Automation of Controlled Drugs on Wards and in the Pharmacy

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Automation of Controlled Drugs on Wards and in
the Pharmacy

• Beryl Langfield
• Executive Lead Pharmacist, CPBS

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Why did we start

• Documentation, storage and ordering of controlled
  drugs (CDs) is time-consuming for both nursing
  and pharmacy staff
• Recording often goes wrong
• We were offered the opportunity to trial
• Pyxis Medsations on wards
• Cardinal CIISafe in pharmacy

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Pyxis Medstations on Wards

• Charing Cross Hospital
• 4 wards to date
• oncology ward
• a neurosurgery HDU (level 2)
• ITU
• respiratory/cardiology ward.

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Aims

• Safe secure storage of CDs on wards
• (some at-risk drugs IV antibiotics)
• Improved access (keys)
• Complete, legible electronic CD register
• Reduced housekeeping balance checks
• Timely ordering from pharmacy

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Medstation

• Access by fingerprint Bio-ID
• Opens specific pocket/drawer
• requires a Bio-ID witness for CDs
• CDs stored in own pocket/drawer
• Allows access to a single dose, a single product
  or a drawer
• Mini, cubie, carousel, matrix drawer
• CD set up requires a confirmed beginning count of
  the stock (blind)

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Medstation

• Record of removal
• Patient name hospital number
• Drug name
• Amount to be administered amount wasted
• Who accessed a drug
• Who witnessed (for CDs)
• Record of receipt from pharmacy
• Record of balance of each medication

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Audit pre- and post-implementation

• Pre-intervention data collected for 3 months and
  post-intervention data collected during four time
  periods
• Number of lines stored on ward
• Average inventory
• Number of CD orders per week
• Time to put away deliveries on ward
• Time to do balance check
• Nurses questionnaire

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Audit pre- and post-implementation
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Nursing Survey

• Easier and quicker to find medication
• Quicker to administer a CD
• Nurses estimate it took 1-5 minutes vs 2-15
  minutes to administer a single dose of an oral CD
• Agency nurses not trained, do not have access
  rights so cannot administer CDs

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Benefits

• Able to store all CDs - ampoules/tablets to PCAs
• Electronic CD register vs hand written paper CD
  register
• Bio-ID vs keys
• Inventory (balance) check weekly
• Nurses like it

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Issues

• Agency/Bank nurses do not have Bio-ID or
  passwords
• New nurses training, passwording
• When it breaks down (not frequently) have to
  revert to manual system
• Allocation of drawers for new/excess products is
  done by pharmacy
• New products temporarily stored in old CD
  cupboard/register

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Cardinal CIISafe - Pharmacy

• Pharmacies in
• Charing Cross Hospital
• Hammersmith Hospital

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Aims

• Safe secure storage of CDs
• Improve the efficiency of the process following
  large increase in range of products and number of
  orders
• Complete electronic CD register (paperless)
• Reduced housekeeping balance checks and
  correcting discrepancies
• Timely supply to wards

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CIISafe

• Each door fitted with shelves and trays of
  various sizes
• Trays further sub-divided to hold several
  products
• Access by password
• Opens specific door and exact location of drug
  shown on screen
• End count required
• Product barcode reading

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Audit

• Pre- and post-intervention data collected
• Reduced time spent daily in supplying wards by 4
  hours a week
• Discrepancies easier to resolve
• Electronic CD register can be interrogated but
  not exported
• Well liked by pharmacy staff, who now volunteer
  to do this task

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Benefits

• Able to store all CDs - ampoules/tablets to PCAs
• Electronic CD register (paperless) vs
  hand-written paper CD register
• Blind count improves correct balances
• No keys (locks)
• Short look-up code with hot key profiles
• Quicker, tidier and easy to retrieve products
• Staff like it

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Issues

• Agency staff do not have passwords or training
• New pharmacy staff training, passwording
• Checking process for non-accredited staff
• Restricted configuration settings
• Number of characters in some fields eg. long drug
  descriptions
• Suppliers Zip codes, telephone numbers

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Implementation

• Set-up
• No additional staff
• Specification of drawer configuration
• Allocation of drugs to drawers
• Training
• Nurse and Pharmacy super-users
• Nurses and pharmacists are generally trained by
  super-users
• Supplier training for recurring problems

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Implementation

• Ongoing support
• Simple problems dealt with by nurses or
  pharmacist
• Call for help
• Remote access by supplier
• On site support
• Passwords controlled centrally by pharmacy
• Super-users assist new users with Bio-IDs

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Other IT

• Medstations interfaced to PAS for ward patient
  list
• Both systems linked to console and interface PC
  in pharmacy
• Backup, archiving

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Electronic CD Registers
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Electronic CD register Medstations

• Electronic CD register (paperless) vs hand
  written paper CD register
• Legible
• Time saving
• Easy to interrogate
• Storage
• Retrievable
• Can export so able to manipulate

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Electronic CD register Medstations

• Export to Excel or Consultant reporting system to
  enable monitoring
• How often a drug is accessed
• How often a drug is refilled
• Low use products
• Patient use
• Discrepancies
• Wastage

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Electronic CD register CIISafe

• Electronic CD register (paperless) vs hand
  written paper CD register
• Legible and accurate
• Time saving (not written or find correct
  register)
• Easy to interrogate
• Storage vs paper register
• Retrievable and backed up
• Cannot export so unable to manipulate

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Future

• Shipman and Accountable Officer
• Use electronic record to interrogate data
• Look for patterns
• Monitor doses administered by individual nurses
• Nurse witness pairing
• Wastage
• Which staff record discrepancies

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Future Developments

• Potential for electronic CD ordering from ward to
  CIISafe improved audit trail
• Wish list - interface between CIISafe and
  pharmacy stock control system to reduce
  duplication
• More interrogation of registers

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Acknowledgement

• Team effort
• dispensary staff
• Nurses on wards
• IT