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Setting up automated dispensing cabinets in a cardiac surgery intensive care unit: what impact for the nursing team and the pharmacy?

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European Statement

Selection, Procurement and Distribution

Author(s)

MARIANNE DE LACROIX DE LA VALETTE

Why was it done?

Managing medications in hospitals is both a health and an economic issue.
Hospital pharmacists are working to improve supply, traceability, safety and stock management in order to meet these challenges.
Healthcare staff must be able to administer the medications prescribed to patients in complete safety, with the products available at the time of order. The management of medications within the department represents a significant amount of time that needs to be reduced.

What was done?

The objective of this study was to analyse the impact of deploying automated dispensing cabinets (ADC) in a cardiac surgery intensive care unit within a university hospital in France.

How was it done?

In 2022, an on-site study was conducted in the cardiac intensive care unit (18 beds) at Rennes University Hospital. The aim was to quantify the time allocated to manage medications before and after the installation of the automated dispensing cabinet.
Several types of measurable metrics were identified and compared. These include picking time for nurses of medications for administration to the patient; time allocated for ordering and storing medications; time to respond to emergency orders; management of narcotics; and time in the management of expired medications.

What has been achieved?

A comparison of the pre and post installation of the automated dispensing cabinet showed nursing time savings in the picking of controlled drugs of 53%. Overall restocking time was decreased by 9%. The number of urgent order requests to pharmacy was decreased by 51%.
The time allocated towards removing expired medications was reduced by 3.8 days / year (nurse FTE). Lastly, the implementation of automated dispensing cabinets reduced the value of the department’s stock by 26%.

What next?

The time spent by nurses in managing medications was significantly reduced after the installation of automated dispensing cabinets. However, some of this time is transferred to the central pharmacy towards restocking the medications into the automated dispensing cabinets.
The automated dispensing cabinets makes it possible to monitor the stock of medicines in a department on a daily basis. This enables for data driven decision making on selection of decentralized stock and respective quantities to maintain.
The deployment of automated dispensing cabinets improves overall efficiencies and allows more time for nurses to provide direct patient care.

Automated dispensing systems: improving and digitising medicines optimisation

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European Statement

Patient Safety and Quality Assurance

Author(s)

Easter Mark

Why was it done?

Medicines storage was low tech in a new high tech Private Finance Initiative (PFI) hospital and security was operationally heavy on nursing teams. The trust was on a journey to Electronic Patient Records (EPR). What was needed was a solution that bought both challenges together – how we implement improved medicines storage that fully leverage the power of a hospital EPR system.

What was done?

Trust-wide implementation of Automated Dispensing Systems, initially to drive safer and legislative compliance with storage. Since implementation, we have improved management of medicines during shortages, taken waste out of operational delivery around supply of medicines, informed teams around medicines safety during heat waves, and we are on a journey to closed loop medicines administration.

How was it done?

A business case recognising the reputational impact of poor Care Quality Commission (CQC) assessment of security, nurse led audit work recognising the impact of medicines handling on Time to Care and recruiting enthusiasts to support the programme.

What has been achieved?

All wards and departments have automated dispensing systems for medication storage – 72 units, including two in pharmacy for controlled drugs and after-hours support.
Medication Safety officer (MSO) used live view to track high risk medicines throughout Covid-19 and beyond. Never missed a dose of high risk medicines by utilising this technology over the Covid period.

Temperature monitoring gives an overview of real time temperature of all stock areas to support informed decision-making during hot and warm weather. Digital ordering by automated dispensing systems has reduced nurse time handling medicines by using pharmacy team time saved from ordering medicines redeployed to fill cabinets instead of nurses.
Increasing breadth of stock holding as top up thrice or more weekly rather than just weekly across Trust.

What next?

Planning benefits of integrating a robot dispensing system and hospital information system next spring. Robotic storage supporting real-time medicines management from stock to temperature all with enhanced security and removes process waste from process especially when combined with other digital initiatives. Trust Go-Live with Cerner in spring 2023 and use of cabinets to support closed loop administration.

Medical supply vending machines – a direct-to-patient distribution method that offers flexibility to outpatients

European Statement

Selection, Procurement and Distribution

Author(s)

Louise Refsgaard, Linda Skovsted, Nina Bøggild

Why was it done?

