Scanning for safety - barcoding progress within the NHS

Following the recent GS1 UK Healthcare Conference, Health Business reports its final Top 10 list of 2017 focusing upon the use of GS1 and PEPPOL standards within the NHS and listing the trusts leading the way in making efficiency savings through the technology

A few years ago, six NHS trust demonstrator sites were awarded a share of £12 million by the Department of Health to demonstrate the benefits of GS1 and PEPPOL standards, including significant efficiencies and cost savings, reduced errors and improved patient outcomes and patient safety.

It is believe that the implementation of electronic procurement systems will help deliver up to £800 million in efficiency savings for the NHS, helping to reduce the estimated £150 million wasted each year on products which have been either oversupplied or perished.

According to Scan4Safety, early signs from across the six demonstrator sites are encouraging, with over £700,000 of savings identified, divided between stock reduction (£233,000), reductions in wastage (£462,000) and non-clinical pay efficiencies (£46,000). Furthermore, the programme estimates that for a typical NHS Hospital trust, the benefits could also include time release to patient care – equivalent to 16 band 5 nurses per trusts, totalling 2,400 band 5 nurses across the NHS. Additionally, it could mean a reduction of inventory averaging £1.5 million per trust, £216 million across the NHS, and ongoing operational efficiencies of £2.4 million per trust annually, reaching £365 million across the NHS.

Speaking on Sky News in January 2017, Health Secretary Jeremy Hunt said: "Scan4Safety is a world first in healthcare – and a vital part of this government's drive to make the NHS the safest and most transparent healthcare system in the world. Using simple barcodes that major industries rely on every day will help to transform standards of care – before, during and after patients have treatment, at the same time as freeing up resources for care by reducing waste."

1 Derby Teaching Hospitals NHS Foundation Trust
Derby Teaching Hospitals NHS Foundation Trust provides health services to a population of over 600,000 people in and around Southern Derbyshire. Chosen by the Department of Health as one of six demonstrator sites for Scan4Safety towards the end of 2015, the trust was concerned with its manual, paper-based tracing process, and therefore implemented barcoding to collect accurate, timely and comprehensive information for product safety recalls and tracking implants and other products to patients.

The use of Scan4Safety makes operations safer and more efficient by using scanners to read every piece of equipment used in a procedure before then linking this to a barcode on each individual patient’s wristband. Using a cloud-based inventory management system, a product catalogue and a barcode scanning solution, the trust can now easily identify all products that are held within the hospital estate, successfully identifying all patients that may have been affected by the products, even patients with implants who are now at home.

Releasing figures at the start of the year, the trust revealed that it had already benefitted from efficiency savings of nearly £800,000 in 2015/16, with further estimates that they would save another £1.18 million in 2016/17.

Approximately 52,000 patient procedures were captured in the last year, resulting in Derby Teaching Hospitals NHS Foundation Trust’s Right First Time at Point of Care project winning the Best System or Initiative Adoption/Roll-Out award at the 2017 ehi Live ceremony.

Kevin Downs, director of Finance and Performance at Derby Teaching Hospitals, said: “A lot of hard work has gone into the successful implementation of this innovative project across the trust, so it is fantastic to have seen all of this effort recognised in this way. After recently becoming the first trust to complete all four phases of the programme, this award represents yet another reason for us all to be proud. Ensuring that we provide our patients with the safest care possible is central to everything that we do at Derby Teaching Hospitals. Scan4Safety has undoubtedly allowed us to do just that, whilst it has also made a huge difference to staff working in our operating theatres.”

2 Royal Cornwall Hospitals NHS Trust
At the start of December 2017, Royal Cornwall Hospitals NHS Trust launched a radio frequency identification system (RFID) to track high-value implants used during surgery, in order to ensure that they can be accounted for at all times. As part of the Scan4Safety programme, the trust aims to reduce the incidence of errors, as well as the amount of labour time hospital personnel spend tracking products, including medicines and implants. As one of the six demonstrator sites, the trust says that implementing a digital system using RFID to replace the paper-based system should be much faster and more accurate.

In September, a review of current inventory management systems and processes within Royal Cornwall Hospitals Trust highlighted a number of areas for improvement, including: heavily overstocked wards; incomplete periodic stock reviews; and a lack of standardised processes for setting up and stocking wards. Therefore, inventory management improvements using GS1 barcoding standards were needed to enable standards to be effectively implemented.

