HD Medi automated dose packaging system has proven itself useful in a number of Parisian geriatric hospitals. Alastair McQueen talks to Chief Pharmacist Monsieur Alain Chevallier to find out why
In recent years, more and more hospital pharmacies are turning towards technological solutions to help with drug distribution. Monsieur Alain Chevellier is Chief Pharmacist at Broca hospital, La Rochecoucald and La Collegiale in Paris, France. In 2005, he installed an automatic, medicine specific dose packaging system as part of a pilot scheme to test its impact on pharmacy efficiency.
“We studied what sorts of drugs we used in our hospitals. Eighty per cent of these drugs are tablets or capsules- because these are geriatric hospitals,” he explains. “So we decided to use a machine like HD Medi- which packages solid medicines-so we could increase the distribution quality of 80% of the drugs we used.”
The machine is composed of canisters that are pre-loaded with the most commonly used solid drugs. According to M Chevallier, the pilot has been very successful. “This machine prepares the drugs for all the patients, so that the nurses don’t have to. They just retrieve the drugs, packaged with the name of the patient, date and the time that we packaged the drug and several other useful pieces of information.”
The new system frees up nurse workloads, so that they can spend more time with patients. “The advantage of a machine like ours is to liberate time for other activities,” he says.
The labelling system also ensures that nurses have access to the information they need to administer the drugs safely. “On each bag we put the name of the patient, the unit, the bed number, and the date and time the drug should be given. We also put, in small characters, the chemical name of the drug,” says M Chevallier.
HD Medi can also be configured to print specific text on the bags, for example, guidance on how a medicine should be administered.
“The nurse must be able to understand what she is manipulating, what she has in her hand,” says M Chevallier. “So we can write a small sentence, when necessary, to prevent misuse of drugs. So, for example, it might say you cannot open the capsule because the drug will be inactive. Or, you can explain if it’s a long-action drug and you should not open the capsule. This information is very useful for the nurse.”
M Chevallier is highly conscious of safety when using automated systems. “The way we chose to use the HD Medi was guided by security. We put one drug in a bag at a time. We refuse to mix different drugs in a bag, because the nurse has to manage what she gives to the patient and she has to know what she is doing at the bed of the patient,” he explains. “Some hospitals do mix different drugs which must be administered at the same time, but the risk is that the nurse will have a bag with different drugs in without knowing what she is doing.”
Physically installing the HD Medi was relatively straightforward. Standing as a tower, it takes up about one metre square. M Chevallier has situated it in a separate room, so that the technicians can operate it undisturbed by patients or nurses. “We have two people who are working with this machine,” he says. “One is the ‘pilot’, and she has to receive the prescription by computer and she sends the prescription to the machine.”
The other technician assists, and also prepares any prescriptions of medicines that are not loaded in the machine. He adds: “These two people work from nine in the morning to three in the afternoon and they are preparing all the drugs for all three hospitals.” Every day they produce 6,000 bags of labelled doses, which are delivered to the various units for the nurses to distribute.
For a hospital to use a system like HD Medi, the pharmacy must be using computerised prescriptions. The system is designed to integrate with all commonly used hospital and pharmacy information systems.
The nurses are very happy with the new process. “The nurses are convinced,” he says. And as well as having more time with the patients, using the HD Medi offers another practical benefit. “If necessary, drugs can be crushed in the bag. So afterwards the nurses can open the bag and put the powder in the food and it’s easier and cleaner than before.”
For M Chevallier, the machine has allowed the hospital to find an economical solution that benefits both patients and nurses. “To do this work as a pharmacy we had two solutions. Either to work with a machine like this or… work with technicians.”
Compared to the number of technicians that are needed to serve all 563 beds in the hospitals, the HD Medi has already proved to be the most economical solution. “In one year we have reimbursed the original outlay,” he notes.
As well as cost saving, the HD Medi can help improve prescription accuracy. However, an effective solution requires planning, says M Chevallier. “These machines are efficient but you must work with controls. Because they can work very quickly, but they can make errors very quickly too. So you must be well organised.”
He adds: “When the technician or nurse prepares the drug, you can read in the literature that they make about 5% errors. If you work with a machine like ours, without controls, I think you have 0.6% of errors. But we put controls after the machines-all the bags are viewed by the technician. I can’t say we have zero errors, but we have been working since 2005 and we have discovered just 2 errors.”
So what type of institutions can benefit most from systems like HD Medi? “These machines are very easy to put in place in a hospital like mine. So geriatric hospitals. It would also very be useful in psychiatric hospitals or in jails. In psychiatric, geriatric and jail, the great majority of drugs are in solid form. When you work in other hospitals with acute patients or surgery or intensive care you will not use the machine as much.”
The machine has other benefits, too. “The machine doesn’t go on strike. When we have Christmas or other holidays, the machines are working and we can prepare all the drugs without problems. If there is the flu, if our technicians are ill, we can still prepare the drugs so this is a good assurance for us,” says M Chevallier.