Use of an automated robotic pouch dispensing system for inpatient medication for complex intermediate care patients has demonstrated a reduction in medication errors, reduced time by pharmacy staff to prepare medications for patients and reduced time for drug administration by nursing staff – with estimated savings to one trust of £7,160.
Salford Royal NHS Foundation Trust, part of the Northern Care Alliance (NCA), worked with PillTime, Medication Management Robotics and the Innovation Agency, the Academic Health Science Network for the North West Coast, to implement a state-of-the-art digital robotic system which identifies, sorts and organises patient medication into easy-to-open pouches.
The medication pouches are personal to each patient, indicating the specific day and time when each pouch needs to be opened and the tablets taken. This has led to:
- A reduction of around 60 per cent in the average pharmacy production time per patient and per medication;
- A reduction in the time taken for drug administration by nurses of approximately three hours per day for an intermediate care unit, and approximately two and a half hours per day at an intermediate care home; and,
- A reduction in the number of drug administration errors, which were halved during the trial.
Demand on nurses in intermediate care units and care homes to administer drugs is increasing. Up to 90 minutes of nursing time four or more times a day is spent administering drugs. The administration of multiple medications make the process of drug administration labour intensive with increased risk of errors.
Pharmacy dispensing can be repetitive and complex, with as many as 15-20 different drugs being administered at any one time. Traditional compliance aids such as dosette boxes make administration simpler for nurses and carers, but can take two pharmacy technicians up to 40 minutes per drug round per patient to produce and verify.
Demand and complexity can also lead to an increased risk of errors for both nursing staff administering drugs and the pharmacy team dispensing them.
Salford Royal worked with PillTime Medication Management Robotics and the Innovation Agency to implement a pilot project.
PillTime provides digital medications services, producing personalised, dose-specific medication pouches. The pilot at Salford Royal was set up to test whether, in a controlled environment, the trust could successfully use the PillTime unit dose dispensing model to package and distribute medication to patients within one intermediate care unit and two intermediate care homes. Roll-out across the three units was phased to embed learning from both dispensing and administration perspectives.
The Innovation Agency helped facilitate the pilot at Salford Royal, supporting an initial site visit. The pilot was supported by Global Digital Exemplar funds and was based on the findings of an earlier trial which was funded by the Innovation Agency.
Cheshire-based Medication Management Robotics, who provided hardware and support for the pilot, have received 12 hours of assistance through a European-funded business support programme in which the Innovation Agency is a partner. Further business support from the Innovation Agency has included introductions to NHS pharmacy, management and procurement teams across Cheshire and Merseyside.
During the three-month pilot project there was a substantial drop in the average pharmacy time required to prepare medications for patients:
A review of a sample of 12 patients on the intermediate care unit identified a drug administration time saving of up to 30 minutes on a typical full medication round.
Following successful roll-out on the intermediate care unit, Pendleton Suite, the service was rolled out to two intermediate care homes: Heartly Green and The Limes. Based on the equivalent costs of nursing time saved across the Pendleton Suite, Heartly Green and The Limes, it is estimated that the trust benefitted from cost savings of £7,160 per month:
|Ward||Beds||Time saved daily (minutes)||Benefit daily||Benefit Weekly||Benefit Monthly|
Other benefits reported during the trial included:
- A reduction in the number of medicines-related incidents reported in the trust incident reporting system compared to the previous three months due to more accurate audit trails;
- Improved checking to ensure the correct tablet is dispensed (through the use of the automated Optical Checker);
- Reduction in wastage costs (pouches delivered for a seven-day period rather than 28 days as previously);
- Increased staff satisfaction with the drug administration process;
- Medication provided in a more timely manner;
- Reduction in the number of missed doses;
- Calmer atmosphere on the wards and reduction in stress when dealing with patients;
- More manageable drug trolleys.
Following a review of the pilot, the trust felt that the solution provided great benefits in terms of patient safety and time saving for nurses and agreed that the technology should be included as part of future organisational change and larger programmes of work. Areas being considered include:
- Extending the service to include other intermediate care units within the NCA;
- Offering the service to private nursing homes and mental health services in the NCA region;
- Using PillTime for issuing discharge medications for patients; and,
- Deploying the solution as part of a centralised pharmacy service for NCA.
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The pilot project commenced in November 2018 and finished in May 2019.
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