Medication management at the Valenciennes General Hospital

Transcription

1 Medication management at the Valenciennes General Hospital Etienne Cousein Chief Pharmacist Pharmacy Medication Department

2 Valenciennes General Hospital 1800 beds facility 577 medicine beds 198 surgery beds 91 obstetric beds 248 psychiatric beds 636 medium and long stay beds 2 nd northern France biggest hospital Partnership with ANHAC Private hospitals in Northern France 1700 beds divided into 7 facilities

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4 Incentives for a new organisation Activity related funding Revenue / Expense consideration Meaningful use of expensive drugs or implantable devices contract New building Pompous nick name : High Tech Building Electronic record outlook Including a CPOE

5 Key objectives and expectations To centralize medication dispensing, in order to Facilitate the control of operations Restrain manpower needs To focus staffs on their core job Nurses Pharmacists Pharmacy techicians

6 Key objectives and expectations No deblisterization No data on drug stability Cross contamination hazard One solution fits all drug forms 24/7 solution To address the morning medical round main flow To have a safe solution for off duty hours

7 Purchase strategy Stock management automation Carrousels, box robot (ARX, ) Rotomat Automated medication dispensing cabinets Unit dose dispensing system Warehouse management software

8 Roll out July 2008: WMS and carrousels September 2008: AMDC January 2009: first unit doses May 2011: Electronic record and CPOE January beds under automated dispensing system 425 daily unit dose delivery 60 weekly unit dose delivery 23 AMDC stand alone (ICU)

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10 Vertical carrousels Ensure bulk distribution for ward stocks Ensure monthly delivery for some long stay beds «Besides» dispensing for unit dose delivery Drug forms not handeled by the robot (bottles, ) Labelled with patient name, room number, dosage,

11 Vertical carrousels

12 Unit dose Package by the robot Most of the drugs are overwrapped If supllier delivers bulk : rewrapped Tablets, capsule, bags, eye drops, Blinded double check

13 Boxstation

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15 Therapies production One bag by dose to be administered, bounded by a ring Sorted by administration time Evening morning noon Number of rings for 24 h depends on each bag thickness

16 Unit dose dispensing system

17 Therapy ring

18 Transport Treatments are gathered together (ring + besides) Ordered in drawers, sorted by room number In the ward: Nurses switch the used drawers with the filled one Sorting between used and intact bags is made in the pharmacy

19 Automated Cabinets New/modified orders are taken in charge by the robot up to 5 pm, delivered around 6:30 pm In case of prescription modification to be applied before 6:30 pm Nurses get to the AMDC AMDC displays the prescription

20 Automated Cabinets Medication access after identification of Nurse (BioID) Patient Product Secured opening Real time connexion to the pharmacy WMS

21 System study Safety and ROI

22 Unit doses dispensed nov.08 jan.09 mar.09 mai.09 jul.09 sep.09 nov.09 jan.10 mar.10 mai.10 jul.10 sep.10 nov.10 jan.11 mar.11 mai.11 jul.11 sep.11 nov.11 jan.12 mar.12 mai.12 jul.12 sep.12 nov.12 jan.13 mar.13 mai.13 jul.13 sep.13 nov.13

23 Order lines checked by the pharmacists janvier février mars Avril mai juin juillet Août Septembre Octobre novembre décembre janvier février mars Avril mai juin juillet Août Septembre Octobre novembre Décembre

24 Manpower Opening dispensing hours Monday to Saturday 8 am to 6:30 pm No 2 days off in a row Pharmacists 8 FTE 4 morning and 2 afternoon shifts dedicated to electronic order checking Pharmacy technicians 14 FTE 3,3 shifts dedicated to unit dose dispensing 1,2 shifts dedicated to AMDC supply Robot Technicians 2 FTE, +1 Swisslog technician

25 ROI leads Nurse time saved 0,5 FTE for 80 beds Drugs consumptions 10 to 15% decrease expected Related to daily dose dispensing Lower medication error tares Most ROI comes from switch from WSS to UDDS Discrepancies between wards May be hard to turn into real money

26 Systems involved in dose dispensing 1,6% 5,4% 12,9% 0,2% 13,7% Carousels Cold chambers Pillpick system Pyxis system Shelvings Narcotics safes 66,2%

27 Medication error rates 16% 14% 12% 10% 8% 6% 4% 2% 0% WSS UDDS

28 Some examples of things we did e-procurement Wards pharmacy Order display on the AMDC Half/quarter tablets management Besides labelling Interface optimization AMDC and robot supply Supplier receipt

29 In the pipe Informatics Data management IT infrastructure security Barecode reading at the bedside Smart pump technology implementation Drug stability studies Clinical pharmacy dedicated team Medication reconciliation

30 Tout n est pas parfait

31 Mais on avance!