To improve securitization of drug use process: computerized prescription and Nominative Automated Drug Dispensing (NADD)

In 2012, according to the French «HPST» law, 10 healthcare establishments created the health-care cooperation group «GCS Pharmacoopé» in order to implement the territorial NADD project (production of over packaged and identified Unit Doses (UD) with preliminary computerised prescription.

The aim is to prove the security and economic impact of this new organization on two Specialist Care Home (SCH) (40 patients each one).

We studied the impact by analyzing indicators evolution, before and after the new organization: indicators related to computerized prescription (prescription concordance/healthcare plan, pharmaceutical substitution regularisation and patient identity), pharmaceutical analysis (average prescription line number, Pharmaceutical Intervention PI) and to the NADD (prescription concordance/pillbox, pillboxes check).

The prescription concordance/pillbox is progressing from 57.5% to 100%: disappearance of substitution regularization errors (from 4.2% to 0%) and identity errors (from 2.5% to 0%).

The check of 553 nominative pillboxes (5918 unit doses) brings out the following errors:

• Conditioning: from 64.3% to 3.1% (due to manual picking),
• Quantity: from 4.1% to 0.6% (mainly thanks to manual picking and robot non conformities),
• Reference: from 0.9% to 0%.

Due to computerised prescription and the « NADD », «GCS Pharmacoopé» is enhancing quality and security of drug use process. On the one part, about the pillbox topics, packaging errors are falling down (-61.2 points) thanks to unit dose over packaging; the residual mistakes are caused by manual picking to complete the pillboxes and a setting process is ongoing to reduce the manual picking. On the other part, quantity errors are declining significantly (-3.49 points): non conformities unit dose production persist (0.51%) and there are notified to robot supplier to be solved. Besides, economic analysis shows an important decrease of treatment costs due to «GCS Pharmacoopé» joint buying policy.