The Christie NHS Foundation Trust NHS Ward-Based Robotics June So Director of Pharmacy

The Christie NHS Foundation Trust

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Ward-Based Robotics

June SoDirector of Pharmacy


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Front of hospital


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Questions

• Are ward-based robotics cost-effective?

• How can they be made affordable?


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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


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The Sheffield Northern General experience - cardiology

Roberts N

Rollout in 3 phases:

• Phase 1 4 Theatres, main stores • Phase 2 Anaesthetic rooms• Phase 3 ICU and recovery

Source: N Roberts business case


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Was it cost-effective?


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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


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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


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Other departments

• Accident & Emergency

eg D Child at Salford Royal

• Medical Admission Units

eg D Ford at Dundee


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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


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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 look-out for the morphine tablets which disappeared from the drugs store at the cancer hospital last week………………………


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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


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Savings in stock

Stock issues£

Pre-installationvalue £

Post-installation value £

Savings in

£

Total after adjustment£

Haematology 5,108 -1,494 6,602 3,118

Clinical oncology

1,461 572 889 889

Total 7,491 4,007 (61%)


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Savings in stock

• Stock not used in 3 months = £1,863

• Total drug savings = £5,870


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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)


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Nurse savings CDs

Organisation Pre-installation Post-installation

Saving

ChristieHaematology

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


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Nurse savings – non CDs

Organisation Pre-installation Post-installation

Saving

Christie Haematology

1 minute 29 seconds 31 seconds (52%)

ChesterA&E department

3 minutes 40 seconds 2 minutes 20 seconds(78%)

Ref. Green C, Hughes D, Baird R. Pharm J 2009;283:395-398


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Number of clinical incidents

• Incidents – no change


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CD incidents pre and post-installationPre- installation Post-installation

Clinical oncology ward 1 major incident No majors;Expired drug issues

Haematology No majors Minor only


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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”


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Other benefits

• Haematology – all issues to individual patient• Plans to feed into the Trust Patient Level

Information & Costing system (PLICS)


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Funding

• How was it funded?• Not enough drug savings to pay for the

cabinets• Staff efficiency savings not used to fund


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Trust approval process


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• Submission focus on risk/governance benefits

• Rejected by CWP • 2 cabinets funded by the Division – and also

engaging with the Christie charity


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Mental Health


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Mental Health

MerseycareTrust

Pre-installationStock in £

Post-installation stock in £

Savings in£

Unwanted drugs/returns

3,036 9.60 3,026.40(99%)

Knowles L. NW Chief Pharmacists Workshop 25 May 2011


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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


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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


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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 savingsNo if exclude staff efficiency savings


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Governance benefits

• Secure audit trail for CDs/high risk medicines• Less risk of diversion• Safety, error prevention eg oxynorm and

oxycontin


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Schwarz HO, Brodoury BA

Significant reduction in missed doses

Ref. Am J Health Syst Pharm 1995; 52: 823-828


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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


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How can they be made affordable?

• Is there potential for price discounting – national or regional procurement frameworks?

eg pharmacy automation in NW


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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


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Wholesaler : supplier split

Trust Ward Wholesaler:supplier splitDrugs value

Guys & StThomas

ICU 40:60

Elderly 40:60

Theatres 55:45

Christie Clinical Oncology 55:45


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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?


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Documents

The Christie NHS Foundation Trust NHS Ward-Based Robotics June So Director of Pharmacy