The medical supply vending machines were implemented during 2021 as a way of direct-to-patient distribution of medicine with more flexibility. The aim was to offer 24-hour access to collect medicine at a location that suits the patient, e.g. close to the patient’s home.

What was done?

Medical supply vending machines were implemented in the Capital Region of Denmark. The vending machines allow patients to collect their medicine whenever and wherever it suits them. It is the patient’s healthcare professional that controls and orders the medicine. The hospital pharmacy staff consults the prescription and labels, dispenses and records the medicine and places it in the vending machine for collection.
Patient and staff satisfaction was surveyed.

How was it done?

The implementation of this new direct-to-patient distribution method was carried out by the Capital Region Hospital Pharmacy in close collaboration with the region’s hospitals and outpatient departments. Installing the machines was fast but a full implementation requires that the clinical staff rethink their practice and accept that dispensing is no longer their responsibility. This has been the biggest obstacle along with creating patient safe procedures.

What has been achieved?

7 medical supply vending machines were installed centrally in hospitals in the Capital Region of Denmark. The machines are now used to distribute medicine to some of the region’s outpatients.
The patient satisfaction survey showed that the patients are very satisfied with the vending machines: 100 % are either ‘highly satisfied’ (86 %) or ‘satisfied’ (14 %) with the new service, and 97 % would like to use it again. The staff was also satisfied with the new service.
Additionally, the quality of medicine dispensing is increased due to hospital pharmacy staff dispensing the medicine rather than nurses.

What next?

In order to offer flexibility to patients and increase the quality of dispensing of medicine, we aim to increase the number of patients that collect their medicine from the vending machines by using the current machines in their full capacity and installing more machines. We also aim to collaborate with Denmark’s other 4 regions, so that patients, who are treated outside their home region, can collect their medicine in a vending machine closer to their home.

INTEGRATION OF A PHARMACIST INTO THE EMERGENCY DEPARTMENT

European Statement

Patient Safety and Quality Assurance

Author(s)

PALOMA CRESPO-ROBLEDO, MARIA SEGURA BEDMAR, IRENE ESCRIBANO VALENCIANO, NURIA BLAZQUEZ-RAMOS, BEATRIZ MARTIN CRUZ, CARMEN MORIEL SANCHEZ

Why was it done?

Patient safety is an essential component of quality care. It’s known that EDs are an element of risk for the onset of adverse events due to conditions related to patients’ comorbidity, communication problems, medication errors and working conditions like limited information about the patient, workload, interruptions, shifts, etc. It was detected that reconciliation of medication was not performed; neither validation of the medication prescribed and medications were stocked with no order and control.

What was done?

A project was developed to increase patient safety in the Emergency Department (ED) based on the presence of a hospital pharmacist in the team.

How was it done?

First thing was to review and validate the medication prescribed in patients who were under observation, at the same time performing a reconciliation given their acute situation. This way a relationship between nurses, physicians, patients and pharmacist was established.
Then, electronic prescription software was integrated within the automated dispensing cabinet (ADC), eliminating potential errors choosing the right drug. Only when a pharmacist has checked the medication, the list appears in the display and can be taken out all at once. The main problem has been to agree the stocks and how nurses can return easily and operatively the medication in order to not accumulate it out of the ADC.

What has been achieved?

Pharmacists’ clinical figure is being disclosed in a country where Hospital Pharmacy is a central and close department. In 43 days, 428 patients got their prescription checked in the ED, 346 pharmaceutical interventions were made in 198 patients, a median (IQR) average of 1 (1,2) interventions per patient. The main reason for an intervention was the adequacy to pharmaceutical forms included in the Hospital(n=130), followed by reconciliation interventions(n=77). Category of errors detected were mostly B (NCC MERP), showing pharmacists can detect an error occurred but that did not reach the patient

What next?

Hospital pharmacists should show their clinical and logistic potential, fighting with other health professionals to increase safety and care in patients. ED is the entrance of patients into the health system and where more errors can be committed, the work of a pharmacist should start at ED to prevent errors and give support and be part of the team.

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