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Optimising medication procurement through integrated database

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European Statement

Selection, Procurement and Distribution

Author(s)

Irene Ruiz-Jarabo Gómez, Marcos Gómez Bermejo, Rocío Vázquez Sánchez, Antonio Illescas Bermudez, Elena Martín Suarez, Teresa Molina García

Why was it done?

Digitization was considered essential in reducing costs related to inventory management and improving responsiveness in critical situations, such as supply shortages. Traditional manual inventory checks and order verifications were time-consuming and error-prone, prompting the need for a digital transformation.

What was done?

In our quest for enhanced medication procurement efficiency within our Hospital Pharmacy Service, we have developed an integrated database.

How was it done?

We have developed a database by consolidating data from two primary sources: our automated medication storage system, Smart Ulises®, and the Economic Management software, Farmatools®. This database encompassed information related to medications falling below predefined minimum stock levels, historical acquisition records, pending medication orders, and warehouse capacities for each medication. Additionally, it seamlessly integrated data obtained from the Spanish Agency of Medicines and Medical Devices (AEMPS) regarding medication shortages.
This database enabled several essential functionalities:
It generates reports suggesting orders for medications below the minimum stock levels, recommending quantities based on historical acquisitions and available storage space.
By considering the suppliers for medications at minimum stock levels, it also identifies medications in alert status (1/3 above the minimum stock) for these suppliers.
Cross-referencing with AEMPS’ medication supply problem database swiftly detects critical medications during shortages
It permits agile identification of pending medication orders.
It identifies locations with incomplete medication inventories and propose medication grouping within our automated medication storage system.

What has been achieved?

The outcomes of our project were transformative:
  We streamlined medication procurement significantly and maximized each medication supply request while promoting sustainability by reducing laboratory-specific medication orders.
  We optimized storage space within our automated medication storage system, aligning medication orders precisely with storage capacities for each medication, leading to more efficient space utilization and reduced storage costs.
  Early detection of medication shortages enabled proactive preparation of alternative solutions to effectively mitigate shortages.
  Simplification of tracking pending medication orders enhanced operational efficiency in claim processing or supplier changes.

What next?

Our next phase focuses on continuous system improvement. This involves incorporating additional data sources to refine medication supply predictions and exploring the potential for complete automation of the medication ordering process. We will also enhance performance measurement to evaluate the effectiveness of our improvements.

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.

COVID-19 VACCINATION PLAN BY THE PHARMACY DEPARTMENT IN A SPANISH HOSPITAL

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European Statement

Selection, Procurement and Distribution

Author(s)

BERTA MONTERO-PASTOR, ELSA IZQUIERDO-GARCÍA, LORENA DE AGUSTÍN SIERRA, ISMAEL ESCOBAR RODRIGUEZ

Why was it done?

The unprecedented mass COVID-19 vaccination has highlighted the need to develop strategies that prioritize and optimize the use of resources. Strategies have been established at the national and community levels, however, each center must implement its own plan according to needs and capabilities for its target population.

What was done?

A Pharmacy Department (PD) vaccination plan including strategies to optimize human and material resources available to deal with mass COVID-19 vaccination.

How was it done?

In plan development, we considered the type of vaccines, storage requirements, the need for specific equipment and workflows, limited vaccine vial supply, and aspects related to staff in the PD.
A standard operating procedure (SOP) was developed for logistic management of vaccine orders, including an SOP for nursing staff if the shipment arrived outside the PD schedule.
For storage, specific space was provided considering the different storage requirements.
The doses corresponding to the vaccination of health professionals and patients from group 7 of the national vaccination strategy (onco-hematologic patients with active treatment, hemodialysis patients, primary immunodeficiencies, HIV -CD4<200cel/ml, Down Syndrome ≥40 years) were prepared centrally in the PD. For the general population, a centralized preparation in PD is not feasible. So, alternatively, PD developed a dispensing circuit and informative material for nursing staff for the correct dosage and traceability of vial batches. In all stages, the use of vials was optimized with strategies such as the selection of adequate packaging material, the grouping of patients, or the exchange of vials between vaccination centers.

What has been achieved?

We received 16230 vaccine vials from four different commercial brands. There have been no incidents related to the receipt and storage of vaccines.
A total of 9753 doses were made. In the whole elaboration process, we only wasted a vial on one occasion and a dose on another.
We dispensed 11911 vaccine vials to the general population. Of these, 13 vials were discarded due to errors in the preparation.

What next?

The development of a specific plan has made it possible to optimize the COVID-19 vaccination process in our hospital. The plan will be adapted and updated according to the updates of the national and community vaccination strategies.

OPTIMIZATION OF DRUG MANAGEMENT

European Statement

Patient Safety and Quality Assurance

Why was it done?

To avoid stock breaks by ensuring at all times the existence of the medicines included in a 2nd level hospital.

What was done?

Optimization of medication management in a Hospital Pharmacy Service (HPS) through the development and use of a purchasing planner.

