Medicines Optimisation Closed Loop Medicines Management & Scan4Safety We’re here today to introduce you to the Scan4Safety programme. Some of you may have already heard about the project as the programme team have been out and about in the hospital, but for those of you haven’t we wanted to give a bit of an overview of the programme, how it will benefit our hospital and how it benefit you. Iain Davidson Chief Pharmacist & CCIO Royal Cornwall Hospitals Trust GDE Learning Network – July 17

View from my office! One of 6 demonstrator sites for the adoption of GS1 and PEPPOL standards- now known as Scan4 Safety

Scan4Safety & GS1 explained GS1 vision is to provide a common language for companies when it comes to identifying people, locations, items and documents. The standards allow information to be captured at “point of use” and to be shared throughout the supply chain. GSRN Global Service Relation Number GTIN Global Trade Item Number GLN Global Location Number So what are GS1 standards? They provide a common language for the NHS for locations, items and people. This isn’t a system change, this is about us all, including our suppliers adopting these common standards to ensure we’re talking a common language. Could we add a barcode image? To this or a plain slide previous

Objectives Introduce the 4 Ps – Scan4Safety will enable us to track our patients, products, and locations. We will be implementing GS1 (barcoding) standards and common ways of working (PEPPOL). Mandated for use in all Acute Trusts by 2020, through the NHS eProcurement Strategy, the Scan4Safety project are adopting these standards earlier. The mandating of a common set of barcoding standards is a world first in healthcare. Improve Efficiency Improve Patient Safety Release Time to Care

GS1 explained So what are GS1 standards? They provide a common language for the NHS for locations, items and people. This isn’t a system change, this is about us all, including our suppliers adopting these common standards to ensure we’re talking a common language. Could we add a barcode image? To this or a plain slide previous

Stock contamination identified Traceability Speed Background – barcoding in retail Stock contamination identified Traceability Speed Why? Barcodes have been an integral part of our lives for years. In retail almost everything we buy has a barcode . These systems have developed to a point where we simply take for granted that they work. There’s a lot we can learn from retail and how efficiently they can trace their products. Just think back to the horse meat scandal, Tesco’s were able to recall their burgers within a matter hours and this was because of the information held within their barcodes.

2010 MHRA safety alert: PIP silicone implants Background – not currently in healthcare 2010 MHRA safety alert: PIP silicone implants When you compare this to how the NHS responded to the PIP breast implant recall and our inability to trace all affected patients, the benefits for barcoding are clear. In my role as executive lead for patient safety - the possibility to automate product recall is an area that I’m very passionate about. Having had hands on experience in dealing with implant recalls and contact tracing of patients and staff, I can clearly appreciate the benefits Scan4Safety could provide. Scan4Safety is a new programme aimed at harnessing barcoding technology to improve safety, enable clinical productivity and drive operational efficiency.

Six Demonstrator sites TRUST DERBY TEACHING HOSPITALS NHS FOUNDATION TRUST LEEDS TEACHING HOSPITALS NHS TRUST NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST PLYMOUTH HOSPITALS NHS TRUST ROYAL CORNWALL HOSPITALS NHS TRUST SALISBURY NHS FOUNDATION TRUST Six Trusts across the country have been selected as Scan4Safety demonstrator sites – to be early adopters of GS1 and PEPPOL standards, and to share the benefits and challenges with the wider NHS. Building capability within the NHS to share across the NHS. Salisbury NHS Foundation Trust and Royal Cornwall Hospitals NHS Trust were two of the sites selected and we’re delighted to be here today to share our learnings with you. Each of the six demonstrator sites are all different. We vary in terms of size and scale and where we all started from before embarking on our journey to implement the standards. So whatever the make-up of your own trust, you should be able to find a role model from among our sites.

GS1 and Digital Medicines

Medicines- The Case for Change Major service change for us. Closed Loop Supply and Closed Loop Medicines Administration. Give examples of 1. drug recall (pt safety) 2. Prescribe and dispense (safety & efficiency) Getting more pharmacy staff onto the wards to support patients When stock used, automatically ordered through the robot. Nurse scans to check right med prescribed and in date etc. GS1 standards as the enbaler to interface with them WIN WIN WIN

Medicines- The Case for Change GS1 GS1 GS1 GS1 GS1 GS1 Major service change for us. Closed Loop Supply and Closed Loop Medicines Administration. Give examples of 1. drug recall (pt safety) 2. Prescribe and dispense (safety & efficiency) Getting more pharmacy staff onto the wards to support patients When stock used, automatically ordered through the robot. Nurse scans to check right med prescribed and in date etc. GS1 standards as the enbaler to interface with them WIN WIN WIN

Falsified Medicines Directive Key Drivers Falsified Medicines Directive Carter Point of care traceability Global Digital Exemplars There are also many other drivers of change, which all lead to a requirement to provide point of care traceability which Scan4Safety will enable. Scan4Safety complements and helps meet your requirements in these other areas. Make GS1 very relevant FMD- really important as will mandate the use of barcode scanning into our dispensing processes- so our IT system providers such as JAC will need to adapt their systems Carter- GS1 is mentioned throughout Carter. HPTP plans for pharmacy. As you know your chief pharmacist has submitted HPTP plans (have you seen them!). The big drive of Carter is saying pharmacy is great value for money- but the best vale for money is on the wards speaking to patients and healthcare workers and optimising medicines. All the other services are very valuable so need to maintain them but make them more efficient- procurement with e-commerce, recall with GTINs, closed loop dispensing means less people and less errors and the time involved with that. We have the technology, we have the data, we have to start to using it better. GDE- helpful for two reasons. 1- they’ve got money. 2- there are clear expectations set out for them.

