Reorganisation of medication processes Spitäler fmi AG

Transkript

1 Reorganisation of medication processes Spitäler fmi AG Spitäler Frutigen Meiringen Interlaken AG, Weissenaustrasse 27, CH-3860 Unterseen, spitäler frutigen meiringen interlaken ag, weissenaustrasse 27, ch-3800 unterseen, 1

2 The Spitäler fmi AG in the overview One of seven regional hospital centers in the canton of berne Serviceprovider for 35 communities ~ 1800 km 2 (30% of the surface of the canton of berne) Three Locations one society Employees (incl. apprentices) ~ Inhabitants Tourism not included Biggest employer in the east bernese oberland Cases Acute care (DRG) ~ Ambulatory care ~ (each 5th patient is a tourist) Turnover ~ 130 Mio. CHF 2

3 Reorganisation of the medication process in the acute care - how it was before - basic requirements - management of master-data - introduction of the systems - conclusion Outlook : what s next 3

4 Before : 2010 old shelves handwritten orders 4

5 Medication Process (Bsp. Uni-Kinderspital Zürich) Patient A 1 Visite Essen Pflege Betreuung Blutentnahme Untersuchungsvorber. 9 Medikamente verabreichen KG Arzt Spezialist nein med. Therapie ja später zu A Pflege Apotheke Kardex Kurven Labor C Kontrolle Stationsapotheke Medi- Bestellung für Lager / lauf. Therpie Listen-Medi ja nein ja 2 Verordnung Rücksprache Station/Arzt Grund / Ersatz? Ersatz B Einlagerung Stationsapotheke Wareneingangskontrolle Medi- Transport nein 3 3 Verordnung in Kardex abschreiben Verabreichungszeiten festlegen Medi abbolen Medi bereitstellen KMT IPS OHC Chir 3 Pflegehandlungen, Dokumentation Verordnung übertragen: Kardex/ Verlaufsblatt 3 4 Abschreiben für Medi- Zubereitung Medi vorrätig Medi-Best. in Apotheke Listen-Medi ja nein nein Rücksprache Station/Arzt ja ja Grund / Ersatz? Ersatz Medi abbolen nein 8 Zubereitung der Medi nach abgeschr. Verordnung Medi abbolen Medi bereitstellen Wareneingangskontrolle Verlaufsblatt / Cardex: Abgabe eintragen Medikamentenverrechnung: teurer Medi auf Leistungsblatt Medi bereitstellen Medi bestellen Rechnungskontrolle 5 Medi bereitstellen Medi bestellen 6 Rechnungskontrolle Lieferant Verwaltung Medi bereitstellen Rechnungskontrolle / Zahlungsfreigabe 7 Medi bereitstellen Rechnungskontrolle / Zahlungsfreigabe Statistik / Verrechnung Dr. J. Götte; Diplomarbeit NDS Wirtschaft 10/1999 5

6 Costs of preparing medications 1,5 million single doses in spitäler fmi ag 2010 We assumed 1 minute per Dose (empirical data) = 1,5 Mio minutes = hours = ca. 13 workplaces (the drugs are not yet ordered, documented, calculated etc.); 13 workplaces cost about 1,3 Mio CHF per year 6

7 Works around medication (without bringing it to patients, medical visits; internal medicine Taking the order and comparing stocks 15 minutes per day ordinary orders 40 minutes 3 x per week extraordinary orders 10 minutes per day clarify orders 15 minutes per day Fill up ordinary orders 20 minutes 3 x per week Fill up extraordinary orders 5 minutes per day Controlled drugs 10 minutes 1 x per week Activity recording 12 minutes per patient Preparing drugs for use 10 minutes per patient / per day Inventory 8 hours 1 x pro Jahr Returning not used drugs 30 minutes 1 x per week Control of expiry dates 2 hours 1 x per month 7

8 Dimension of costs of medications errors An Estimation Spitäler fmi AG : 1.5 Millionen single dosis Medication errors = 1% 1 4% having negative impact on patients medication errors per year (41 per day) 600 (1.64 per day) with negative impact on patients Additional costs per case = 1.8 Mio CHF/year 1 Van den Bemt et. al. Drug related Problems in hospitalized patients; Drug safety 2000: Bates DW; Spell N; Cullen DJ; Burdick E; Laird N; Petersen LA; Small SD; Sweitzer BJ; Leape LL; The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA1997; 277(4):

9 Goals replacing the old shelves Gain of efficiency in the medication process Elimination of weak points Better safety Better ergonomics Lowering workload Complete activity recording High cost medications are integrated automatically (DRG). 9

