Danuty Misiak
Mar 14, 2024
System UnitBox
O kliencie
Automatyczne apteczki oddziałowe UnitBox to urządzenia, które zastępują klasyczne szafy na leki, ale dodatkowo oferują wiele innych udogodnień, a wszystko zgodnie z obowiązującym prawem i dobrymi praktykami. Co sprawia, że system UniBox jest idealnym rozwiązaniem dla każdego szpitala? Chociażby to, że zlecenia lekarskie są ujęte w elektronicznym systemie z widocznymi, aktualnymi stanami leków, a same leki są przechowywane w specjalnych szufladach lub lodówkach, stwarzających im optymalne warunki. Wszystkie środki lecznicze znajdują się pod pełną kontrolą – apteczki są wyposażone w czytnik kodów i dlatego 100% leków wychodzących z maszyny jest poddawana weryfikacji. Nie ma możliwości pomylenia się i np. wyjęcia leku, który nie jest ujęty w zleceniu lekarskim (poza np. trybem awaryjnym, używanym w szczególnych, jasno określonych przypadkach). Do ważniejszych funkcji należy jeszcze możliwość generowania personalizowanych raportów np. remanentu „na życzenie”. O pozostałych możliwościach systemu UnitBox chętnie opowiemy podczas wspólnego spotkania.
About the Client
The implementation was carried out in the SP ZZOZ in Kozienice. The facility was established in 1981. Initially, it had six departments and had 309 beds. Today, it is one of the most dynamically operating medical centers in Mazovia, which at the end of 2023 received the title of Laureate of the Polish Quality Award and won 2nd place in Mazovia in the medical plebiscite “Hippocrates 2023”, in the “Hospital of the Year” category. The facility currently has 13 specialist departments. Considering these indicators, the Chief Pharmaceutical Inspectorate in the report on Clinical Pharmacy Solutions and the Activity of Pharmacists in Medical Entities indicated that “[…] the implementation of all systems supporting warehouse management and enabling drug tracking and control of the correctness of administration to the patient, as well as devices supporting the preparation of medicinal products, especially dangerous ones, must become a priority for medical units.”* Therefore, the digitalization of hospitals has become not only a trend but also a necessity.
Context
Challenges
The issue of drug management and the safety of their dispensing is a large-scale challenge and a significant problem in every medical facility in the country and abroad. It is worth noting that in Poland, there is no unified report on medical errors related to drug administration, but American studies indicate that “[…] medication-related errors occur in 20% of doses intended for hospitalized patients. As much as 38% of errors in pharmacotherapy concern the improper administration of drugs. It is also estimated that the costs associated with additional care due to committed errors amount to 17-29 billion dollars annually.” **
Roman Wysocki – Director of SP ZZOZ in Kozienice – was looking for effective solutions that would optimize the operation of the facility he manages and make it a safe medical center for patients and a comfortable workplace for medical staff. One of the challenges included in this hospital-wide strategy was to revolutionize drug management. Another essential aspect was the need to address the issue of financial resources allocated for securing monthly supplies of drugs and small medical equipment. These items generated significant expenses, and there was also a problem in monitoring the validity of medicinal products. Low-rotation drugs expired on some wards, while elsewhere, their constant shortage was recorded (due to underestimations). It was also more challenging to implement the FIFO principle - drugs with an older expiry date were not issued first. The facility in Kozienice had poor financial liquidity, so the planned innovation was expected to bring measurable financial savings to the facility, noticeable in the first months after its implementation.
Applied Solution
The UnitBox system (comprising, among others, 20 automatic dispensing cabinets) and its integration with the local HIS system. ADC UnitBox, are devices that replace traditional medicine cabinets but additionally offer many other conveniences, all in accordance with applicable law and best practices. What makes the UnitBox system the ideal solution for every hospital? For one, doctor's prescriptions are included in an electronic system with visible, current drug statuses, and the drugs are stored in special drawers or refrigerators, creating optimal conditions for them. All medicinal products are fully controlled - the cabinets are equipped with a barcode reader, so 100% of the drugs being dispensed are verified. There is no possibility of error, e.g., taking a drug not included in the doctor's prescription (except, for example, in emergency mode, used in specific, clearly defined cases). Among the more important functions is the ability to generate personalized reports, e.g., inventory “on demand”. We are happy to discuss other possibilities of the UnitBox system during a joint meeting.
The implementation was carried out in the SP ZZOZ in Kozienice. The facility was established in 1981. Initially, it had six departments and had 309 beds. Today, it is one of the most dynamically operating medical centers in Mazovia, which at the end of 2023 received the title of Laureate of the Polish Quality Award and won 2nd place in Mazovia in the medical plebiscite “Hippocrates 2023”, in the “Hospital of the Year” category. The facility currently has 13 specialist departments. Considering these indicators, the Chief Pharmaceutical Inspectorate in the report on Clinical Pharmacy Solutions and the Activity of Pharmacists in Medical Entities indicated that “[…] the implementation of all systems supporting warehouse management and enabling drug tracking and control of the correctness of administration to the patient, as well as devices supporting the preparation of medicinal products, especially dangerous ones, must become a priority for medical units.”* Therefore, the digitalization of hospitals has become not only a trend but also a necessity.