Royal Cornwall Hospitals Trust identified over-stocking in wards to the value of over £1 million, as well as holding stock for over seven weeks, as opposed to the recommended level of two weeks of stock in wards.

The design of standardised layouts for all store rooms improved the ability of staff to locate stock easily, no matter where they were in the hospital. Alongside investment in new equipment to create efficiency storage areas, and further staff training, the trust reduced the number of unique items stocked in medical wards by an average of 22 per cent, with the reduction reaching 40 per cent in trauma wards. Furthermore, the trust saw a year-on-year reduction in the ordering of medical consumables by 21 per cent for a medical ward.

Royal Cornwall Hospitals Trust also removed 880 obsolete stock items valued at £93,000, including 2,800 out of date products with a value of £61,000.

Dawnne Jenkins, a ward sister at the trust, said: “Scan4Safety has enabled us to create a relatives room and a storage area for medical equipment, reducing clutter in the Ward. Time has been released to care as all stock is in one location and easy to identify. I am saving money from my budget every month.”

3 Salisbury NHS Foundation Trust
Salisbury NHS Foundation Trust is one of six NHS trusts in England to be selected as a Scan4Safety demonstrator site. Following a highly successful rollout in cardiology in October 2016, Salisbury NHS Foundation Trust launched a new Inventory Management System, Genesis Automation, with point-of-use scanning in orthopaedic theatres in March this year.

Through the Scan4Safety Programme and the introduction of point-of-use scanning, 93 per cent of the trust’s implantable devices have been accurately tracked to a patient. With 60 members of staff fully trained, this means that in the event of a future product recall, the affected product can now be automatically traced to the patient and appropriate action quickly taken. Additionally, by scanning products at point-of-use, stock is now automatically replenished, releasing time for clinical staff to care who previously had to complete these stock orders.

Like many other trusts, Salisbury NHS Foundation Trust didn’t have visibility of its stock wastage. This has now been identified as around 10-15 per cent of total inventory value. Through point-of-use scanning, the trust has improved visibility of its stock and can better track expiring stock and wastage, including identifying the reasons why items are being discarded. This enables the trust to reduce waste in the future.

The trust is now looking to roll the technology out across all areas of the hospital so that 100 per cent of all implantable devices can be tracked by early 2018. It has already saved £121,069 through product range rationalisation in orthopaedic theatres, and, as the data continues to build, the trust believes that more benefits will become apparent.

Tim Wells, consultant cardiologist at the trust, said: “Knowledge is power – not only does this provide
us with a level of data and insight that can be used to better challenge clinical practice and variation, helping us to reduce inefficiencies and improve patient experience and outcomes – more importantly it ultimately helps to safeguard our patients from avoidable harm. In the event of a product recall, we can now easily and quickly track an affected product to the right patient.”

4 Plymouth Hospitals NHS Trust
Back in February 2017, Plymouth Hospitals NHS Trust became one of the first trusts in the country to have applied barcoded labels to every room on the estate, as part of a national Scan4Safety programme.

With over 6,700 rooms within the hospital estate, the unique numbers enable trust staff to reference any location on its site, helping to improve efficiency. The GLNs are also shared with suppliers who work within the trust so that they too can keep accurate and up-to-date delivery information.

Speaking in February, Theresa Gunn, Quality System Manager at Derriford Hospital, said: “I’m very proud of the work my team has done to complete this task one year ahead of the Department of Health’s suggested timescales. Now that we have barcodes available in every room, the trust will be able to use these to accurately and efficiently record locations where activities occur. Staff will be able to quickly and easily scan the GLN barcode to track where products are delivered or care is administered. This, in turn, will enable the Trust to more accurately and efficiently locate products or patients.”

This was the second milestone reached by the trust earlier this year, with the Scan4Safety demonstrator site also announced in February that it was on target to reduce waste and increase efficiency by achieving transaction information milestone. With support of NHS Shared Business Services and Global Health Exchange (GHX), the trust has streamlined the payment and product identification process for suppliers, reducing waste across the ‘Purchase to pay’ process.

