installing medicine smart store cabinets by bill pulman deputy pharmacy system administrator (ward...
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Installing Medicine Smart Store Cabinets By Bill Pulman
Deputy Pharmacy System Administrator (Ward Automation)
TopicsWhat is a cabinetThe VisionFrom tender to go-liveInterfacingPreparationCabinet installationRestock processThe teamWhere are we now (inc QR)Problems encounteredSavings
What is a Medicine Smart Store Cabinet?A fully automated cabinet that provides end
users with instant information and access to stock medication twenty four hours a day, seven days a week.
Orders are automated and delivered by pharmacy staff to cater for the individual ward requirements and needs. Stock is checked weekly to monitor levels and usage.
The VisionUsers spend less time
preparing and dispensing medicines enabling more time at the patients bedside.
Efficient timely and safe system that protects and aids users. Safety features like bar code readers for high risk items like Potassium
Better control of inventory stock Reports available to identify key information.
A cleaner environment to hold stock and prepare medications
Availability of financial reporting
Improve preparing discharge medicine on ward.
Reduce cost of unused, waste and overstocked medicine.
Ability to Quality Review areas and assess performance.
A flexible, robust system that will deliver.
Decrease the need for Ad Hoc deliveries.
From Tender to Go-LiveTendered 2008Staff needs were identified and recruited for projectGlobal stock List reviewDevelop interfaceProject plan devised with weekly follow-up meetingsPhysical location of cabinets agreedMeet with ward staff. Discuss early implementersFinalise ward go live order and co-ordinate work needed
on wards
InterfacingJAC wasn’t dm+d compliant
No Mechanism for HL7 Interface into Pharmacy System
Product Development path already defined until 2011 (as of 2008)
Only solution was to replicate PDA Ward Top Up system - BWPROF
The Interface eventually drove the Omnicell Catalogue Design
Interfacing JAC BWPROF - PDA Top-Up ProcessNot widely used by JAC user community. Involved:
Copy, Paste and Synchronise Ward profile Count Medicines on Top-Up Return to Pharmacy Process Transfer of File to PC Run BWPROF to book out medicines.
Sample extract files (written in Hexadecimal) from Royal Liverpool Hospital
US Omnicell Developer reversed engineered output files to develop the interface.
Key components of the interface drove the development of the Catalogue
InterfacingReplicating BWPROF
InterfacingReplicating BWPROF
Shared DriveOmnicenter Server
InterfacingKey Interface Fields, Including Name and JAC Indexed Field:
Location lnkdwb Ward / Cost Centre lnkacb Drug name lnkdid Drugpack lnkdpz Profile SectionNo. Max Qty Number Qty Number
Major Change on JAC is to create a section called Cabinet, and relocate Major Change on JAC is to create a section called Cabinet, and relocate all medicines into that sectionall medicines into that section
Interfacing
Pharmacy Server
Booked out on JAC
Omnicenter Server Shared Drive
A large number of data mismatches arising from changes on JAC’s ward profile not reflected on the Omnicell cabinet.