How was it done?

One obstacle we encountered was knowing the inventory in real time. This required a computer program for stock management, human resources or intelligent warehouses to enable real-time inventory control.
After the training, learning and updating of working procedures, an analysis of the consumption of the drugs included in the pharmacotherapy guide was carried out in order to calculate the minimum stocks, safety stocks, maximum stocks and order points.
Data were loaded into the management software and parameters were defined so that when a drug reached the point of order a purchase proposal would be made until the maximum stock was reached.

What has been achieved?

In February 2020, the purchasing planning system was implemented. The planner’s lists were parameterized to organize the drugs by therapeutic groups or areas of interest within the HPS. In addition, communication among all professionals was enhanced for rapid response to a lack of medication and a periodic inventory counting plan was designed to ensure adequate stock.
After changes, more than 80% of HPS medications are ordered through purchasing planning, reducing stock breaks due to never reaching the safety stock of selected drugs.

What next?

This system is applicable to all HPS that has the same management software. It is necessary to have an optimization system in the drug management to ensure their real stock in the hospital environment and their availability for patients.

CAN TRANSPARENCY IN THE SUPPLY CHAIN IMPROVE DRUG SUPPLY TO HOSPITAL PHARMACIES?

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European Statement

Selection, Procurement and Distribution

Author(s)

Lars Munck

Why was it done?

After years with increasing numbers of backorders and unplanned drug changes implemented in the hospitals under time pressures, we decided in 2017 to replace firefighting with proactive action through better transparency between hospital pharmacies and drug suppliers.

What was done?

We established a national Sales & Operations planning (S&OP) unit able to develop and implement a national S&OP process for drugs on national tender:
• All hospital pharmacies estimate their expected purchase volume (number of packs) of each item-number.
• National estimates for each item-number are shared on a national supplier portal (web-page).
• Advise suppliers, when new estimates are shared on the portal, to confirm supply capability or report potential supply problems.
• Proactive solutions/decisions are made for potential supply problems.
• Suppliers share production lead-time to enable planning of tenders and drug-changes accordingly.
• Monthly review process in place: hospital pharmacies/clinical pharmacy update estimates for changed drug use, suppliers re-confirm their supply capability accordingly, and national solutions/decisions are made for new potential supply problems.

How was it done?

1. INVOLVING hospital pharmacies and suppliers in step-by-step development.
2. HELPING hospital pharmacies to estimate and identify estimates that require revision to improve estimate accuracy.
3. ACTIVE COMMUNICATION of estimates to suppliers.
4. Rebuild supplier’s TRUST in our estimates as accuracy improved.
5. Ask suppliers to confirm supply capability.
6. Open and CROSS-FUNCTIONAL DIALOGUE. Dialogue concerning possible solutions to potential supply problems.

What has been achieved?

Proactive solutions/decisions for potential supply problems have improved the overall supply situation/information, and have improved patient safety, as fewer unplanned drug changes are implemented under time pressures. The number of backorders have stabilised during 2017 to 2018. We have not experienced the explosions in backorders that some of our neighbouring countries have experienced. Transparency across the supply chain has generated trust and enabled more value-adding and cross-functional dialogue such as sharing causes of estimate changes and early sharing of potential supply problems. Positive feedback from hospital pharmacies and suppliers regarding resources/benefits from participating in the S&OP process.

What next?

Continue to improve the S&OP process/tools. Helping hospital pharmacies in predicting changes in drug estimates, based on the impact of national decisions about drug selection in therapeutic areas. Willing to help other countries.

ALGORITHM TO DEVELOP AN ESSENTIAL DRUG LIST

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European Statement

Selection, Procurement and Distribution

Author(s)

Kim Florian Green, Torsten Hoppe-Tichy

Why was it done?

Drug shortages are an increasing problem for hospitals in Germany. The management is time consuming and might endanger safety of drug therapy. Therefore, it is essential to take precautions to deal with upcoming shortages in advance.

What was done?

Development of an algorithm to create an essential drug list in consideration of logistic and clinical aspects.

How was it done?

The first step was classification of the hospital formulary. We used 4 types for classification (oral medication, parenteral medication, medicinal products, and dietetics). Following a priorisation for parenteral and oral drugs cause of the fact we discovered in an internal benchmark that durgshortages with parenteral drugs lead to a larger workload. After that we assessed drug consumption for each drug by year, quarter and month and conducted an extending selective inventory control (ABC-XYZ-Analysis).
Next step was to create a step-by-step decision-tree considering local clinical pathways and logistics define essential drugs. The algorithm displays typical procurement processes and infrastructure in German hospitals pharmacies and the common search for alternative drug therapies.

What has been achieved?

The combination of the algorithm and the ABC-XYZ-Analysis lead to an individual list of essential drugs and allows to define logistic measures for each of them.

What next?

The list allows us to define an adequate stock for upcoming drugshortages. Internal benchmarking for process robustness. External validation of our algorithm is necessary.

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