singapore electronic medicines management experience
TRANSCRIPT
Singapore Electronic Medicines Management
Experience
Angelina Tan
Senior Principal Pharmacist, Singapore General Hospital
17th October 2014
WAMSG Symposium
Singapore General Hospital (SGH)
• World’s 2nd largest teaching hospital to achieve JCI accreditation in 2005; Asia’s 1st hospital to achieve MAGNET recognition in 2010
• Oldest hospital in Singapore
• 1782 Inpatient Beds
• 33 Ward
• 36 Clinical Specialties
Medication Use Process Before 2010
• Manual processes
• Medication charts and records
• Ward imprest
• Non-ward imprest are supplied through pharmacy – medication charts sent down
• Pharmacists will review medication orders either on the ward or when the charts comes to pharmacy
Medication Use Process – Implementation of Closed Loop Medication Management From 2010
• Implemented electronic prescribing – no more medication charts!
• Minimizes transcription errors and errors arising from illegible handwriting
• Packing errors
• Pharmacists and doctors have remote access to medication orders
Closed Loop Medication Management From 2010
Doctor’s Order
Pharmacist’s Verification
Medication Cabinet/cart
Manual Manual Manual Manual Electronic Electronic
Pharmacist’s Supply
Computer On wheels
Identify Patient
Closed Loop Medication Management – closing the gaps
Doctor’s Order
Pharmacist’s Verification
Medication Cabinet/cart
Computer On wheels
Identify Patient
Manual Manual Manual Manual Electronic Electronic
Pharmacist’s Supply
I2M SAFE Project – 2012
Inpatient Medication Management – Safe, Accurate, Fast and Efficient (I2MSAFE)
Involved Pharmacy, Nursing Informatics (NI) & Integrated Health Information Systems (IHIS)
Objectives:
Improving safety and quality of medication management process incorporating:
o Automated unit dose packaging machines
o Electronically secured automated medication cabinets
o A bedside barcode medication administration system
Closed Loop Medication Management I2M SAFE Project
Doctor’s Order
Pharmacist’s Verification
Automated Supply/Unit
dosing Identify Patient
Electronic Electronic Electronic Electronic Electronic Electronic
Solutions
IPAS/ Robot
AMC Automated Medication
Cart/scanner SCM
KBMA
Wireless scanner
RFID
Automated Medication
Cabinet
Automated Medication
Cart
Model of Care
Hybrid drug distribution model
o Automated drug supply from pharmacy
o Automated Medication Cabinet (AMC)
in the ward
Stat/initial doses for the first 24h and injections from
decentralised AMC ward stocks
Model of Care
Subsequent supply of routine doses from central
pharmacy
Knowledge-based medication administration
o Nurses perform bedside barcode scanning before
drug administration
Combined advantages of the centralised and decentralised model
o Improves accessibility & availability of drugs
o Reduce nursing time queuing at AMC to obtain medications for administration
The only institution using this model to date
Advantages of the Hybrid Model
I2M SAFE: Components of Inpatient Pharmacy Automation System (IPAS) Swisslog® for automated unit dose packaging, storage and dispensing Pyxis® AMC for storage and dispensing of wardstocks Smart Electronic Med cart with auto bin assignment Blispack® machine for unit dose bar code packaging for paracetamol tablets Outsource barcoding of high volume medications that Swisslog® is unable to manage
100% barcoding of formulary drugs 98% of formulary tablets/ capsules/ injections are re-packaged and supplied as unit doses
Inpatient Pharmacy Automation System (IPAS) Robotic pack/dispense system
Packs unit doses into drug
nest
Rings up patient specific
bundle
Daily supply - cartfill
Also supplies stock to AMC
IPAS Key Features – Swisslog® Swisslog® handles a wide range
of dosage forms, including loose tablets/capsules, blister strips, ampoules and vials o re-packages drugs into
barcoded unit doses o stores unit doses in its drug
nest o assembles and dispenses
patient-specific unit doses bound in rings
o accepts returned medication back into the drug nest via barcode scanning
IPAS Key Features – Swisslog®
3 Swisslog® units supply 20,000 unit doses a day
Key Features – Automated Medication Cabinet
Better drug accessibility and availability (up to 85% of drug range)
Timely drug administration Improved security (bio ID access) Manages inventory and expiry date
monitoring Controlled drugs recording and
tracking Patient profiling Medication replenishment using
barcode scanning Fridge temperature monitoring Billing AMC stock replenishment is auto-
triggered to Swisslog® for packaging
Knowledge Based Medication Administration Previous workflow with Old Medication Cart
Big, bulky and takes up space
Nurses do not push the cart to patient’s bedside for medication administration
Needs to be manually locked
Multiple drawers open at a time
Knowledge Based Medication Administration New Automated Medication Cart
Small footprint
Long battery life – 13 hours
Nurse login to use med cart
Two scanners – One tethered and one wireless
Tethered scanner keeps both the nurse’s hands free
Wireless scanner scans patient’s RFID wrist tag to open the drawer
Only allows one drawer to be open at a time
Knowledge Based Medication Administration Radio Frequency Identification Tag (RFID)
Assigned to patient during admission
Worn together with the identification wristband
Embedded active and passive chip o Active used for Bed
Management System
o Passive used for KBMA
o Only wireless Scanner can read the passive chip to identify patient
I2M SAFE Project - CLMM
Inpatient
Medication
Order
Verification
of Medication
Order
Unit Dose
Medication
Packed By
Robotic
System
Delivery of
medication
to Bedside
Bedside
Verification
using RFID
Pharmacy load unit doses
directly into Automated
Medication Cabinets Patient
medication with
(bar-coded
label) delivered
2
1
3 4
5
6
• Graph shows medication events reported for errors in manual pack, machine pack, loading and interface issues
• Undefined trend of error during the period of system stabilisation and machine optimisation which coincides with hospital wide roll out
• Since May 2014, there have been reduction in errors and is expected to decrease as the system stabilised
Challenges of I2MSAFE project
• Availability of barcodes on medications that are not packed by Swisslog®
• Swisslog® may not be able to process some blister packs due to packaging
• Space constraints in AMC
Timeline of I2MSAFE
Oct 2012
Inpatient Pharmacy Renovation
Jan 2013
Ward Renovation
Mar 2013
Implementation of AMC
Sep 2013
Pilot
Unit dose drug supply and
bedside barcode
administration
Nov 2014
Hospital-wide implementation
Mar 2014
Completion of hospital-wide
CLMM implementation
Thank You [email protected]