CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference...
Transcript of CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference...
![Page 1: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/1.jpg)
CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS
Pr Pascal BONNABRYHead of pharmacy
Global GS1 Healthcare ConferenceDubai, April 18, 2016
![Page 2: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/2.jpg)
Introduction
A full traceability of the medication process is the
final objective to reach
The implementation should be progressive,
as a puzzle
To make the proof of concept, it is important to
select
Pilot processes
Pilot products
Pilot persons (patients, healthcare workers)
![Page 3: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/3.jpg)
High-risk process, with potentially dramatic
consequences for patients in case of error
Critical and costly drugs, a full traceability has a
clear added value
Last check at bedside complex and time
consuming
Product preparation centralized at the pharmacy,
with a possibility to identify the final container
Computerized prescription already implemented
Why cytotoxic as pilot process ?
![Page 4: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/4.jpg)
10 points to check before the administration
Control complexity
Balbaaki R, HUG, 2006
![Page 5: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/5.jpg)
Detected errors
Total: 0.45 %
Major: 0.19 %
High workload (>60/day)
increase the risk(Odds-Ratio = 2)
Errors during cytotoxic preparation
Limat S, Pharm World Sci 2001;23:102
n=30’819
![Page 6: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/6.jpg)
Failure during verification and administration
Prakash V, BMJ Qual Saf 2014;23:884
Simulation study
![Page 7: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/7.jpg)
Error detection in a simulation setting
Impact of a check-list
Balbaaki R, HUG, 2006
n=62
86.4% 98.6%
0
20
40
60
80
100
No help Check-list
![Page 8: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/8.jpg)
The impact of a paper check-list in the real life
is certainly lower
Compliance rate
Efficacy of the control (time constraints, interruptions)
The paper check-list is not a traceability tool
Need for an efficient electronic process
Check-list in real life
![Page 9: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/9.jpg)
IT in the cytotoxic process
Electronicprescription
Bedsidescanning
Preparation withgravimetric control
+ Dose-banding
(2016)
Automatedpreparations
(2015)
![Page 10: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/10.jpg)
Bedside scanningOrganisation
Database
Cytotoxic
Patient
Nurse
Physician
![Page 11: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/11.jpg)
Increase patient safety
Increase patient satisfaction(safety feeling)
Increase efficiency(documentation, stock management, invoicing,…)
Increase nurses satisfaction
Reduce costs(especially related to errors)
Bedside scanningObjectives
Foote SO, Nursing Economics 2008;26:207
![Page 12: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/12.jpg)
Safety first
Efficiency
Documenting
Invoicing
…
Traceability
Tracing
Tracking
Traceability as a side effect
![Page 13: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/13.jpg)
Actors identificationPatient
Caregiver Drug
![Page 14: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/14.jpg)
![Page 15: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/15.jpg)
Patient identification
8018 7613167 80009627382
GSRN (with hospital ID encapsulated)
HUG IDGCP
![Page 16: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/16.jpg)
Product identification (cytotoxic)
01 07613167000009 7003 1103161400 21 cyt-11198499
GTIN - cytos EXP (date and time) Serial # HUG
![Page 17: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/17.jpg)
Need to have a standardized system to identify
objects, persons and places
GS1 is an international standard, recognized in
the fields of logistic and health
GS1 is the dominant standard for drug
identification around the world
Increasing interoperability needs in and between
hospitals, important to abandon proprietary
systems
Why GS1?
![Page 18: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/18.jpg)
DatamatrixSimple to print and to read
Robust
Need a service to calculate the image from the alphanumerical sequence
RFID (initial choice)
Scan at distance, under bed sheet, …
More costly
Need specific labels and printers
Encoding problems (suboptimal reliability)
Practical problems (syringes, liquids)
Data carrier (drug and patient)
![Page 19: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/19.jpg)
Computer on wheel (COW) and scanner
Platform already working for physicians
Full access to the electronic patient record
Can manage all nurses activities
Cumbersome at bedside
PDA (initial choice)
Mobile and accessible (in the pocket)
Specific to a single/few task(s)
Connectivity problems (Wi-Fi deconnexion)
Readers
![Page 20: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/20.jpg)
Electronic traceability of a cytotoxic
Who?What ?When ?
![Page 21: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/21.jpg)
Tracking of cytotoxics
![Page 22: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/22.jpg)
Follow the implementation
Scanning rates during the first months
Fleury M, HUG, 2012
Outpatient medical oncology
![Page 23: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/23.jpg)
Consider users
Fleury M, HUG, 2012
![Page 24: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/24.jpg)
31h observation (onco-gynaecology, outpatient clinic)
89 stressors (2.7/h), 27 unplanned movements
24% related to the bedside scanning software
Fleury M, HUG, 2012
Consider environment
![Page 25: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/25.jpg)
Advices
Use standard identification system
Involve specialists of standards
Use robust technologies (data carrier, readers…)
Have a strategy, but…
Start small and scale-up (selected processes
and areas)
Involve the users and identify the workarounds
Do not re-invent the wheel
![Page 26: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/26.jpg)
Next steps
Blood transfusion
Drugs, starting with
Biologicals (traceability)
High-risk drugs (safety)
Implantable medical devices
Patient transportation
…
![Page 27: CYTOTOXIC TRACEABILITY AND PATIENT WRISTBANDS · 2016. 4. 28. · Global GS1 Healthcare Conference Dubai, April 18, 2016. Introduction ... (2015) Bedside scanning Organisation Database](https://reader033.fdocuments.us/reader033/viewer/2022060517/604979d83e81af23433c1bcd/html5/thumbnails/27.jpg)
Thank you for your attention
Tom Thumb - Traceability by Charles Perrault
[email protected] presentation can be downloaded
http://pharmacie.hug-ge.ch/ens/conferences.html