AUTOMATION TO IMPROVE THE SAFETY AND THE EFFICIENCY OF DRUG MANAGEMENT
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1 AUTOMATION TO IMPROVE THE SAFETY AND THE EFFICIENCY OF DRUG MANAGEMENT Pr Pascal BONNABRY Head of pharmacy 8th Medication Safety Conference Abu Dhabi, November 6, 2015 Learning objectives At the end of the lecture the participants should be able to understand the limits of human reliability and its impact on safety in the medication process to define a strategic map of the integration of information technologies in the medication process of their institution to evaluate the benefits and the risks related to automation for drug management 1
2 Medication: challenges Safety Among the 3 main sources of avoidable adverse events Efficiency Difficult to perform highly without appropriate tools for stock management Economics Value of decentralized stocks Traceability Increasing requirements by authorities An obsolete organisation? 39% Prescription Industry stock Central pharmacy stock Avoidable adverse drug events: 6.5% of admissions Ward stock 11% Administration 38% Bates DW, JAMA 1995;274:29 2
3 Quiz Order of magnitude of dispensing errors by healthcare professionals? A. 0.01% B. 0.1% C. 1% D. 10% Quiz - answer Order of magnitude of dispensing errors by healthcare professionals? A. 0.01% B. 0.1% C. 1% D. 10% 3
4 Dispensing errors (experimental) Error rate = 3 % 20% 6% 74% Selection error Repartition error Counting error Garnerin P, Eur J Clin Pharmacol 2007;63:769 Quiz Performance of controls to catch errors? Example: double-check of dispensedd drugs? A. 70% B. 85% C. 95% D. 99% 4
5 Quiz - answer Performance of controls to catch errors? Example: double-check of dispensedd drugs? A. 70% B. 85% C. 95% D. 99% Limited performance of controls Introduction of errors during unit dose dispensing Detection ability during human-performed control: Pharmacists: 87.7% Nurses: 82.1% Facchinetti NJ, Med Care 1999;37:39-43 Efficacy 85% (known value in the industry) Do not be too confident with the double-checks! 5
6 Challenges in hospital pharmacy Strategic priorities Optimize safety, efficiency and traceability of the physical circuit of drugs Optimize the information flow during prescription, dispensing, preparation and administration of drugs Challenges in hospital pharmacy Human resources Facts Increasing workload Difficult to get more resources Resources used for poor added-value tasks Objectives Automate poor added-value tasks Enable professional advancement Improve motivation and satisfaction 6
7 Hospital pharmacy and IT Medication process Production Clinical pharmacy Potential interests of information technologies To improve The safety by reducing the rate of errors and improving the reliability of controls The traceability by facilitating the registration of logs The efficiency by increasing the working performance The communication by connecting the different steps of the process 7
8 Many questions Positive impacts? New risks? Return on investment (ROI)? Interoperability? Commercial partner(s)? Implementation? User s training? Need to define a visionary strategy! Medication process organisation Existing models Global distribution The pharmacy delivers boxes of drugs and nurses dispense individual treatments from the ward stock Nominal or individual distribution Drug dispensing is performed at the pharmacy, for each patient, based on a prescription 8
9 Medication process organisation Individual distribution is more convenient in some conditions Few prescription modifications (chronic care) Pharmacy close to the wards At the HUG, the global model was selected Acute care in majority Long distance between the pharmacy and some wards (multi-sites hospital) The process of the future? Robotized distribution Automated dispensing system Industry stock EDI Central pharmacy stock Ward stock CPOE Clinical information system Distribution with scanning Logistic information system Bedside scanning Smart Pumps 9
10 The process of the future? HUG situation 2015 Robotized distribution Automated dispensing system Industry stock EDI Central pharmacy stock Ward stock CPOE Clinical information system Distribution with scanning Logistic information system Bedside scanning Smart Pumps Cytotoxics: a special process Automated preparations (2015) Electronic prescription + Dose-banding (2016) Preparation with gravimetric control Bedside scanning 10
11 Robotized distribution Robotized distribution Impact on the safety 095% 0.95 Manual distribution 1.11 % Conveyor s Scanning improvement 0.48 % Robot (2011) 0.13 % Robot (2015) n=5805 n=2437 n=4365 n=5562 Wrong drug Missing quantity Additional quantity Wrong dispatch Conveyor error Final manual matching Damaged medication François O et al, HUG,
12 Robotized distribution Impact on the efficiency 2 FTE François O et al, HUG, 2013 Automated dispensing systems 12
![Automated dispensing system Impact on the safety (experimental) Error rate [%] 3 2.5 2 1.5 1 0.](/docs-images/76/73283849/images/13-0.jpg "5 without with 0 Total Omission Selection Counting Repartition Du Pasquier C, Riberdy L, HUG,")
13 Automated dispensing system Impact on the safety (experimental) Error rate [%] without with 0 Total Omission Selection Counting Repartition Du Pasquier C, Riberdy L, HUG, 2003 Automated dispensing system Impact on the efficiency % Lines asked in emergency mode Before (manual) Pilot with ADS After (manual) Surgical ward, 28 beds François O et al, HUG,
14 Automated dispensing system Nurses opinion on improvements improves the safety of care? improves the stock management? strongly agree 63% strongly agree 66% agree 31% agree 22% disagree 3% disagree 9% strongly 0% strongly 0% no opinion 3% no opinion 0% improves medication traceability? strongly agree 66% agree 22% disagree 13% strongly no opinion 0% 0% François O et al, HUG, 2015 Quiz Which of the following assertions on automated t dispensingi systems is false? A. Stock management is improved by the electronic management of stock levels B. The full traceability simplifies the procedures for narcotics management C. The benefits are maximized by a strong integration in the information system D. The ROI can only be obtained in more than 8 years 14
15 Quiz - answer Which of the following assertions on automated t dispensingi systems is false? A. Stock management is improved by the electronic management of stock levels B. The full traceability simplifies the procedures for narcotics management C. The benefits are maximized by a strong integration in the information system D. The ROI can only be obtained in more than 8 years Lessons learned Automation and robotisation are important strategies t to optimize i drug management Safety, traceability and efficiency can be improved A strategic vision should be elaborated by any hospital The implementation must be intelligently and interdisciplinary decided and planified These projects are very challenging and must be leaded These projects are very challenging and must be leaded by a competent and available team 15
16 THANK YOU FOR YOUR ATTENTION Maxime Guyon, 2014 References Garnerin P et al, Measuring human error probabilities in drug preparation: a pilot simulation study. Eur J Clin Pharmacol 2007;63: Chapuis C et al, Automated drug dispensing system reduces medication errors in an intensive care setting. Crit Care Med 2010;38: Fox BI et al. ASHP national survey on informatics: assessment of theadoption anduseof pharmacy informatics in US hospitals Am J Health Syst Pharm 2015;72: The presentation can be downloaded ge.ch/ens/conferences.html 16
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