Medicines Storage Medicines Storage Audit – Audit –

A Live SolutionA Live SolutionNeil CarvellNeil Carvell

Pharmacy Supply ManagerPharmacy Supply Manager&&

Debbie BrentonDebbie BrentonDeputy Director of Pharmacy (Operational Manager)Deputy Director of Pharmacy (Operational Manager)

OverviewOverview

• BackgroundBackground• Case for ChangeCase for Change• The SolutionThe Solution• Benefits of MeridianBenefits of Meridian• ImplementationImplementation• Meridian in UseMeridian in Use• Lessons LearntLessons Learnt• The FutureThe Future

IntroductionIntroduction

• Plymouth Hospitals NHS TrustPlymouth Hospitals NHS Trust- 900 bed Teaching Hospital900 bed Teaching Hospital- Secondary & tertiary care provider Secondary & tertiary care provider

for Plymouth, North & East Cornwall for Plymouth, North & East Cornwall and South & West Devonand South & West Devon

- Population of 450,000Population of 450,000

BackgroundBackground

• Annual audit undertakenAnnual audit undertaken– LimitationLimitation

• Manual data collection and analysisManual data collection and analysis• Time lag between data entry and reportTime lag between data entry and report• Undertaken by clinical staffUndertaken by clinical staff• Lack of engagement from clinical areas with action Lack of engagement from clinical areas with action

planplan

• Stepping Hill incidentStepping Hill incident– DH audit requirementsDH audit requirements– CQC involvementCQC involvement

• Improved internal focusImproved internal focus

Case for ChangeCase for Change

• To provide assurance of compliance with the To provide assurance of compliance with the Medicines Management PolicyMedicines Management Policy

• To provide assurance that storage conditions are To provide assurance that storage conditions are met.met.

• Reduce the risk of medicines wastage due to Reduce the risk of medicines wastage due to incorrect storage.incorrect storage.

• To raise the profile of medicines security and To raise the profile of medicines security and storage within the Trust.storage within the Trust.

• To develop a governance framework for the storage To develop a governance framework for the storage of medicines at a ward and department level.of medicines at a ward and department level.

• To drive improvements in practiceTo drive improvements in practice

The Solution - Meridian The Solution - Meridian

• Technology platform for Technology platform for patient/stakeholder feedback and auditpatient/stakeholder feedback and audit

• Fully hosted secure web based solutionFully hosted secure web based solution• License includes ability to build and adapt License includes ability to build and adapt

surveys/audits and deploy instantly to any surveys/audits and deploy instantly to any internet enabled deviceinternet enabled device

- No limit to number of surveys or usersNo limit to number of surveys or users- Licence also covers use of kiosks, email or Licence also covers use of kiosks, email or

SMS Text surveysSMS Text surveys• Supports Equality and Diversity Supports Equality and Diversity

programme – different languages, programme – different languages, graphics, audio and videographics, audio and video

Benefits of MeridianBenefits of Meridian

• Provide a platform for clinical care Provide a platform for clinical care feedback and audit solutions via one feedback and audit solutions via one provider and within one annual license provider and within one annual license fee of £30kfee of £30k

• Reduce time wasted on input of manual Reduce time wasted on input of manual data into spreadsheetsdata into spreadsheets

• Provide real time quantitative dataProvide real time quantitative data• Provide KPI analysis from Directorate Provide KPI analysis from Directorate

to Board level in standardised formatto Board level in standardised format

Implementation of Implementation of MeridianMeridian

• Initial trial in one Directorate and Initial trial in one Directorate and two auditstwo audits

• Trial extendedTrial extended- Orthopaedics – delayed discharge Orthopaedics – delayed discharge

reasonsreasons- GI & Renal – Ward managers auditGI & Renal – Ward managers audit- Pharmacy – Missed doses & Pharmacy – Missed doses &