10 Evaluation of several systems: Complete centralisation : producing unit-doses per patient e.g. Pillpicker (Swisslog) Advandages Complete medication out of one hand (Verpackung incl. solutions, syringes, Lösungen etc.) No preparation of drugs for the nurses anymore Disadvantages Velocity (ca. 7 h for 130 beds 1 machine) Creating big dipendencies (hours for medical rounds, Flexibility for changing orders is low) 7-day service of the pharmacy Cost / benefit not in a good relation for Spitäler fmi ag 10

11 Evaluation of several systems: central packaging of the oral medication (per patient) Proud Yuyama (Baxter) Advantages Partial relief for nurses; fast acting machine (ca. 30 portions/min) Only partial replacement of the old shelves on the wards (Reserves, iv drugs, solutions). Disadvantages Different processes for different medications Creating big dipendencies (hours for medical rounds, Flexibility for changing orders is low) Good for nursing homes (decision to by a machine to build up a service for regional nursing homes) 11

12 Evaluation of several systems: electronically bound medication cabinets on the wards Z.B. Mach4 HSD Schränke Advantages The process is the same for every drug Big flexibility on the wards Medical rounds are not touched organisation of the pharmacy and the wards is not touched Disadvantages Dependencies of IT Limited for one person per login Partial relief for nurses 12

13 Decisions Spitäler fmi ag Phase 1: Public offer of medication cabinets. Condition : Complete integration of surrounding systems (Patient- Management, Clinical Systems, Pharmacy System, Accounting-System, Active Directory Public offer of a Blistermachine for nursing homes Phase 2: Combination of the electronic medication cabinets with the Blistermachine : Work in progress 13

14 What s the innovation of the solution? transparency in real time and gain of efficiency from the order entry to the preparation of the drug 1. Total integration in all surrounding systems Most of actual known systems are Stande-alone Solution with only partial integration. -> consequenes are a very high level of master data maintainence. what means 1? (1 piece, 1 mg, 1 ml, 1 drop, 1 mmol etc?). In Intensive Care 1 for the same drug might be different form a «normal» setting. ALL Systems have to know what 1 means. From the order entry to the health insurance. 14

15 What means «1» with multidose vials? No solution with «one fits all» Vi De Tropfen Konakion Ampullen i.v. applcation oral application

16 Elektronische Abbildung des Prozesses bei der Nicht eineindeutigen Festlegung der Verordnungseinheit Patient A 1 Visite Essen Pflege Betreuung Blutentnahme Untersuchungsvorber. 9 Medikamente verabreichen KG Arzt Spezialist nein med. Therapie ja später zu A Pflege Apotheke Kardex Kurven Labor C Kontrolle Stationsapotheke Medi- Bestellung für Lager / lauf. Therpie Listen-Medi ja nein ja 2 Verordnung Rücksprache Station/Arzt Grund / Ersatz? Ersatz B Einlagerung Stationsapotheke Wareneingangskontrolle Medi- Transport nein 3 3 Verordnung in Kardex abschreiben Verabreichungszeiten festlegen Medi abbolen Medi bereitstellen KMT IPS OHC Chir 3 Pflegehandlungen, Dokumentation Verordnung übertragen: Kardex/ Verlaufsblatt 3 4 Abschreiben für Medi- Zubereitung Medi vorrätig Medi-Best. in Apotheke Listen-Medi ja nein nein Rücksprache Station/Arzt ja ja Grund / Ersatz? Ersatz Medi abbolen nein 8 Zubereitung der Medi nach abgeschr. Verordnung Medi abbolen Medi bereitstellen Wareneingangskontrolle Verlaufsblatt / Cardex: Abgabe eintragen Medikamentenverrechnung: teurer Medi auf Leistungsblatt Medi bereitstellen Medi bestellen Rechnungskontrolle 5 Medi bereitstellen Medi bestellen 6 Rechnungskontrolle Lieferant Verwaltung Medi bereitstellen Rechnungskontrolle / Zahlungsfreigabe 7 Medi bereitstellen Rechnungskontrolle / Zahlungsfreigabe Statistik / Verrechnung Dr. J. Götte; Diplomarbeit NDS Wirtschaft 10/1999

17 Stammdatenveredelung fmi-style Hospindex als Grunddatenbank Koppelung mit Materialwirtschaftssystem Ergänzungen via SQL Datenbank (Front End Access Self made...) 17

