Online Non-prescription Ordering Service (ONPOS) By Jayne Marie Lucas Senior Medicines Management Technician Central Essex Community Services
The Background (where it all began) 2002 Successfully piloted dressing initiative 2007 Successful Pilot of 3 district nurse bases ONPOS 2008/09 Roll out to all community nursing teams 2010 Re-established the link nurse group. 2011- Roll out to community hospitals and podiatry services
Services using ONPOS @ CECS Community nurses/integrated care teams (initial service user) Tissue Viability/Leg Ulcer Clinic Podiatry clinics and Podiatric surgery Community Hospital wards
Practice Prior To ONPOS Dressing products ordered on prescription predominantly by requesting from GP Dressings no longer required by the patient often used as boot stock Poor formulary compliance <40% Clinicians were unaware of product usage and expenditure No audit trail or data to work with
What is an Online Non Prescription Ordering Service Nurse/Health worker completes an online order from an agreed formulary list Order is sent electronically to agreed supplier Pharmacist/ Wholesaler supplies order to the base/ward/department PCT/Organisation s finance department is invoiced and then payment is made to the supplier
Why use an Online Non Prescription Ordering Service Reduces waste Saves time Avoids Technical Fraud Improves patient care with first dressing stock available Removes the inability to order items not on FP10 Supports formulary compliance Provides audit information
Advantages of Medicines Management Reduce Waste Improved budget control see the spend of different user groups i.e. DN s, Wards, Community services Easy access to real time data Base- details about each base( who s ordering, when, what.) Product reports show details of product usage Spend spending can be monitored to manage budgets Orders can be seen, tracked, monitored and reviewed Formulary Compliance (over 90% in most cases) Mid Essex formulary compliance is now 99.85% within our District Nurses.
Advantages to the Community Nurse More efficient system for obtaining dressings vs FP10 Online Ordering Stock delivered to nurse base NO need for prescription writing NO waiting for GPs to sign prescriptions Improve patient care by having correct dressing first time every time- Prevention of ordering same prescription several times Allows monitoring of dressings usage
Advantages to the Tissue Viability Nurse Appropriate use of products Promotes formulary compliance Allows for more tailored training Monitor overspending Improved budget control Reduce waste in patients home
Advantages for Medicines Management and Governance Robust governance procedures ensures formulary compliance and patient safety Dressings ordered on FP10 are the property of the patient It is illegal to transfer patient named stock on another patient We wouldn t do this with a drug!
Monitoring and reporting Engagement with team managers Quarterly ONPOS meetings Monthly reports to team managers highlighting Overall spend for their teams and forecast for end of year Overall spend for each month Monthly spend for each product High spends are highlighted and appropriate action taken.
Supported by ONPOS Established the link nurse group Delegation of responsibilities Programme of education including: Wound management Critical appraisal skills Conducting a product evaluation and providing useful feedback
Changes Achieved using ONPOS Management of high expenditure Significant saving resulting from product review Improved formulary adherence and monitoring of compliance
Management of high expenditure Month 11-16 spends of over 25k for one District nurse base. Data discussed with the link nurse and team manager of the base. Working with nursing staff to establish minimum and maximum stocks. Team established a process for staff taking stock out (identifying patient and signing stock out) Team manager and link nurse discussed spend at team meeting, From month 18 to 24 spend significantly reduced by %%
Changes to product use as a result of ONPOS data ONPOS data revealed an absorbent dressing product was being used excessively and some inappropriate use was identified within community nursing practice. Super absorbents accounted for a spend of 34,823 over a 3 month period Annual cost of 139,292 for super absorbent dressings
Using Data With Link Nurses The data for this high spend was fed back to the link nurse groups It was agreed that we would evaluate similar products described as superabsorbent to identify any potential cost savings The process for the evaluation was agreed
Outcomes Within 3 months we made significant cost savings without affecting the quality of care A total saving of 7.5k (3 months data) A potential annual saving of 30k
Outcomes Additional cost savings were identified by examining the data- Nurses reported previously needing to use a contact layer underneath the absorbent product. However a non-adherent contact layer was integral within one of the new dressings which negated the use of another dressing.
Outcomes According to ONPOS data we are now aware of further savings with reference to spend on contact layers. A total saving of 3k (3 months data) A potential annual saving of 12k Total potential annual savings of 42k
Benefits For The Organisation Places the patient experience at the heart of health care. Makes information work for the organisation. Supports quality improvement in action. Supports front line staff with decision making.
QIPP Quality Improving patient care Innovation Implementing changes Productivity Better use of resources Prevention Preventing re-admission
Formulary Compliance Using ONPOS data and spurious codes for prescribing: Formulary compliance from April 2010 March 2011 for community nursing 99.99%
Overall Savings 2009/10-1.2 million allocated budget (D/N s) Beginning of 2009/10 projected spend for the year - 1.4 million Using ONPOS data to inform practice we reduced our projected spend To: 1.2million 2009/10 To: 1.16million 2010/11 To: 1.15million 2011/12
The Future Explore extending the scheme to nursing homes and children's services Explore other sources of supply for further cost savings. Further develop the database for identification of high cost patients. Establish stock levels and excess stock sharing scheme.
Summary Using ONPOS has enabled us to:- Be proactive and reactive when necessary Be clinically effective whilst remaining efficient and within budgets Measure our outcomes both financially and clinically Work collaboratively with our colleagues to encourage ownership and accountability of change and spend. Negotiate effectively with industry