Transcript PowerPoint Presentation Template

Ward-Based Robotics
June So
Director of Pharmacy
The Christie NHS
NHS Foundation Trust
Front of hospital
The Christie NHS
NHS Foundation Trust
Questions
• Are ward-based robotics cost-effective?
• How can they be made affordable?
The Christie NHS
NHS Foundation Trust
The Christie NHS
NHS Foundation Trust
Benefits of ward-based robotics
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Drug savings
Product recall
Improved security and audit trail
Staff savings for nurses, pharmacy
Reduced selection/administration errors
Clinical decision support
Reduction in missed doses
Green C, Hughes D, Baird R. Pharmaceutical Journal Oct 2009; 283: 395-398
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NHS Foundation Trust
The Sheffield Northern General
experience - cardiology
Roberts N
Rollout in 3 phases:
• Phase 1
• Phase 2
• Phase 3
4 Theatres, main stores
Anaesthetic rooms
ICU and recovery
Source: N Roberts business case
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Was it cost-effective?
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Case studies in general theatres
– one-off stock reduction
Hospital
Percentage stock reduction
Birmingham UHB
21%
Countess of Chester
45%
Halton
38%
Kings College
20% (over £1m)
Leeds
23%
Sheffield Northern
38%
Warrington
26%
Source: Avantec data on file
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NHS Foundation Trust
Case studies in general theatres consumption reduction
Hospital
Percentage reduction
Birmingham UHB
16%
Countess of Chester
24%
Halton
5%
Sheffield
126k
Kings College
5%
Manchester South
27%
Warrington
16%
Source: Avantec data on file
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Other departments
• Accident & Emergency
eg D Child at Salford Royal
• Medical Admission Units
eg D Ford at Dundee
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Oncology
• 1 haematology + 1 clinical oncology ward
• Pilot: cabinets on free loan
• Drugs including Controlled Drugs
Parameters:
• stock savings, unused stock
• staff time savings
• reduction in incidents
Ref: So J, Kaye D, Oldham H et al. Hospital Pharmacy Europe 2011; 054: 5-7
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Manchester Evening News
Alert on stolen drugs
October 08, 2007
DRUGS stolen from Christie
Hospital
could prove fatal if taken
without medical
supervision.
Police are warning the
public to be on the lookout for the morphine
tablets which
disappeared from the
drugs store at the cancer
hospital last
week………………………
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Business case development
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•
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•
Service managers
Nurse leads
Pharmacy
Time/motion sheets counter-signed by Trust
Scepticism of ward staff in haematology
Approval from Trust to conduct a pilot
IT support
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NHS Foundation Trust
Savings in stock
Stock
issues
£
Postinstallation
value £
Savings in
£
Total after
adjustment
£
Haematology 5,108
-1,494
6,602
3,118
Clinical
oncology
572
889
889
7,491
4,007 (61%)
Total
Preinstallation
value £
1,461
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Savings in stock
• Stock not used in 3 months = £1,863
• Total drug savings = £5,870
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NHS Foundation Trust
Pharmacy time savings
(top-up)
Ward
Time saved
Haematology
58 minutes per visit
(2x per week = 116 minutes
Clinical oncology
43 minutes per visit
(1x per week = 43 minutes)
Total time saved per week
159 minutes
(2.65 hours)
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Nurse savings CDs
Organisation
Pre-installation
Postinstallation
Saving
Christie
Haematology
3 minutes 10
secs
45 secs
2 minutes 25
secs
(76%)
Charing Cross
8 minutes
4 minutes
4 minutes
(50%)
Ref. Franklin BD, McLeod M, Miller G. Pharm Man 2009 26(2);9-14
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Nurse savings – non CDs
Organisation
Pre-installation
Postinstallation
Saving
Christie
Haematology
1 minute
29 seconds
31 seconds
(52%)
Chester
A&E department
3 minutes
40 seconds
2 minutes 20
seconds
(78%)
Ref. Green C, Hughes D, Baird R. Pharm J 2009;283:395-398
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NHS Foundation Trust
Number of clinical incidents
• Incidents – no change
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CD incidents pre and postinstallation
Pre- installation
Post-installation
Clinical oncology ward
1 major incident
No majors;
Expired drug issues
Haematology
No majors
Minor only
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NHS Foundation Trust
Nurse satisfaction
D Pickersgill, ward manager, clinical oncology
“ It is very user friendly, using finger print ID, no
more searching through cupboards, the drug
round is a lot quicker, more time is spent with
patients”
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Other benefits
• Haematology – all issues to individual patient
• Plans to feed into the Trust Patient Level
Information & Costing system (PLICS)
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Funding
• How was it funded?
