Transcript Performance Indicators

City Hospitals Sunderland
NHS Foundation Trust
NHS
City Hospitals Sunderland – April 2009- March 2011
David G Miller - Chief Pharmacist
City Hospitals Sunderland
NHS Foundation Trust
PHARMACY PROFILE
• Current Establishment
–
–
–
–
50 wte Pharmacists
40 wte Technicians
20 wte Assistants
5 wte Other
• IMM Inpatient Service
- 32 inpatient wards
Managing Medicines - Enhancing Patient Care
NHS
• Pharmacists
How do we do it?
– Speak to every new patient to find out what medication they take at
home and if they are allergic to any medicines.
– Compare this to the medical notes and EP and advise the doctors of
any changes that need to be made.
– Regularly review patients prescriptions whilst they are on the ward
– Attend ward rounds and provide prescribing advice
– Review medication on discharge to ensure patients are sent home on
the appropriate treatment
– Communicate any changes to the GP
How do we do it?
• Technicians
– Check Patient’s own drugs
– Order and maintain supplies of medication in white lockers
ready for patient’s discharge
– Organise any additional supplies needed for discharge
prescriptions
– Counsel the patient’s about how to take their medication and
what it is for
City Hospitals Sunderland
NHS Foundation Trust
ELECTRONIC PRESCRIBING
• Inpatient EPMA system
Managing Medicines - Enhancing Patient Care
NHS
How many queries?
Day
Number of
prescriptions
Number of
prescriptions
which
required an
intervention
Total
number of
individual
prescription
deficiencies.
Mon
140
32
33
Tue
160
29
35
Wed
139
38
47
Thur
128
23
28
Fri
118
33
33
Total
685
155
176
15 15
146
Regarding
prescription
legality
Regarding
prescription
contents
Regarding
supply
problems
Chart 1: Overview of where
deficiencies occur
Table 3: Overview prescription deficiencies
-Total of 176 deficiencies were recorded over the five day period.
-Approximately 25 % of prescription’s were deficient in contents.
-The majority of deficiencies (83 %) occurred within the prescription
contents.
40
35
Frequency
30
25
20
15
10
5
0
Chart 4: Deficiencies occurring within the prescription contents
-Missing Strength e.g. Bisoprolol 1.25 mg, 2.5 mg or 3.75 mg etc..
-Ambiguous e.g. Take three per week. 3 tablets on the same day of the
week? one tablets on three different days of the week.
-Frequency e.g. High dose prednisolone twice daily.
-Illegible e.g. Cannot read course length, frequency, dosage form etc.
Prescriber contacted
The actions taken to resolve queries.
Nurse/department staff
contacted
Patient/representative consulted
37
53
4
20
1
Hiss checked (PMR)
Took own decision without
contacting prescriber – PNC
Contacted MI
Endorsed prescription,
42
3
-Prescriptions endorsing was the most frequent action i.e. The contents
were understood and annotated to make them more legible, coherent etc...
-A large proportion of prescriptions were PNC’d i.e. The pharmacist made
a professional decision.
-Pharmacist’s also contacted prescriber’s on a regular basis.
Hospital Prescription Journey
Arrives in pharmacy
Prescription charges
Pharmacist clinical check
Dispensing Process
Accuracy check
Prescription Written
Issue to Patient
Counselling
CHEMOTHERAPY
Final Release
City Hospitals Sunderland
NHS Foundation Trust
Outpatient Medication Issues
• Increased Focus on Medication Errors
– 6 Mercaptopurine 50mg daily
Mercaptopurine 50mg tablets
Six tablets to be taken daily
A Patient
X00000000
Managing Medicines - Enhancing Patient Care
DD/MM/YYYY
NHS
DEAS (2002)
Wrong Drug Supplied
23%
Wrong Strength of Right Drug supplied
23%
Wrong Quantity
10%
Wrong warning or directions
10%
Wrong drug name or label details
9%
Wrong strength on label
8%
Wrong form
7%
Wrong patient Name on label
7%
Based on reports of 89 UK Hospitals and 7000 errors (1991-2001)
City Hospitals Sunderland
NHS Foundation Trust
Robot Benefits
•
•
•
•
•
•
•
Reduced Inventory & Stockholding
Reduced Losses and Discrepancies
Reduced Staffing
Quicker Dispensing Times
Reduced Dispensing Errors
Reduced Floor Space
National Initiatives
NHS
City Hospitals Sunderland
NHS Foundation Trust
Labelling Benefits
•
•
•
•
•
•
Closed Loop prescribing to label attached
Can dispense automatically from any ward
Deals with DfD workload
No labels at End of day
Few Unlabelled Packs
More OPD Dispensing
NHS
DEAS (2002)
Robot
Wrong Drug Supplied
23%
Wrong Strength of Right Drug supplied
23%
Wrong Quantity
10%
Wrong warning or directions
10% X
Wrong drug name or label details
9%
X
Wrong strength on label
8%
X
Wrong form
7%
Wrong patient Name on label
7%
X
Based on reports of 89 UK Hospitals and 7000 errors (1991-2001)
City Hospitals Sunderland
NHS Foundation Trust
NHS
ELECTRONIC PRESCRIBING
• Electronic Prescribing performs well for most patients
with most medicines for most of the time CfH –
Briefing for Pharmacists
Managing Medicines - Enhancing Patient Care
DEAS (2002)
Robot
EP
Wrong Drug Supplied
23%
?
Wrong Strength of Right Drug supplied
23%
?
Wrong Quantity
10%
?
Wrong warning or directions
10% X
Wrong drug name or label details
9%
X
Wrong strength on label
8%
X
Wrong form
7%
Wrong patient Name on label
7%
?
X
Based on reports of 89 UK Hospitals and 7000 errors (1991-2001)
Unprevented Error rates per 100,000
Average
Outpatients
Inpatients
1st Qtr
0
5
10
15
20
25
30
Trial in Autumn in 5-7 English Hospitals
Leading Pharmacy School led
Safe, effective and economic ?
Patients Perspective ?
Which patients have problems ?
Advantages and Disadvantages
compared to Traditional Model ?
What changes required to maximise
benefits?
Does it fit principles?
Do staff see it as friend or imposition?
BENEFITS
•“Pharmacist Consult” with
every Transaction
•Personalised Structured
Counselling
•Pharmacist Control of Process
•Near Patient Dispensing
•Reduced Operating Costs
•After Hours Service
•Peak Hour Queue Management
•Delivery to Remote Locations
•Less Dispensary more Clinical