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Review of Best Practices for Next‐Generation SengkangNext Generation Sengkang Health Pharmacy

25th FAPA Congress 11th October 2014

Angelina Tan

Head, Pharmacy Dept, Sengkang Health

Senior Principal Pharmacist, Singapore General Hospital

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ObjectivesObjectives• Sharing of processesg p

• Findings

• Adaptation of ideas

April 30, 2014 Presentation title 2

AimAim

To innovate and explore new ways to bring pharmacy practice to a new frontier at thepharmacy practice to a new frontier at the upcoming Sengkang Health Hospitals through review of current medication use and relatedreview of current medication use and related supply chain processes both locally and internationally.

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Sengkang HospitalSengkang Hospital• Part of Singhealthg• New hospital to serve the North East

population of Singapore (~ 1 millionpopulation of Singapore ( 1 million residents)

• Total of 1400 beds• Total of 1400 beds• Completed in 2018• General hospital, community hospital and a

Outpatient block.p• Integration of care into the community

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Sengkang HospitalSengkang Hospital

Vision: Healthy Living, Fulfilling lives

Mission: Better Health Together

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Current Practices and TechnologyCurrent Practices and Technology

• Model of care: physician centricModel of care: physician centric

• Closed Loop Medication Management

‐ Electronic prescribing

‐ Unit dose or medication dispensing‐ Unit dose or medication dispensing (automated)

‐ Knowledge based medication administration (KBMA)( )

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Current Practices and TechnologyCurrent Practices and Technology

• Automated inventory management (wardAutomated inventory management (ward level and at Pharmacy stores)

d l• Home delivery services

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MethodsMethods

Sit i it• Site visits

• Focus group discussions

• Review of evidence with end users, medical planners and consultantsplanners and consultants

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Model of CareModel of Care• Patient‐centric care

• Integrated care with the community

O t ti t di ti ili ti• Outpatient medication reconciliation


Closed Loop MedicationClosed Loop Medication Managementg• Visits to various hospitals to view their

medication management systems

• Most have electronic prescribingMost have electronic prescribing

• Packing machines (Swisslog®, Rowa®, Parata®, ®)JVM®)

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Medications dispensing andMedications dispensing and packing machinesp g

Advantages Disadvantagesg g

Reduce picking packing errors

Not all medications can be packed or dispensed

More efficientMay not

necessarily reduce manpower

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Features Limitations

Swisslog® (Inpatient) • Cut individual blister • Not all medications canSwisslog (Inpatient) Cut individual blister packaged in a pack

• Medications for one patient ringed

Not all medications can be packaged with Swisslog, limited by the orientation of thepatient ringed

• Can package any medications (blister strips and loose tablets)

orientation of the blister strip

p )• Allow returns and reuse

into Drug Nest

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JVM® (Inpatient) • Package individual • Tablets have to beJVM (Inpatient) Package individual tablets into a pack

Tablets have to be presented loose therefore blister strips have to be deblistered

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Rowa® (Outpatient) • Stores and inventorise • Medications that areRowa (Outpatient) Stores and inventorisecalendar packs or boxes of medications for dispensing

Medications that are available in non‐calendar packs e.g. 1000s, have to bedispensing 1000s, have to be repackaged into calendar or smaller boxes

• Unable to process loose tablets

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Parata® (Outpatient) • Dispense and label • Unable to processParata (Outpatient) Dispense and label bottles of loose tablets

Unable to process medications in blister strips, will need to deblister

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Knowledge Based MedicationKnowledge Based Medication Administration

• Final stage in the close loop medication management process

• Nurse will scan patient’s ID before• Nurse will scan patient s ID before administering medication, system will also

f i f di iprompt for scanning of medication to ensure the correct medication is given to the patient

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Automated Inventory SystemsAutomated Inventory Systems (Ward Level)( )‐ Pyxis®

‐ Omnicell®

‐ MedRovers®MedRovers

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Pyxis • Medications placed in • Space (especially to y pcubies or towers

• Links to fridge

p ( p ystore unit dose packages)

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Omnicell • Light guided LED picks • Space (especially to g g p• Medications stored in

individual drawers or towers

p ( p ystore unit dose packages)

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MedRovers • Storage of medications • Space and line itemsMedRovers • Storage of medications (IV/Orals/Bulk infusions) on wheels

• Automated

• Space and line items

• Automated

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Automated Inventory SystemsAutomated Inventory Systems (Pharmacy Store)( y )• Conveyor belt system (similar to that of

k )supermarket system)

• Automated storage and retrieval system g y

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Home Delivery SystemHome Delivery System• Reduces the need for patients to wait forReduces the need for patients to wait for

their repeat prescriptions• Looking for innovative ways to deliver• Looking for innovative ways to deliver

medications to the patients e.g. self collection via post office boxescollection via post office boxes

• Limited by locations of the boxes e.g. in non‐i di i dair conditioned areas

• Multidisciplinary home carep y• Online ordering of medications

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ConclusionsConclusions

• System to fit your workflow• System to fit your workflow

• No particular automation is better than the other

• New and innovative ways of deliveringNew and innovative ways of delivering services to patients

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