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
7
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