1. 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

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

3. 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

4. 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

5. 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

6. 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.

7. 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.

8. 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.

9. GS1 and Digital Medicines

10. 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

11. 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

12. 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.

13. Digital Global Exemplars

14. 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)

15. 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.

16. 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

17. 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’

18. GS1 & Closed Loop Systems

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

20. Or Product GTINs+ ?

21. 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

22. 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

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

27. dm+d- Hierarchy is key

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

29. 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

30. 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

31. 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

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

33. 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

34. 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.

35. 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

36. JAC partnership with BIQ for bedside scanning technology

37. 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

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

39. 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