Plymouth Hospitals NHS Trust also has plans to use GS1 standards within trauma and orthopaedics, so that theatre teams can track products such as knee and hip implants used by each patient and so support faster product recall, and more efficient inventory management. In October, Lord Carter of Coles visited the trust to analyse the eOutcomes work, as one of the only hospitals in the country using such an electronic system. The trust revealed as part of his visit that out of a total of circa 9,000 clinic attendances, it processed 6,300 outcomes electronically, capturing the outcomes for patients in real time.

5 Leeds Teaching Hospitals NHS Trust
In September 2017, Leeds Teaching Hospitals NHS Trust announced plans to link information gathered from barcodes to its electronic patient record and patient administration systems. As the largest of the Scan4Safety demonstrator sites, the move has been heralded as ‘quite revolutionary’ and will allow for the scanning of a wristband to immediately supply information from the patient record.

Focusing on stock and inventory management, which the trust first started implementing using GS1 barcoding in 1999, Leeds teaching Hospitals NHS Trust uses a system known as ‘CHOC Stock’, which enables the live update of stock usage through barcode scanning at point of use and has achieved ongoing revenue benefits by using quality inventory information to reduce unnecessary stock holding levels without the risk of stock outages. The system is implemented throughout the hospital including cardiology, radiology, orthopaedic and trauma, and, to date, has 3,000 barcoded items which can be scanned at 270 stocking points. Leeds Teaching Hospitals NHS Trust has so far saved £812,000 through reducing the amount of stock they hold.

Discussing the GS1 demonstrator site programme announcement, Tony Whitfield, director of Finance at the trust, said: “We are delighted to be working on this exciting project, which will enhance patient safety while enabling us to have a much greater overview of all the items we use every day to look after 1.5 million patients every year, reducing waste. It will mean that every location, medicine and medical device will be identified using a unique barcode which is also associated with a particular patient, providing additional monitoring for safety purposes.

“It will make it easier to track individual patient journeys through our hospitals and ensure we only order the stock we need at the time we need it, delivering significant cost savings. We also see the broader opportunities the adoption of standards bring in, supporting us to deliver year-on-year improvements to the way we design services to best meet the needs of our patients.”

6 North Tees and Hartlepool NHS Foundation Trust
North Tees and Hartlepool NHS Foundation Trust was also among the six NHS trusts that were chosen to be at the forefront of rolling out a set of new national standards, receiving part of the £12 million funding to demonstrate significant efficiencies and cost savings through the adoption of GS1 barcoding and PEPPOL standards.

Since 2016, all in-patient wristbands used at the trust are 100 per cent GS1 compliant, including Neonates, with location numbering (GLNs) used in all of the trust locations. The trust has also adopted a new catalogue management solution from VirtualStock, called The EDGE, as part of a focused drive to design-out process inefficiencies both within the hospital and its wider supply base and to deliver a radical step-change in system interoperability.

As of December last year, North Tees and Hartlepool NHS Foundation Trust reported ‘a significant milestone’ in the Scan4Safety programme, following the ‘smoothest upgrade ever’ of their Electronic Medicines Management solution.

Philip Dean, head of pharmacy, North Tees and Hartlepool NHS Foundation Trust, said: “Largely this was down to the planning and preparatory work between staff at the trust and staff at EMIS Health, working together to ensure a seamless upgrade. The changeover of systems was invisible to our pharmacy staff and users - our expectations were excelled on the day. This upgrade means that we can now fully support Scan4Safety, and we can also achieve dm+d compliance, all of which will be a great benefit for the trust and the wider health economy.”

7 Taunton & Somerset NHS Foundation Trust
Musgrove Park Hospital, an acute hospital that is part of Taunton and Somerset NHS Foundation Trust, serves a population of over 340,000. Adopting the measures outlined in the eProcurement Strategy, the trust aimed to use GS1 standards to better inefficient working patterns and processes and began approaching all of its suppliers and solution providers to ensure all products received were uniquely identified, supporting the management of data at every stage of a product being received, stored and used.

The trust has seen immediate benefits in improving their processes, including stock adjustments since 2014/15, beginning with £0.5 million the year following GS1 standard introductions. Moreover, the trust now turns more accurate reporting of stock turn figures, which means they not only know what is used, but which items aren’t used. This removes over-ordering and has saved the organisation £20,000 in expired stock that would have previously been wasted.

With a truly accurate view of product data and costing per procedure, Taunton and Somerset NHS Foundation Trust plans to continue the implementation across other areas, firstly in cardiology, Dday surgery, general and ortho theatres, radiology, ITU and A&E, before implementing it further in oncology, maternity, wards and, eventually, all other areas.

