Implementation of the UnitBox system and its integration with the local HIS system at the Independent Public Healthcare Complex in Kozienice.
Client: SP ZZOZ in Kozienice.
Objective: To reduce the cost of drug logistics by implementing a system for storing and distributing drugs and integrating it with the HIS system.
Year of implementation: 2023.
Implemented solution: The UnitBox system (consisting of, among others, 20 automatic dispensing cabinets) and its integration with the local HIS system.
Context
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 there is no uniform report on medical errors related to drug administration in Poland, but American studies indicate that "[...] drug-related errors occur in 20% of doses intended for hospitalized patients. As much as 38% of errors in pharmacotherapy relate to improper drug administration. It is also estimated that the costs associated with additional care as a result of committed errors are at the level of 17-29 billion dollars annually." Taking these indicators into account, the Chief Pharmaceutical Inspectorate in the report Solutions in the field of clinical pharmacy and the activity of pharmacists in healthcare entities indicated that "[...] the implementation of all systems supporting warehouse management and enabling drug tracking and control of 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." Thus, the digitization of hospitals has become not only a trend but also a necessity.
About the client
The implementation was carried out at the Independent Public Healthcare Complex (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 the second place in Mazovia in the medical plebiscite "Hippocrates 2023," in the category "Hospital of the Year." The facility currently operates 13 specialist departments.
Roman Wysocki - Director of SP ZZOZ in Kozienice - was looking for effective solutions that would optimize the operation of the facility he managed and make it a safe medical center for patients and a comfortable place of work for medical staff. One of the challenges included in this hospital-wide strategy was to revolutionize drug management. Equally important was the necessity to address the issue of financial resources allocated for securing monthly stock of drugs and small medical equipment. These items generated significant expenses, and additionally, there was a problem in monitoring the validity of medicinal products. Low-rotation drugs expired in some departments, while elsewhere their constant lack was registered (due to underestimations). It was also harder 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 already in the first months after its implementation.
The UnitBox System
The automatic dispensing cabinets UnitBox are devices that replace classic medicine cabinets but also offer many other amenities, all in accordance with applicable law and good practices. What makes the UnitBox system an ideal solution for every hospital? For instance, doctor's orders are captured in an electronic system with visible, current drug statuses, and the drugs themselves are stored in special drawers or refrigerators, providing them with optimal conditions. All medicinal products are under full control - the cabinets are equipped with a barcode reader, and therefore 100% of the drugs leaving the machine are subjected to verification. There is no possibility of making a mistake and, for example, taking out a drug that is not included in the doctor's order (except for, e.g., emergency mode, used in special, clearly defined cases). Among the more important functions is also the ability to generate personalized reports, e.g., inventory "on demand."
Challenges
The biggest challenge and at the same time a threat to the success of the implemented project turned out to be changing the long-standing habits and routines of the staff and switching to automation of actions that were previously performed manually and had documentation in paper form. There was a need to integrate dispersed, individual dispensing cabinets and standardize processes related to logistics concerning drugs and small medical equipment. During the implementation of automatic dispensing cabinets, we also encountered several major technical challenges. For example, we had to adapt the IT infrastructure, which involved cabling the entire hospital and building a new network and electrical infrastructure. One of the actions was also preparing a test environment to check the system's functioning before full implementation. The project's realization also necessitated the training of nearly 150 people, who worked at different hours, on 15 departments.
Stages of the implementation process
From Analysis to Full-Scale Operation: Unveiling the Journey of Implementing UnitBox in a Hospital Setting
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Conducting a pre-implementation analysis and detailing processes.
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Delivery and installation of air conditioning for cooling hospital rooms.
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Delivery of EDM, installation, and configuration of server infrastructure.
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Construction and implementation of an integrated drug storage and administration distribution system along with equipping the central pharmacy. Delivery, setting up, and integrating UnitBox devices into the IT environment.
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Training and on-the-job instructions combined with launching the system in hospital units.
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Starting full-scale work of the staff with the devices and the UnitBox system environment.
Results
The early testing phase was crucial for the successful deployment of the UnitBox automatic e-pharmacy system across all hospital departments, ensuring a smooth integration and error-free operation. The introduction of UnitBox, including 20 automatic dispensing cabinets, granted the hospital full control over medication dispensation, significantly enhancing patient safety and staff work comfort.
Document processing and administrative work were reduced by 80% due to full digitization, with office work now taking no more than an hour a day. The cost of pharmacotherapy dropped by roughly 10%, and the facility's ability to search for drug substitutes or alternatives enhanced, along with constant stock level monitoring.
Within the first three months post-implementation, the hospital witnessed substantial improvements. Processes for managing drug deliveries, storage, distribution, and inventory became digitized and streamlined. Drug administration accuracy reached 100% thanks to the UnitBox cabinets, which facilitated dose tracking and administration timing for each patient.
Automation led to a 70% reduction in medical supply overstock, positively impacting financial liquidity and generating average savings of 50 PLN per patient per month. The hospital's competitive edge and attractiveness for patients improved as it showcased the benefits of medical innovation.
Staff efficiency improved remarkably, with nurses saving an average of 2 hours per day, reducing drug preparation time to 2-4 minutes per patient. This optimization was achieved by eliminating manual paperwork processes. Staff time savings for compiling doctor's orders increased to 57%, with UnitBox streamlining the order process and providing immediate drug availability updates.
The accreditation process became smoother, enhancing the hospital's reimbursement level from the National Health Fund and increasing financial inflow. UnitBox helped standardize procedures, ensuring the safety of high-risk medications and enabling precise documentation and accountability for compliance with procedures.
100%
control over medication dispensation
80%
reduction
in
documentation
70%
reduction in medical supply overstock
Document processing and administrative work were reduced by 80% due to full digitization, with office work now taking no more than an hour a day. The cost of pharmacotherapy dropped by roughly 10%, and the facility's ability to search for drug substitutes or alternatives enhanced, along with constant stock level monitoring.
Photo gallery
Return to Kozienice
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1 Gawrońska-Błaszczyk, A., Zarządzanie procesem przepływu produktów leczniczych w szpitalu, Instytut Logistyki i Magazynowania, Poznań, 2018 r.
2https://www.gov.pl/web/zdrowie/raport-2022-rozwiazania-w-zakresie-farmacji-klinicznej-oraz-dzialalnosci-farmaceutow-w-podmiotach-leczniczych.
* Badania własne, przeprowadzone w SP ZZOZ w Kozienicach w okresie 03-07.2023 r.