Many of the NHS's standard processes for distributing and storing medicines at the near patient level were initially developed in the seventies and many of these processes remain unchanged and in place to-day.
The effectiveness of an organisation’s ability to manage medicines at near patient level increases the responsiveness of their pharmaceutical care and improves patient safety – two vital elements of the whole patient experience.
Parts of the process can be very labour intensive and, as a result, a great number of man-hours are lost to managing, maintaining and dealing with any number of common issues that arise - from pharmacy staff manually counting stock levels to nursing staff having to go hunting for missing drug trolley keys.
Drug selection errors are easily made
Fig. 1 Drug selection errors are easy
In addition, a manual approach also allows access to drugs on largely unrecorded and unsupported basis. This leads to other issues and safety risks such as stock being used up entirely (which in turn leads to "borrowing" from other locations) and drug selection errors.
Ward-based automation can have a significant role in reducing drug selection errors while improving stock monitoring, ordering and audit. These are all processes where staff time can be released to focus on patient care and reducing waiting times. The proliferation of dispensing robots over the last decade has demonstrated how automation can improve safety and efficiency in hospital pharmacies.
The evidence to-date1 also suggests that additional gains in staff productivity and overall job satisfaction are a significant driver for the introduction of this type of automation and an indication of the likely high levels of end-user acceptance and engagement.
Resolving these types of issue and tackling the ongoing pressure to decrease the length of hospital inpatient stays means that the delivery methods and flexibility of pharmaceutical care will need to change significantly too. Hospitals are now beginning to look at how adopting new models can further improve medicines management and tackle the inefficiencies of the existing processes.
Described as "a pharmacy without walls" (Prof R. Purkis, Pharmaceutical Journal), the model that appears to be evolving is a hybrid (hub and spoke) model which is enabled by patient medication discharge at ward level and implementation of front line automation.
Distribution model trends
Currently, most hospitals operate a central dispensary and the reliance on human intervention and control increases the risk of errors significantly as hospital activity and individual workloads increase. The logistical activity required for this model provides an opportune target for significantly improving the efficiency of delivering better patient care.
For example, one large DGH we spoke to believes that, due to size of the building and the total distance that needs to be covered, it takes approximately two hours to fulfil a full round of ward deliveries by operating a central dispensary. They believe that the amount of patient time spent waiting for medication to arrive can be dramatically reduced by moving supplies to the near patient level.
The minimum waiting time between a drug being ordered via e-prescribing and being available for administration or discharge can be reduced to virtually nil by having a secure drug store in close proximity to patients. This model also allows further opportunities to make the supply-chain more efficient. For example, stock top-ups of common drug types can be automated via the pharmacy management system: accelerating ward-stock top-up processes and reducing on-demand ward stock supply requests.
Automated cabinets give additional and immediate flexibility to an organisation’s medicines management model by providing a secure medicines storage environment at the near patient level. The MDG system’s clinically focussed design brings benefits nearer to the patient and increases the capabilities of NHS staff to provide the best pharmaceutical care. The key benefits include:
- Nurses having quick, easy and controlled access to drugs supplies;
- Drugs retaining their viability because their storage is controlled and monitored;
- Stock outages due to oversight being eliminated by semi-automatic stock control and ordering;
- Manual stock taking can be almost entirely eliminated.
- The system’s flexibility and configurability allowing the number of stock top-ups from pharmacy to be reviewed and adjusted on an ongoing basis.
The system’s versatility has been demonstrated at Imperial NHS Trust where it has been installed in a number of configurations for different requirements:
- Care of the elderly - where patients have a large number of meds;
- A&E for TTA packs - which improves access time to meds and quicker discharge; and
- Night Storage/Emergency cupboard - with secure access and control.
Ref: 1. Imperial College NHS Foundation Trust. BMJ - Barber, Cornford & Klecun.