Action: Action: Control / Remove general Control / Remove general access to JAC to manage changesaccess to JAC to manage changes
Any unmatched data fields can result in a processing error - Most noticeable errors occurred during contract changes
Pre-Go-Live Checks & ProcessesCatalogueInterface between Omnicell and present
Pharmacy system Omnicell server (and back-up server)Training program (no defined American
training book)SOP creationEquipment support
Cabinet InstallationConfirm works dept completed any prep work required (tests
& certificates)Configure cabinet for quantity, size, locationLiase with ward staffAgree re-stocking schedule with Pharmacy & Ward Train ward staff (min 80% before go-live)Deploy cabinets to ward area & transfer stockCarry out 100% stock checkRemove over-stock Handover system to ward staffTrainers present to assist during shift change and problems
encountered
Restocking ProcessCabinet talks to server through interface (24/7) Restock file created by cabinet server and stored on trust
server as a PDA output fileFiles processed using BWPROF (up to 12 wards daily)JAC picking list createdStock is selected and packed (at Guy’s a Robot processes
within 12 minsStock delivered to the wardStock put away by ATO/Pharm Tech
Our TeamPicking and putting away automated orders.Cycle counting and expiry checking cabinet inventory.Training all end users.Report writing and reviewingStock list analysingBuying in stockIntegrating within long standing MDT’sSystem Administration
Where we are now30 wards successfully installed with Medicine Smart Store
at Guy’s and St. Thomas NHS Foundation trustOngoing training of pharmacy users and all end usersAdding more safety features, Validating more “High Risk”
medications such as HeparinReports and schedulingSetting up a specialist European training centre on siteUndertaking Quality reviewProviding tours and information to overseas visitors and
NHS trusts across the UK
Trust used Datix reported incidents to propose list of medicines to be validated using GS1 13 barcodes
Potassium IV’s Initially Configured (Now trialled for 6 months)
Plan to include Heparins & Insulins
Scope to move to 2D data matrix
No “validated” catalogue to use (such as dm+d) so used a number of Pharmacy Safety No “validated” catalogue to use (such as dm+d) so used a number of Pharmacy Safety Team to triple check configuration of barcodes on Omnicell systemTeam to triple check configuration of barcodes on Omnicell system
GS1 13 Barcodes
Encountered ProblemsChange of work practice (biggest in over 25 years)Nursing staff reverting to old practices Interface / processing problemsPack / drug changes (frequent)Training issues (understanding of ‘how to use it’)Equipment failureJammed drawers
Bypassing the System
Problems Encountered
Bypassing the System
Problems Encountered
Bypassing the System
Problems Encountered
Quality ReviewSystem Admin tasksTraining including re-fresher training and super user trainingMeeting Clinical LeadsLooking at key performance indicatorsWard SavingsMeet clinical leads and ward pharmacist to explain data
analysis and stock saving recommendationsCurrently assessing data usage across 30 clinical areas to
optimise PAR levels, deliveries and possible financial savings.
Inventory Savings We currently hold stock £127,000 worth of stock across 30
wards.
Our target from the outset would be to reduce this figure by 20% or £25,400
We have achieved the figure of £16,027 from 12 areas so far. So anticipate achieving that figure in the coming few weeks of Quality Review.
Quality Review SavingsNorth£560.63
Doulton and HDU
£1200
Victoria
£2520.72
SarahSwift
£1745.17
Page£923.83
Alan Ap
£520.92
Howard
£172.40
Hillyer
s£581.40
Luke£617.46
ICU 2£3288.8
4
ICU 1£3288.84
Total Saving
£16,027
The Future??????Complete phases to Guy’s ward, Evelina Children’s
hospital and TheatresFurther savings across the stock listsReview metrics of quality and improvementUse 2D bar coding technology to track expiry dates and
batch numbers.Learn from other established sites that use this type of
technology around the world.Automate reports to include safety stock, other high risk
medications.
Developments
Display Screensin Stores
Email Trigger EventsWeb Output
Omnicenter Server
The VisionUsers spend less time preparing
and dispensing medicines enabling more time at the patients bedside.
Efficient timely and safe system that protects and aids users. Safety features like bar code readers for high risk items like Potassium
Better control of inventory stock Reports available to identify key information.
A cleaner environment to hold stock and prepare medications
Availability of financial reporting Improve preparing discharge
medicine on ward.Reduce cost of unused, waste and
overstocked medicine.Ability to Quality Review areas
and assess performance.A flexible, robust system that will
deliver.Decrease the need for Ad Hoc
deliveries.
Contact DetailsDaniel Mandeman Chief Pharmacy Technician
Automation System Administrator. [email protected]
07818013755
William Pulman Senior Pharmacy Technician Deputy System Administrator. [email protected] 07817738912