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Ward-Based Robotics June So Director of Pharmacy The Christie NHS NHS Foundation Trust Front of hospital The Christie NHS NHS Foundation Trust Questions • Are ward-based robotics cost-effective? • How can they be made affordable? The Christie NHS NHS Foundation Trust The Christie NHS NHS Foundation Trust Benefits of ward-based robotics • • • • • • • Drug savings Product recall Improved security and audit trail Staff savings for nurses, pharmacy Reduced selection/administration errors Clinical decision support Reduction in missed doses Green C, Hughes D, Baird R. Pharmaceutical Journal Oct 2009; 283: 395-398 The Christie NHS NHS Foundation Trust The Sheffield Northern General experience - cardiology Roberts N Rollout in 3 phases: • Phase 1 • Phase 2 • Phase 3 4 Theatres, main stores Anaesthetic rooms ICU and recovery Source: N Roberts business case The Christie NHS NHS Foundation Trust Was it cost-effective? The Christie NHS NHS Foundation Trust Case studies in general theatres – one-off stock reduction Hospital Percentage stock reduction Birmingham UHB 21% Countess of Chester 45% Halton 38% Kings College 20% (over £1m) Leeds 23% Sheffield Northern 38% Warrington 26% Source: Avantec data on file The Christie NHS NHS Foundation Trust Case studies in general theatres consumption reduction Hospital Percentage reduction Birmingham UHB 16% Countess of Chester 24% Halton 5% Sheffield 126k Kings College 5% Manchester South 27% Warrington 16% Source: Avantec data on file The Christie NHS NHS Foundation Trust Other departments • Accident & Emergency eg D Child at Salford Royal • Medical Admission Units eg D Ford at Dundee The Christie NHS NHS Foundation Trust Oncology • 1 haematology + 1 clinical oncology ward • Pilot: cabinets on free loan • Drugs including Controlled Drugs Parameters: • stock savings, unused stock • staff time savings • reduction in incidents Ref: So J, Kaye D, Oldham H et al. Hospital Pharmacy Europe 2011; 054: 5-7 The Christie NHS NHS Foundation Trust Manchester Evening News Alert on stolen drugs October 08, 2007 DRUGS stolen from Christie Hospital could prove fatal if taken without medical supervision. Police are warning the public to be on the lookout for the morphine tablets which disappeared from the drugs store at the cancer hospital last week……………………… The Christie NHS NHS Foundation Trust Business case development • • • • • • • Service managers Nurse leads Pharmacy Time/motion sheets counter-signed by Trust Scepticism of ward staff in haematology Approval from Trust to conduct a pilot IT support The Christie NHS NHS Foundation Trust Savings in stock Stock issues £ Postinstallation value £ Savings in £ Total after adjustment £ Haematology 5,108 -1,494 6,602 3,118 Clinical oncology 572 889 889 7,491 4,007 (61%) Total Preinstallation value £ 1,461 The Christie NHS NHS Foundation Trust Savings in stock • Stock not used in 3 months = £1,863 • Total drug savings = £5,870 The Christie NHS NHS Foundation Trust Pharmacy time savings (top-up) Ward Time saved Haematology 58 minutes per visit (2x per week = 116 minutes Clinical oncology 43 minutes per visit (1x per week = 43 minutes) Total time saved per week 159 minutes (2.65 hours) The Christie NHS NHS Foundation Trust Nurse savings CDs Organisation Pre-installation Postinstallation Saving Christie Haematology 3 minutes 10 secs 45 secs 2 minutes 25 secs (76%) Charing Cross 8 minutes 4 minutes 4 minutes (50%) Ref. Franklin BD, McLeod M, Miller G. Pharm Man 2009 26(2);9-14 The Christie NHS NHS Foundation Trust Nurse savings – non CDs Organisation Pre-installation Postinstallation Saving Christie Haematology 1 minute 29 seconds 31 seconds (52%) Chester A&E department 3 minutes 40 seconds 2 minutes 20 seconds (78%) Ref. Green C, Hughes D, Baird R. Pharm J 2009;283:395-398 The Christie NHS NHS Foundation Trust Number of clinical incidents • Incidents – no change The Christie NHS NHS Foundation Trust CD incidents pre and postinstallation Pre- installation