Medicines StorageMedicines Storage

Medicines Storage HistoricallyMedicines Storage Historically

• Carried out paper based audit Carried out paper based audit yearly in 38 clinical areasyearly in 38 clinical areas

• Carried out by ward pharmacistCarried out by ward pharmacist• Clinical areas not auditedClinical areas not audited• Significant drain on limited Significant drain on limited

pharmacist resourcepharmacist resource• Delay before results knownDelay before results known

- Actions difficult to push through- Actions difficult to push through

ObjectivesObjectives

• Improve frequency of auditsImprove frequency of audits• Increase number of clinical areas Increase number of clinical areas

auditedaudited• Decrease time taken to complete Decrease time taken to complete

auditaudit• Decrease time taken to input dataDecrease time taken to input data• Provide real time feedback from Provide real time feedback from

auditsaudits- Allowing immediate corrective and Allowing immediate corrective and

preventative actionspreventative actions• Carry out Estates work to enable Carry out Estates work to enable

clinical areas to correctly store clinical areas to correctly store medicinesmedicines

• Pharmacy ATO’s to carry out audit as Pharmacy ATO’s to carry out audit as part of routine top-up processpart of routine top-up process

Implementation CostsImplementation Costs

• Licence Fee £30kLicence Fee £30k• 2 iPads purchased for Pharmacy2 iPads purchased for Pharmacy

£399 per unit£399 per unit• £100 set up cost£100 set up cost• £50 annual service contract£50 annual service contract

Other uses of MeridianOther uses of Meridian

• Patient Experience Patient Experience Surveys:Surveys:

- DermatologyDermatology- Day CaseDay Case- Hip/Knee PatientsHip/Knee Patients- InpatientInpatient

• Quality and Safety Quality and Safety Audits:Audits:

- Cannula AuditCannula Audit- Catheter Care AuditCatheter Care Audit- Hand HygieneHand Hygiene- Re-Admission AuditRe-Admission Audit- Theatre AuditTheatre Audit- C.Diff AuditC.Diff Audit- Safer Surgery AuditSafer Surgery Audit

Meridian in useMeridian in use

• Audit is now built in to the routine for ATO’s carrying out Audit is now built in to the routine for ATO’s carrying out top-upstop-ups

• Results are monitored weeklyResults are monitored weekly• Clinical areas not achieving required standard undergo Clinical areas not achieving required standard undergo

repeat audits on an increased basisrepeat audits on an increased basis• Reason for not achieving standard passed to ward Reason for not achieving standard passed to ward

manager and matron immediately for actions to be takenmanager and matron immediately for actions to be taken

ResultsResults

• Average monthly audit resultsAverage monthly audit results

• Example of a report from MeridianExample of a report from Meridian

SecuritySecurity

• Meridian software and Trust’s Meridian software and Trust’s wireless network only available from wireless network only available from Trust assetted devices.Trust assetted devices.

• This prevents personal devices This prevents personal devices connecting to the networkconnecting to the network

• Devices added to Trust device Devices added to Trust device directorydirectory

• Firewall to prevent unknown Firewall to prevent unknown devices/users accessdevices/users access

Lessons LearntLessons Learnt

• Ensure process complianceEnsure process compliance• Engage ward staffEngage ward staff• Pharmacy staff trainingPharmacy staff training• Escalation process of resultsEscalation process of results

Other uses of MeridianOther uses of Meridian

• Patient Experience SurveysPatient Experience Surveys- Your Maternity CareYour Maternity Care- Dermatology FeedbackDermatology Feedback- Day Case FeedbackDay Case Feedback- Hip/Knee Patient FeedbackHip/Knee Patient Feedback- Inpatient SurveyInpatient Survey

Further development for Further development for Meridian use within PharmacyMeridian use within Pharmacy

- CD storage auditCD storage audit- Missed dose auditMissed dose audit- Continuous out- Patient Satisfaction Continuous out- Patient Satisfaction

survey with on site partnership survey with on site partnership (Lloyds Pharmacy)(Lloyds Pharmacy)