HUG Pharmacy & Sterilisation

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06/09/2013 1 HUG HUG Pharmacy & Sterilisation Prof. Pascal BONNABRY M. Hervé NEY M. Hervé NEY Berner Fachhochschule Geneva, September 13, 2013 Agenda 13h45 HUG presentation 00 14h00 Theoretical introduction, processes at the: - Pharmacy - Sterilisation 15h00 Visit in 2 groups (1 hour per visit) - Pharmacy - Sterilisation - Sterilisation 17h00 Debriefing and use cases 18h00 End

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Microsoft PowerPoint - SafetyProcess_ BernerFachhochschule_13.pptxBerner Fachhochschule
0014h00 Theoretical introduction, processes at the: - Pharmacy - Sterilisation
15h00 Visit in 2 groups (1 hour per visit) - Pharmacy - Sterilisation- Sterilisation
17h00 Debriefing and use cases
18h00 End
Annual report 2011
Annual report 2011
Men at work…
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at the hospital
Prof. Pascal BONNABRY
Pharmacy strategic priorities
• Optimize the safety the efficiency• Optimize the safety, the efficiency and the traceability of the physical circuit of drugs
• Optimize the information flow during prescription, dispensing, preparationprescription, dispensing, preparation and administration of drugs
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• 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 the prescription
Global or individual ?
• 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)
Prescription
EPR
MP
Selection Calculation Counting
20%
Administration errors
• Error rate= 19 %
Observation study in 36 institutions Barker KN, Arch Intern Med 2002;162:1897
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• Detection ability during human-performed control:
• Pharmacists: 87.7% • Nurses: 82.1%
Efficiency ≈ 85% (known value in the industry)
Do not be too confident with the double-checks !
Implementation of IT in the medication process
Diogène 1 - 1978
Potential interests of IT
• 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 processes
Many questions before to start
• Positive impacts ? • New risks ?• New risks ? • Return on investment ? • System selection ? • Commercial or homemade ? • Interoperability ? • User’s training strategy ?• User s training strategy ? • Acceptability ?
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Industry stock
EPR
Industry stock
EPR
François O et al, HUG, 2013
Selection 0% Conveyor 0.27% Manual finalisation 0%
≈ 4500 avoided errors/yr
François O et al, HUG, 2013
- 2 FTE ROI 4.5 years
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• Experimental
3
0
0.5
1
1.5
2
2.5
3
Automation of drug dispensing Efficiency
• Real life (digestive surgery ward) 600
M in
ut es
/w ee
without
beginning
routine
M
0
100
200
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• Cytostatics DrugNurse
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Clinical information
Computer-assisted production management
• Objectives T t t f ti b IT – To support any type of preparation by IT
• Batches • Cytostatics • TPN • Other individualized prescriptions
– To implement in-process electronic controls during the most critical stepsthe most critical steps
– To link individualized preparation to their prescription and their administration
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Production management Gravimetry
• Cytostatics (Cato Cypro )
Automated (BAXA) 1 x 2.5h = 2.5 h
Prerequisite to successful IT implementation
• Electronic management of processesElectronic management of processes (CPOE, stocks, …)
• Technical infrastructure (hard-, soft-)
• Acceptability (patients, caregivers)
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• Product ID (cytostatics)y
01 07613167000009 7003 1103161400 21 cyt-11198499 GTIN - cytos EXP (date and time) Serial
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• Product ID (batch production)p
How to progress?
• Determine an institutional strategy and an implementation schedule taking into accountimplementation schedule, taking into account – the local organisation – the local culture – the expected return on investment
• Involve the different partners • Re-think the process organisation
(re-engineering) • Manage each projet independently, without
loosing the global vision
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Conclusion
• The medication process at the hospital is complex and involves many differentcomplex and involves many different professionals
• A clever organisation contributes to improve the safety, the efficiency, the communication and the traceability
• IT take more and more importance in the i h h iprocess improvement approaches: their
implementation is necessary but is a challenge • Each hospital must determine a strategy, based
on the local context