Digital Global Exemplars

GDE Aims From the FYFV-Next Steps (March 2017) Exemplars that will inspire others. Work with other acute trusts to develop a blueprint that can be deployed to other hospitals (“fast followers”). In the future, hospitals won’t merely choose an IT vendor, they will choose a hospital that they want to partner with and implement the same system, keeping the IT 80% the same and making only the 20% of changes that are absolutely necessary to meet local needs. Expectation is HIMSS level 7 (or equivalent). (ACUTE CARE EMRAM STAGE 7 REVIEWER’S GUIDE, 2016V2)

What is HIMSS Level 7 Paperless prescribing. Closed loop medicines administration. Closed loop medicines supply. Decision support. Adoption of standards dm&d and GS1. Advanced electronic signatures.

Falsified Medicines Directive Key Drivers GS1 is the Key Enabler Falsified Medicines Directive Global Digital Exemplars Point of care traceability Carter There are also many other drivers of change, which all lead to a requirement to provide point of care traceability which Scan4Safety will enable. Scan4Safety complements and helps meet your requirements in these other areas. Make GS1 very relevant

Use Cases Batch Number- GTIN- Product name- link to dm+d Support Product Recall throughout the Supply Chain GTIN- Product name- link to dm+d Closed loop administration Closed loop supply Scanning at meds rec Advanced shipping notices Accurate non-robot dispensing Expiry date- Support stock control and patient safety Serialisation Number- required for Falsified Medicines Directive Patient level costing And here is why…. So for GS1 compliance its not just about the GTIN- we need our IT systems to be capturing all of this data- all of which can help us with medication safety. ‘GTIN+ Extensions’

GS1 & Closed Loop Systems

Unit Dose Dispensing?? Requires complete change of infrastructure Discharge medicines to consider

Or Product GTINs+ ?

Closed Loop Supply Desirables Paperless process Order raised directly from the prescription Automated dispensing system if possible If manual- a bar-code verification system Labels produced and affixed automatically Digital positive confirmation of all key data attributes at final check Minimal/ no human manual data entry

Closed Loop Supply Doctor prescribes Decision to Supply Electronic Transfer of Information to PSC Robot Picks & Labels Manual picking- scanning product against the order Barcode enabled final accuracy check Automated label & Label Affixed Barcode enabled decommission & dispatch

Some of My Essentials! dm+d GTIN datapool A co-ordinated specification

dm+d- Hierarchy is key

dm+d- Hierarchy is key GTIN = AMPP Data Structure is key

GTIN Datapool GTIN Datapool FMD Database New Product Retrieves GTIN & linked data attributes. Populates PSC and Robot drug files Verify/Decommission Minimise local file build and automate the updates. Needs to be commissioned On EPMA side- crucial for use of PODs New Product Product Arrives in Pharmacy Manual/ Robot scan of product Dispense Medicine Final check and release

Co-ordinated Specification Pharmacy S4S working group We’ve done a specification Processed mapped all the main workflows Engaged with EMIS and JAC Engaged with BD and Omnicell Engaged with the ABPI

Closed Loop Administration Doctor prescribes Decision to Administer The Five Rights Patient Drug Dose Time Route Scan patient Scan Drug Confirm dose and route Scan nurse to confirm administration

Some Essentials dm+d GTIN datapool A co-ordinated specification

dm+d- Hierarchy is key GTIN link to AMPP through to VTM Data Structure is key again- this time in reverse. Need to be able to scan a drug and links to the VTM at prescriber level to say- yes this is an appropriate drug to fill this prescirpion. PODs may have never touched your system and therefore… GTIN datapool JAC dm+d compliant version just links VMP to product- not the full heirarchy

EPMA/Pharmacy Stock Control System GTIN Datapool EPMA/Pharmacy Stock Control System Retrieves GTIN & linked data attributes. Product Supplied by the Hospital Positive Confirmation ‘Right Drug’ Scan Product at Administration Patients Own Drug Minimise local file build and automate the updates. Needs to be commissioned On EPMA side- crucial for use of PODs GTIN Datapool Retrieves GTIN & linked data attributes.

Co-ordinated Specification EPMA is not a ‘primary use case’ for S4S demo sites. In theory not covered by the £2m Minimal engagement with EPMA vendors (though EMIS and JAC have integrated solutions). Covered in specification and process maps

JAC partnership with BIQ for bedside scanning technology

Objectives Introduce the 4 Ps – Scan4Safety will enable us to track our patients, products, and locations. We will be implementing GS1 (barcoding) standards and common ways of working (PEPPOL). Mandated for use in all Acute Trusts by 2020, through the NHS eProcurement Strategy, the Scan4Safety project are adopting these standards earlier. The mandating of a common set of barcoding standards is a world first in healthcare. Improve Efficiency Improve Patient Safety Release Time to Care

Co-Ordinated & Collaborative Digital Medicines Healthcare Providers Our Suppliers DoH

Thank You For Listening I think we need to add a slide about key learning – can the scan4safety team give some thought to this such as the need for clinical engagement, the pitfalls you have found in cardiology which will change the approach in Theatres. What are we now doing differently in cardiology, how much have we saved, what have been the key improvements? This slide should probably go as a summary prior to the wordle. SE – slide now added showing benefits and challenges. Scan4Safety@nhs.net #scan4safety