PBS HMC

Chris Shenton

Pharmacist

Joondalup Hospital Pharmacy & SouthWest Hospital Pharmacy

PBS-HMC CHART IMPLEMENTATION – CREATING AN ELECTRONIC DOCUMENT

WORKFLOW IMPROVES MEDICATION SAFETY AND EFFICIENCY.

Overview

Trial implementation at Bunbury & Joondalup

A swift introduction of charts with little issues or complaints

Highlights

Benefits across many areas, with some standouts

Paperless pharmacy

How we implemented with an electronic Document Management

System

Economic benefits

PBS charts + workflow result in efficiencies for all stakeholders

Reduced prescriber time

Reduced prescriber time:

Current NIMC acute chart: 16 fields/item

Proposed PBS HMC acute: 7 fields/item (+6 at initiation of chart)

1 2 3

4

5 6 7 8 9

10 11 12 13

14 15 16

1 2

3 4 5

6

7

1

2

3

4

5

6

+

Curr

ent

NIM

C

Pro

pose

d

PBS H

MC

Reduced ‘owing’ prescriptions

Reduced ‘owings’ prescriptions:

90% reduction during trial, resulting in a big reduction in prescriber time

Particularly beneficial for PBS Authority items

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Number of owings

90%

Data from Bunbury

Implementation of new chart at week 5

Implementation week 5

Other benefits

Further reduction in prescriber time:

Average number of regular medicines per chart: 7.21

Existing NIMC acute chart: 7 spaces (plus: VDM/VTE Proph/warfarin)

Proposed PBS HMC acute: 8 spaces (plus: VDM/VTE Proph/warfarin)

Better utilisation of the PBS

In particular improved ability to dispense PBS prn items from chart

Potential reduced errors from not having to interpret handwriting

from a carbon-copy tear-off

Other sites have implemented with chemotherapy prescribing &

dispensing

Chart printing cost! PBS charts are less than 10% of the price of the

current tear-off chart

1. 2014 NIMC Audit Report, ACQSHC

The PBS HMC chart in combination with the acceptance of

scanned prescriptions as valid records, has inspired us to

change the method of PBS dispensing. Using ideas from

popular apps as Snapchat and Evernote we have been able

to create a workflow that accurately captures orders and

processes them without paper in the pharmacy.

Our workflow PBS Chart

written up

by doctor

Nurse images

chart and

indicates which

items to be

dispensed or

Pharmacy

technician

images chart

with mobile

device on ward.

Images uploaded

immediately to

dispensary

technician screen

Image of chart is

now stored in

pharmacy DMS

system linked to

patient & marked

with required

items.

Item dispensed and

dispense Rx number is

linked to eDMS

record.

Dispensed

medicine

delivered to

ward

Final data

stored in DMS

system with all

required PBS

metadata

attached.

Final check by

pharmacist scan label

barcode, check chart

image & scan product

barcode.

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3

4

5

6

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8

9

Capture chart using mobile android device.

PBS Chart images are captured using an Android mobile app.

The front page and required order pages are captured. Required items are ticked on screen. The chart is then uploaded to dispensary.

Workflow queue of charts awaiting dispensing

The dispensing technician has a web browser with charts awaiting

processing.

Once a chart is opened for processing all other screens show “inuse”.

Once completed it is marked finished and drops from the workflow

screen.

Item required shows as “ticked” in the browser

The required item is ticked.

Dispensing is completed in regular pharmacy dispensing software.

Dispensed item linked to image, then marked as

finished.

After dispensing the image is linked to the corresponding Rx number in the screen.

This screen shows the chart marked as “4 of 4 done” and the Rx number 168905

etc. linked to the image.

The finished icon is chosen and the system removes the chart from the queue of

work

Final data set held in Document Management

System

The final data held in the DMS system for each prescription image. The image of the chart is a two page image with the front page of the chart not shown.

Note the metadata on the RHS includes all required PBS data.

Scan and final pharmacist check

Click here

to check

image of

PBS chart

Image of chart presented to checking pharmacist

Scan product barcode to verify check and record supply

Reduced transcription errors

Jan Feb Mar Apr May Jun Jul Aug Sep

Errors

Introduction of digital imaging reduced transcription errors

Ability to zoom on areas of the chart increased readability

Introduction of digital imaging

Other benefits of the electronic system

Chart does not need to leave the patient file

Patient safety

Saves time +++

Ordering can be caregiver led

Android tablets in nursing stations

Saves time +++

High quality photo

Tablet photos are much easier to decipher reducing transcription

errors

Fast recall of charts

No need to chase up files from medical records as often

Economic benefits Nursing

Reduced ordering time

Medical

Discharge Rx time

Owing Rx

Hospital

PBS reimbursement increase

Discharge Rx

Chart Printing

Patient

Discharge Time

Pharmacy

Claim time – cashflow

OwingRx Management

Order collection

Workflow efficiency

$4.67

$12.66

$6.88

$3.38

$15.04

Total $43.63 per

patient/week.

Public patients still see a

benefit around $17.00

per patient/week.

Acknowledgements

Sean Grieve – Coding the IT solutions

Travis Bailey – Bunbury trial & Presentation

Leah Henderson – Bunbury Trial

Christine Procter & Mayli Foong – Joondalup Trial

Kym Cockin – DON, SJOG Hospital Bunbury

Michelle Young, DDON, Joondalup Health Campus