A Project to Reduce Drugs A Project to Reduce Drugs Returned from Medical Wards, Returned from Medical Wards, TKOHTKOH

Daisy Chia, Pharmacist, TKOH

Budget Constraints in Health Care

Can we help??

Introduction

Wards

Pharmacy Department

Drug CartDrug CartIn use by patients

Drug Return Drug Return BasketBasket

NOT in useby patients

Screening drugs for reuse by

pharmacy

Dispensing for non ward stock items

For re-use

WASTE

Discontinued items +

Refills for discharged or plan for discharge patients

Problems IdentifiedProblems Identified

Wastage Consumables

Time

Manpower

Unused Drugs

Additional ProblemAdditional Problem

Unwanted Drugs in Ward

Medication Errors !!

Unused Drugs

Returned from Wards

Money down the drain

＋Medication

Errors

System for Inpatient Dispensing

Computerized Automatic Refill System (CARS)

System Features (2)System Features (2)

When will it stop refilling?

Patients are Discharged

Drugs are signed off

Updated in the system

☆

☆

☆

Preset Duration is

ended

Wards

Pharmacy Department

Drug CartIn use by patients

Drug Return Basket

NOT in useby patients

Screening drugs for

reuse

Dispensing for non ward stock items

CARS

Continuous and automatic supply of medication for in-patients

Pharmacists are able to screen the complete drug profile

Large amount of drugs returned from wards-- Why?

Time LagTime Lag::

In UpdatingIn Updating:

•Patient status in IPAS

•Patient’s drug profile

Workflow logistics:Workflow logistics:

•Automatic refill for more than one day

Unable to Reflect:Unable to Reflect:•Plan for Discharge

How to close the loop?

1. To have a most updated drug profilefor patients

2. To shorten the refill duration

3. To have the most updated patient status

Pharmacy Medical Ward

1 month Pilot Study 1 month Pilot Study

Fax the discharge list

Inform pharmacy any cancellation of discharge

Amendments in

CARS

Refill

Results for the Pilot Study (1)

42 Patients(58 items) $1,645 $19,740

Study

for 1 monthin 1 Ward

STOPRefills Savings

Projected Yearly

Savings

Result of the Pilot Study (2)

Ward

Positive Responses

Savings in Manpower

Risk of Medication

Errors

Result of the Pilot Study (3)

Pharmacy

Savings in Manpower

Drug Disposal Consumables

What’s Next?

The result of the pilot study was presented by APN in the Medical Department meeting

DOM (Med) supported the idea and the project was implemented in all medical wards

Another step forward

Results

“YES!”From DTC

“Great !”From Nursing

Committee

Implementation in all Medical Wards

Reduce Unnecessary Refills and Drug Disposals (Medical Wards)

Period: Oct to Dec 2005 (3 months)

5 medical wards

Discharged lists were faxed to Pharmacy before generation of drug refills

Resources needed:

Manpower:

Clerical assistants (wards)--- 10minsDispenser in Pharmacy --- 10mins

Results Of 3 months Pilot Results Of 3 months Pilot StudyStudy

Projected Yearly

Savings: $120,000

(2.7% of the total Drug

Expenditure for 5 Med.

Wards)38%16% $31,607

Drug Refills

Ward Returned

Drugs

Savings

Projection and ExpectationProjection and Expectation

A large hospital with more than 40 wards may save up to

$1 Million / year

Special Thanks …..

Ms. Christina Tong, the APN of the Medical Department

Nurses and Doctors of the Medical Department

SharingSharing…………

Small ideas may end up with big outcomes

Be creative and keep thinking, fruitful returns may be found

Thank YouThank You