18 Medikamente über Infusionen 18

19 Elektronische Fassung mit Links 19

20 Steuerung der Verordnung Eingriff so früh wie möglich

21 What s the innovation of the solution? 2. The promptly reporting of drugs perscribed that are not in the cabinet Old system: Order entry; after medical round look up in the shelves; if not ther order in the pharmacy or change of the order. Time gap from order entry to the first drug administration up to 8 h Sytem today : Order entry is computerised. Data are matched with the medical cabinet. If a drug is not there the pharmacy has immediately the information and can react (changing the order oder ordering/delivering the drug. big time savings, quicker begin of therapy, shorter hospital stay. 21

22 Webtools Mach4 Not conforme units 22

23 Webtools Mach4 drugs not in stock on the wards 23

24 Selection of patients 24

25 Selection of drugs per patient 25

26 Single Drug «conforme» unit for nursing staff 26

27 Cockpit in the pharmacy 27

28 wards in Frutigen and Interlaken incl. Urgency in I + F, ICU, + pharmacy Frutigen; smallest unit: ambulatory biggest unit : 26 Beds (internal medicine) 28

29 What s the innovation of the solution? 3. Integration of an external location (Spital Frutigen 30 km) The local hospital pharmacy could be closed. Once a day service (6 times a week) to frutigen. Installation of a medication cabinet in the «old» pharmacy of frutigen (additional cabinet) with a complementary assortment of drugs 29

30 What s the innovation of the solution? 4. The combination of medication cabinet with blisterpacks Goal : For patients with a high probability of a stable medication in the next 24 hours the Blistermachine could give a subsidiary service for the nurses. Developement in progress. 30

31 What changes for nurses Change for nurses Who does it? Orders medication cabinet Compare orders with stocks medication cabinet exceptional orders Unpack, Repack Inventory Controlled substances Fill up Clarifying orders Accounting Cleaning Control of expiry dates medication cabinet + KIS resp. PDMS Pharmacy medication cabinet medication cabinet Pharmacy (GS1 Barcodes) Pharmacy directly with medical staff medication cabinet Pharmacy Pharmacy / medication cabinet Preparing drugs (nur orale feste Formen) Pharmacy / Blistermachine (Phase 2) 31

32 Interaction of systems = sender; = reciever Klinik-Informationsystem (KIS) resp. Patientdatamanagementsystem (PDMS; Intensiv care) Order on case number. Master data Patientadministrationsystem Patient Data (PatID, CaseNr; Changes); Accounting per patient Pharmacy Order System Drug master data automatic orders Elektronic medication cabinets patient data medical order drug master data accounting orders additional informations Blisers (UOMS) medical orders and patient data from the cabinet Feedback for medical cabinet what has been «blistered» 32

33 Zentrale Userverwaltung Badge-System Krankenkassen ORBIS (Michel-Gruppe) KISIM (Kliniksystem) Hospis Patientensystem Leistungsdaten Admin. Patientendaten Zentr. Apotheke Frutigen Mach4 el. Medischrank PDMS (IPS- System) Stammdatenveredelung Spitalapotheke fmi Web Apotheke MACH4 el. Medischränke Log. Stammdaten Log. Stammdaten Hospis Materialwirtschaft Hospis Webshop Batchflow-Halbautomat. Rüstsystem OFAC; Krankenkassen SIEMS (Heimsystem) Verblisterungs- Maschine Baxter GoldenGate Öffentliche Apotheke (pharmindex) realisiert Q2/Q3 16 Sage (Heimsystem) CareCoach (Heimsystem) UOMS (Intermediär + Erfassungssystem) 33

34 Companies Spitäler fmi AG; Pharmacy, IT Büro Keller Unternehmensberatung (public offers) Mach4 Pharma-Systems (electronic medication cabinets; IT Interfaces and GUI s) CISTEC (Clinical informationsystem Acute care) IMESO (Patientdatamanagementsystem; Intensive care) Nexus (Schweiz) AG (Patientmanagement, Accounting, Materials management) Tecost SA (SIEMS, order system nursing homes) 4Trees GmbH (UOMS) HCI Solutions AG (Master Data Drugs; Hospindex) Baxter (Schweiz) AG, Blistermachine ZIUZ, Controlldevice for the blisermachine 34

35 What s next? 1. The last mile : bed-side-scanning 2. organisation of the admission to the hospital : Medication reconciliation Progress! Swiss foundation for patient safety 3. organisation of the exit from the hospital : - depends on the admission 35

36 Thanks for your attention! Bilder : Interlaken Tourismus