• Not enough drug savings to pay for the
cabinets
• Staff efficiency savings not used to fund
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Trust approval process
• Capital and Workforce Planning Committee
Jun 2008
• Clinical Support Services Divisional Board
• Cancer Network Services Divisional Board
Jun 2010 • Cancer Centre Services Divisional Board
• Capital and Workforce Planning Committee
Aug 2010
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• Submission focus on risk/governance
benefits
• Rejected by CWP
• 2 cabinets funded by the Division – and also
engaging with the Christie charity
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Mental Health
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NHS Foundation Trust
Mental Health
Merseycare
Trust
Pre-installation
Stock in £
Postinstallation
stock in £
Savings in
£
Unwanted
drugs/returns
3,036
9.60
3,026.40
(99%)
Knowles L. NW Chief Pharmacists Workshop 25 May 2011
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Mental Health
One ward
Costs
£
Hardware/software
15k purchase
Staff costs
7.5k project lead (15 months)
TOTAL
22.5k
Savings
£
Stock rationalisation, returns
15k (15 months)
Pharmacy assistant 0.25 WTE
4.3k
Pharmacist 0.1WTE
4.8k
TOTAL
24.1k
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Cost of ward robotics
Specialty
Purchase cost
£
Cardiac theatres
25k – 30k or more
Mental Health ward
15k
Neurology
20k
Oncology ward
25k
Opthalmology
28k
Radiology
13k
Theatres
15k – 37.5k
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Are they cost-effective?
Ward/dept type
Theatres
Yes
Accident & Emergency
?Yes (if include staff efficiency
savings)
Medical Admissions Unit
?Yes (if include staff efficiency
savings)
Mental health wards
Yes
Oncology wards
?Yes if include staff efficiency
savings
No if exclude staff efficiency savings
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Governance benefits
• Secure audit trail for CDs/high risk medicines
• Less risk of diversion
• Safety, error prevention eg oxynorm and
oxycontin
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Schwarz HO, Brodoury BA
Significant reduction in missed doses
Ref. Am J Health Syst Pharm 1995; 52: 823-828
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Borel JM & Rascati KL
• Reduction in delayed medicines and errors
Pre- installation 16.9%
Post installation 10.4%
Statistically significant
Ref: Am J Health System Pharm. 1995;52:1875-1879
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How can they be made affordable?
• Is there potential for price discounting –
national or regional procurement
frameworks?
eg pharmacy automation in NW
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The Christie NHS
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Potential for increased benefits –
scope for more savings?
Green C, Hughes D & Baird R.
Wholesaler/supplier managed inventory
• How feasible is it?
• Could it be more cost-effective?
• Are there any tangible savings?
Ref. Green C, Hughes D & Baird R. Pharm J 2009,283:395-398
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NHS Foundation Trust
Wholesaler : supplier split
Trust
Ward
Wholesaler:
supplier split
Drugs value
Guys & St
Thomas
ICU
40:60
Elderly
40:60
Theatres
55:45
Clinical
Oncology
55:45
Christie
The Christie NHS
NHS Foundation Trust
Conclusion
• Ward based robotics is here to stay
• QIPP (Quality, Innovation, Productivity,
Prevention)
• Cost-effective – Yes in selected settings
• Can they be made more affordable? –
procurement, Ward Order Assembly?
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NHS Foundation Trust
The Christie NHS
NHS Foundation Trust