilot demonstrated proof of concept for remote ordering– Potential to interface EPMA to pharmacy stock control system

The future…

Recently rolled out across all three cancer wards– Looked at use of wireless terminals already on most wards

(often under-utilised) but issues with installing JAC on these– Delay whilst approval to purchase toughbook laptops

Reducing stock holding in chemo satellite now workload moved to robot

Considering use of robot to dispense pre-chemo anti-emetics (planned workload)

Potential to – Manage stock returns to JAC “live”– Top-up “live”

Awaiting EPMA