ENSURING EFFICIENCY AND SAFETY IN THEATRES An insight into Derby Teaching Hospitals’ implementation of GS1 standards to help improve clinical effectiveness and deliver process benefits. Gary Adams, Healthlogistics Chris Roe, Derby Teaching Hospitals NHS Foundation Trust Jayne Green, Derby Teaching Hospitals NHS Foundation Trust
SCAN4SAFETY – DERBY’S JOURNEY Derby Teaching Hospitals NHS Foundation Trust
ACCURATE DATA, TRANSFORMING HEALTHCARE THE DERBY STORY – AIMS & OBJECTIVES Supporting the provision of high quality, safer patient care Manage and coordinate hospital resources efficiently and cost effectively Delivery of accurate and reliable data ensuring devices and consumables are available where and when they are needed – at the right price
MOTIVATION/ DRIVERS FOR ACTION Big picture – NHS landscape NHS procures 1.7m different items 61 Trusts purchased 1750 cannula One Trust bought 29 different types of rubber glove Up to £5bn in savings required Requirement to improve patient safety ( PIP scandal) Local Trust level remit Inventory management savings Patient safety improvement – ‘track & trace’ Improved coding Roll out of GS1/PEPPOL standards for SCAN4SAFETY The data that hTrak solution provides enables Trusts to have detailed discussions – and directs and supports decision making
THE STOCK ROOM THE STARTING POINT (2013)
IMPLEMENTATION PLAN AND TIMESCALES Initial Planning stages (commenced Hand Theatres (November 2015) November 2013) 3 theatres Roll out to General Theatres (April 2014) Gynae and Children's (January 2016) 9 theatres, multiple specialties 6 theatres General Day case Theatres (December 2014) Trauma and Orthopaedics (June 2016) 3 theatres, multiple specialties 8 theatres Radiology (January 2015) WARDS /Outpatients - Pilot ( August 2016) 2 suites Ward 403 Cardio Catheter Labs (May 2015) 2 labs Endoscopy live with clinical trial Urology day case (August 2015) 2 theatres All theatres now Live! Ophthalmology (Sept 2015) 3 theatres
TODAY - OVER 91,000 PROCEDURES CAPTURED
Our Theatre Data Capture Device • Patient : Scan Wristband (GS1 GSRN) 40 plus theatres & suites Timers : Knife to skin, time in recovery • • Location : Records locations ( GLN’s ) • Staff : Who is present. (GSRN) Procedure : Operations linked to OPCS codes • • In Theatre : Questions Anaesthetic : Type used • • Devices : Products, Trays & Implants used (GTIN’s) Including Lot, Batch and expiry data Inventory : Enables automatic ordering •
Full traceability across our theatres and suites Product Recall; PC: H7493926224300 LOT:18787023 Built into BAU Derby Process
Full traceability across our theatres and suites
Once identified the patient – Case Study
Full Product Traceability
Location Catalogue Inventory Purchase Product Patient ID ID Mgmt. Mgmt. to Pay Recall Tray Traceability ‘Infection Control’ 50 hours work per patient Low confidence in results Pre Scanning Solution: Affected Patients CJD Instances Reported Patients Notes Reviewed Trays Identified Identified • Min. 50 hour review per patient • Cannot be 100% confident that ALL patients who subsequently came into contact with the contaminated trays could be identified 30 mins work for all patients NOW: High confidence in results Affected Patients CJD Instances Reported hTrak Reviewed Trays Identified Identified 30 minutes to identify ALL affected trays and patients • High level of confidence in the findings as all information electronically captures •
Test Case Study – CJD Scare ‘Trays and Instruments’ Three Patients Identified Patient • Tray and Instrument used • Other Patients affected? •
Providing consultants with detailed Pre-op notes, prior to carrying out surgery Knowledge of implants prior to procedure: • How many plates / screws are in already? • Types of screw heads to expect? The right equipment to hand? • Not going in blind! •
Part of the pre-op note now available
Clinical Case Studies Mr Keith Jones, Clinical Director of Surgery https://vimeo.com/208638272
Submitted Evidence: Laparoscopic Cholecystectomy Consumable Costs and Consultant Variation Avg Consultant Avg No of Avg No Avg No of Lower Upper Std Avg Max Min Consumable Variance Description Products of Staff Minutes Procedures Quartile Quartile Deviation LoS LoS Los Cost Cons A £285 82 5 181 1 £285 £285 £0 - 3.00 3.00 3.00 Cons B £239 74 7 127 3 £232 £250 £37 £19 1.00 1.00 1.00 Cons C £231 70 6 123 6 £192 £255 £160 £59 1.83 5.00 1.00 Cons D £227 70 6 98 9 £197 £248 £146 £45 1.56 6.00 1.00 Cons E £223 70 5 100 11 £216 £235 £120 £31 1.27 4.00 1.00 Cons F £218 69 6 93 6 £203 £238 £60 £24 1.00 1.00 1.00 Cons G £209 62 6 79 8 £192 £231 £103 £38 1.63 4.00 1.00 Cons H £188 64 7 90 9 £164 £224 £149 £53 1.25 2.00 1.00
Positive outcomes and the long term impact All information tracked to individual Patient and can feed the electronic record: 1. Products Tracked to Patients across all 40 clinical rooms (inc store rooms) 2. Full Traceability of Trays and Instruments ‘Infection Control’ 3. Full Traceability of Staff and Location ‘Scheduling / Productivity’ 4. Data that enables: • Consultant to Consultant discussion • Clinical and Product Variance / Training / LoS / PRE-OP information SUI Resolution – What actually happened in theatre? • Reduced Clinical admin • • Ordering / Writing up / Duplication of data / Accuracy improved • Case Carts and Product Standardisation imminent • Financial - Conservative savings of £1m per annum
BENEFITS Patient safety improvements • Ability to address Clinical variation with detailed and owned undisputed information • Advance procedure information Time released to patient care Clinician time diverted back to patient care • Band 7 released time from searching for stock • Greater efficiencies in stock control • Elimination of obsolete stock • Culture change in terms of waste, opening and using only what is needed • Reductions in the stock holding • Visibility of consumption (Adjusted Min / Max) • Released stock storage space Unexpected benefits Workflow management • Process improvements •
OVERCOMING CHALLENGES Implementation strategy lessons learned Staff engagement at all levels – scanning for safety and traceability will always engage staff ( it’s all about the patient ) Input from stakeholders within an area and establish a key champion to ensure accurate product data Comprehensive training programme to include a test period prior to going live Trust implementation team who will engage with the staff and have a visual presence in the area Look for ways to make the process ‘quick and slick’ – customised scan sheets
Video - Adopting new ways of working https://vimeo.com/208638272
For more information or to visit Derby Teaching Hospitals please email Healthlogistics contactus@healthlogistics.co.uk www.healthlogistics.co.uk
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