Two years ago my ward was asked to participate in a pilot project to test a ‘closed loop’ electronic prescribing and medicines administration system, using barcodes and pharmacy pre-prepared unit doses of medicines.
The pilot was being run as a partnership between Leicester’s Hospitals and a company called IBSL(UK). Prior to this my ward used paper drug charts and patients own medicines, labelled for discharge.
We have been using the new system for just over eighteen months, and we love it because using barcode checking to match prescription, patient and medicine gives us confidence that a medication error is less likely to occur.
We always have access to readable drug charts, we do not spend time looking for missing paper ones. The ward is much tidier with around 80% of medicines stored in the cabinet. We can use our time in a different way providing better care to patients.
The unit doses are prepared in pharmacy, using automation, and each packet contains a single blister, vial or pre-filled syringe with a unique barcode. Medicines are prescribed electronically using a software called SOFIA. This also links the ward based medicines storage/retrieval cabinet called MARIO, and stocks in the unit dose laboratory. MARIO is loaded daily with unit dose packs, the quantity is determined from current prescriptions and past use. Before each drug round we lock the drugs trolley onto the MARIO cabinet and electronically request the cabinet to pick medication for that round. The cabinet selects medicines from the electronic prescription and puts the packs into a separate drawer for each patient. The drawer number is recorded in the SOFIA software.
This process takes about 10 minutes. This time allows us to complete other tasks such as gathering medication such as insulin, liquids, and creams which are not in the MARIO. Once the trolley is loaded, and moved to the bedside we scan the patient’s barcoded SOFIA wristband. The prescription is then displayed on the trolley laptop including the drawer number. We scan each unit dose pack. For correct medicines the administration box changes from grey to light green. If incorrect, a warning that there is no prescription is given. Once all doses are scanned, correct and administered to the patient we confirm administration, and the boxes all turn dark green. If a prescribed medicine is not given, a reason for omission is required and the administration box turns red.
Omitted doses as a result of unavailable medicines on our pilot wards have reduced from a Trust-wide average of around 10% to just above 1%.
SOFIA keeps the information on all past prescribing and administration making audit and SUI incident investigation easier.
Finally, we have reduced our overall spend on medication by around 20% across the four wards in the pilot.
Our nurses love the system and we would face a revolt if we went back to traditional drug round https://vimeo.com/119543770