SP ZZOZ in Kozienice
Roman Wysocki – Director of SP ZZOZ in Kozienice – was looking for effective solutions that would optimize the operation of the facility he manages and make it a safe medical center for patients and a comfortable workplace for medical staff. One of the challenges included in this hospital-wide strategy was to revolutionize drug management. Another essential aspect was the need to address the issue of financial resources allocated for securing monthly supplies of drugs and small medical equipment. These items generated significant expenses, and there was also a problem in monitoring the validity of medicinal products. Low-rotation drugs expired on some wards, while elsewhere, their constant shortage was recorded (due to underestimations). It was also more challenging to implement the FIFO principle - drugs with an older expiry date were not issued first. The facility in Kozienice had poor financial liquidity, so the planned innovation was expected to bring measurable financial savings to the facility, noticeable in the first months after its implementation.
Results Context Challenges
The biggest challenge, and at the same time a threat to the success of the project, turned out to be changing the long-standing habits and practices of the staff and switching to automation of actions that had previously been performed manually and had paper documentation. There was a need for integration of dispersed, individual ward medicine cabinets and standardization of processes related to the logistics of drugs and small medical equipment. During the implementation of automatic medicine cabinets, we also encountered several more significant technical challenges. For example, we had to adjust the IT infrastructure, which involved cabling the entire hospital, building a new network and electrical infrastructure. One of the actions was also preparing a test environment to check the system's operation before full implementation. The project also necessitated the training of nearly 150 people, who worked at different hours, across 15 departments.
Results
The decision to conduct earlier tests of the system played a crucial role in the process of implementing automatic e-pharmacies. Above all, it allowed the seamless implementation of UnitBox in all hospital wards. The productive implementation was preceded by numerous tests that eliminated errors and failures during integration with the information system. Thanks to this, all devices worked according to plan.
By implementing the UnitBox system (which included, among others, 20 automatic dispensing cabinets), the hospital achieved 100% control* over the dispensed drugs, which directly improved patient safety and the comfort of the staff's work.
Within 3 months of implementing the UnitBox system, visible changes occurred in the entire facility's operation. Documentation was digitized, and processes related to deliveries, storage, distribution, and inventory of drugs and medical materials were standardized and organized.
The level of control over administered drugs increased to 100%. UnitBox cabinets enabled easy tracking of doses and monitoring of the timing of drug administration to individual patients, thus enhancing the safety of hospital pharmacotherapy. The built-in 2D barcode reader necessitated scanning each drug before removing it from the cabinet.
The facility began to fully utilize the potential of its staff and optimize the work of the entire unit – the working time of nurses (aside from patient care) after implementing changes was reduced to an average of 2 hours per day on each ward (considering the preparation of a set of drugs on a ward with 35 beds). This translated to an average of 2 to 4 minutes per day for each hospitalized patient. Such spectacular optimization of working time was possible thanks to the elimination of manual processes related to preparing paper documentation. The time savings for the staff increased to 57%* (during the compilation of doctor's orders). UnitBox intuitively systematized the process by suggesting subsequent steps during order completion and indicating the exact location of the drug. If a drug is not available, such information is reported by the reporting system before starting the entire process.
The reduction in the number of dispatch documents, and thus office work time, amounted to 80%* (full digitization of drug dispatch allowed for automatic creation of documents). The "office" work time was reduced to a maximum of 1 hour per day.*
Optimization of pharmacotherapy costs amounted to ~10%.*
The authorities of SPZZOZ in Kozienice pointed out, among other things, the possibility of quickly and efficiently searching for substitutes or alternative preparations, constant monitoring of stock levels on wards (through daily emails) or performing inventory “on demand”. Thanks to the automation of processes, medical supplies were reduced by an average of 70%* (ending the issue of expired stocks of drugs and small medical equipment and unnecessary stockpiling). As part of the system implementation, we profile the device and implement automations in intralogistics optimized for stock levels.
The reduction in the number of items in stock in the ward pharmacy positively affected financial liquidity. The hospital began to generate steady savings, which amounted to an average of 50 PLN per patient per month.* As a result, the competitiveness of the facility also increased, becoming a positive example of the benefits of implementing medical innovations. The hospital more easily underwent the accreditation process (allowing for an increase in the level of reimbursement from the National Health Fund, and thus financial inflows to the hospital).
We are in constant contact with our clients, asking for feedback and evaluating the effectiveness of our solutions. How did the UnitBox system perform? Judge for yourself.
**Gawrońska-Błaszczyk, A., Zarządzanie procesem przepływu produktów leczniczych w szpitalu, Instytut Logistyki i Magazynowania, Poznań, 2018 r.