Post-installation Clinical oncology ward 1 major incident No majors; Expired drug issues Haematology No majors Minor only The Christie NHS NHS Foundation Trust Nurse satisfaction D Pickersgill, ward manager, clinical oncology “ It is very user friendly, using finger print ID, no more searching through cupboards, the drug round is a lot quicker, more time is spent with patients” The Christie NHS NHS Foundation Trust Other benefits • Haematology – all issues to individual patient • Plans to feed into the Trust Patient Level Information & Costing system (PLICS) The Christie NHS NHS Foundation Trust Funding • How was it funded? • Not enough drug savings to pay for the cabinets • Staff efficiency savings not used to fund The Christie NHS NHS Foundation Trust Trust approval process • Capital and Workforce Planning Committee Jun 2008 • Clinical Support Services Divisional Board • Cancer Network Services Divisional Board Jun 2010 • Cancer Centre Services Divisional Board • Capital and Workforce Planning Committee Aug 2010 The Christie NHS NHS Foundation Trust • Submission focus on risk/governance benefits • Rejected by CWP • 2 cabinets funded by the Division – and also engaging with the Christie charity The Christie NHS NHS Foundation Trust Mental Health The Christie NHS NHS Foundation Trust Mental Health Merseycare Trust Pre-installation Stock in £ Postinstallation stock in £ Savings in £ Unwanted drugs/returns 3,036 9.60 3,026.40 (99%) Knowles L. NW Chief Pharmacists Workshop 25 May 2011 The Christie NHS NHS Foundation Trust Mental Health One ward Costs £ Hardware/software 15k purchase Staff costs 7.5k project lead (15 months) TOTAL 22.5k Savings £ Stock rationalisation, returns 15k (15 months) Pharmacy assistant 0.25 WTE 4.3k Pharmacist 0.1WTE 4.8k TOTAL 24.1k The Christie NHS NHS Foundation Trust Cost of ward robotics Specialty Purchase cost £ Cardiac theatres 25k – 30k or more Mental Health ward 15k Neurology 20k Oncology ward 25k Opthalmology 28k Radiology 13k Theatres 15k – 37.5k The Christie NHS NHS Foundation Trust Are they cost-effective? Ward/dept type Theatres Yes Accident & Emergency ?Yes (if include staff efficiency savings) Medical Admissions Unit ?Yes (if include staff efficiency savings) Mental health wards Yes Oncology wards ?Yes if include staff efficiency savings No if exclude staff efficiency savings The Christie NHS NHS Foundation Trust Governance benefits • Secure audit trail for CDs/high risk medicines • Less risk of diversion • Safety, error prevention eg oxynorm and oxycontin The Christie NHS NHS Foundation Trust The Christie NHS NHS Foundation Trust Schwarz HO, Brodoury BA Significant reduction in missed doses Ref. Am J Health Syst Pharm 1995; 52: 823-828 The Christie NHS NHS Foundation Trust Borel JM & Rascati KL • Reduction in delayed medicines and errors Pre- installation 16.9% Post installation 10.4% Statistically significant Ref: Am J Health System Pharm. 1995;52:1875-1879 The Christie NHS NHS Foundation Trust How can they be made affordable? • Is there potential for price discounting – national or regional procurement frameworks? eg pharmacy automation in NW The Christie NHS NHS Foundation Trust The Christie NHS NHS Foundation Trust Potential for increased benefits – scope for more savings? Green C, Hughes D & Baird R. Wholesaler/supplier managed inventory • How feasible is it? • Could it be more cost-effective? • Are there any tangible savings? Ref. Green C, Hughes D & Baird R. Pharm J 2009,283:395-398 The Christie NHS NHS Foundation Trust Wholesaler : supplier split Trust Ward Wholesaler: supplier split Drugs value Guys & St Thomas ICU 40:60 Elderly 40:60 Theatres 55:45 Clinical Oncology 55:45 Christie The Christie NHS NHS Foundation Trust Conclusion • Ward based robotics is here to stay • QIPP (Quality, Innovation, Productivity, Prevention) • Cost-effective – Yes in selected settings • Can they be made more affordable? – procurement, Ward Order Assembly? The Christie NHS NHS Foundation Trust The Christie NHS NHS Foundation Trust