Nicola Hall, managing director of Ingenica Solutions, the inventory management solution provider used by the trust, said: “Inventory management is fast emerging as a powerful mode to help the NHS achieve significant savings. We are very pleased to continue to work with Musgrove Park Hospital on this large-scale roll out. The hospital is already an example of how efficient and effective solutions improve outcomes; it is a major implementation, that brings great benefits, hence the high level of importance attached to this project.”

8 Cambridge University Hospitals NHS Foundation Trust
Comprising of Addenbrooke’s and the Rosie, Cambridge University Hospitals NHS Foundation Trust is one of only five academic health science centres in the UK and a leading national centre for specialist treatment for rare or complex conditions. According to GS1 UK, the trust was spending unnecessary time manually locating and recording each mobile medical device it was using, detracting for patient care and contributing to the purchasing of unnecessary additional stock.

Using Radio Frequency Identification (RFID), the hospital’s clinical engineering team starting seeing the benefits of automating the process of tracking devices, with trolleys fitted with RFID readers able to automatically record the date, time and location of any tagged devices within a range of 11 metres. Data recorded in July 2015 revealed that a total of 7,500 higher-value medical devices had been fitted with RFID tags, with work already underway to fit the remaining 32,500 assets with tags.

As a result of using GS1 EPC standard tags, device utilisation levels have increased, reducing the need to purchase additional equipment. Additionally, audits now take just eight minutes, compared to 90 minutes per ward previously, and clinical staff are now more easily able to receive a device when needed. Average times for supplying a device to a ward is down to approximately 12 minutes.

9 Portsmouth Hospitals NHS Trust
Also focusing on improving their inventory management system, Portsmouth Hospitals NHS Trust made steps to enhance its methods for knowing what stock is available at all times across the entire trust, reducing waste and saving money in the process.

In 2012, the trust discovered that 13 different types of barcodes were not identified with a uniform system, with different suppliers, manufacturers and distributors often using the same codes for different products. Additionally, stock levels were often inconsistent, sometimes too low and sometimes too high, with inventory values often declared incorrectly. Therefore, a new inventory management system was planned using GS1 standards to identify all products. Initially, the system was implemented across a 27 theatre complex with 40 supporting locations, cardiology, audiology and six wards.

Striving to get 100 per cent of products barcoded, the Portsmouth Hospitals NHS Trust now uses Global Trade Item Numbers (GTINs) to uniquely identify products and can now use products with the shortest life remaining first, meaning less wastage of expired products. With figures likely to have improved since, stock has been reduced by 20 per cent and waste has impressively been reduced to less than one per cent. The estate’s department has started its procurement process for a GS1 compliant facilities management system to enable efficient space management.

Alongside Derby Teaching Hospitals NHS Foundation Trust, Portsmouth Hospitals NHS Trust was awarded the ‘GS1 Healthcare Best Provider Implementation Case Study Awards’ at the 2015 Global GS1 Healthcare Conference in Budapest.

Alan Hoskins, director of Procurement & Commercial Services, said: “The initial roll-out across our theatres has already delivered a huge return on investment. In the first year we saw 8.5 times saving from the initial investment freeing up finances for re-investment in other areas.”

10 University Hospitals Coventry and Warwickshire NHS Trust
As one of the UK’s largest NHS trusts in the country, caring for over one million people, University Hospitals Coventry and Warwickshire NHS Trust first introduced a blood tracking system on 2006, with an upgrade in 2012 introducing the use of patient wristbands. The hospital is the second largest user of blood in the region and uses Blood Track Tx, a system which ensures patients receive compatible blood by matching barcodes on their wristband and on product labels.

The Department of Health’s eProcurement Strategy requires GS1 barcoding on the patient wristband complying with ISB 1077 Patient Identification standard. University Hospitals Coventry and Warwickshire NHS Trust then implemented the use of 2D barcodes on patient wristbands allowing for greater positive patient identification, as well as trialling the Path Collect system, an electronic system of labelling blood sample tubes.

Since the implementation of the blood tracking system, blood wastage has been reduced to 4.1 per cent and blood stock management has been enhanced. The implementation of the GS1 DataMatrix wristband ensures positive patient identification throughout the transfusion process, which is essential to the provision of safe and effective care to patients.