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Smart access control saves thousands of nursing hours to Portiuncula Hospital

Monday 01 June 2015

Portiuncula Hospital, a 194 bed public hospital located in Ballinasloe, County Galway, Ireland, has improved the efficiency and security of its medication stores with the installation of a smart access control solution from SALTO Systems.

SALTO Systems at IFSEC London 2015 ' on stand G180

Background
The hospital's pharmacy department wanted to improve the efficiency and security of the medication process which was using traditional locks on its drug cupboards and drug trolleys to store and access medications. This was important as the hospital has to comply with the HIQA standard that drug cupboards and drug trolleys are locked at all times. Most wards at the hospital have several cupboards, each with a different key, with the nurse in charge of the ward taking responsibility for the keys for the duration of their shift. The problem with this was that nursing staff often spent considerable time determining who had the keys and then which key fitted which lock.

To eliminate this problem the pharmacy department decided to look at replacing keys with SALTO smart card operated XS4 locker locks and wall readers. These would provide a high level of security protection and control when and by whom medication could be accessed.

A business case was submitted to hospital management which secured funding of '25,000 towards the introduction of the new locking system. Two members of the pharmacy department then undertook a site visit to another hospital to view the locking system in use providing access to drug cupboards and trolleys, and following this a multidisciplinary team involving nursing, pharmacy, IT and maintenance staff at Portiuncula hospital worked together on this Quality Improvement project.

Kieran Gorey from Doorware, SALTO's Irish distributor which subsequently carried out the installation at the hospital, says 'The new locking system is now in use in 12 clinical areas with 46 cupboard locks and 11 trolley locks installed. Locks have also been introduced into the pharmacy department for the storage of benzodiazepines and hypnotics. Further rollouts to the Theatre and the Emergency Department are also planned.

Now only authorised nursing and pharmacy staff can access the drug cupboards and drug trolleys and the medicines contained within them. Every time the cupboards or trolleys are opened the event is logged automatically via their audit trail facility - the lock continuously recording the last 1,000 operations into its memory - giving hospital management a vital security record of who accessed it and when.'

Nursing and pharmacy staff consequently received new smart card badges which were individually programmed to allow them access to the drug cupboards and trolleys as required. Previous access to blood products in the laboratory and general door access throughout the hospital were also integrated into the new smart card.

Fitting the XS4 locks to designated drug cabinets and trolleys together with the printing of smart card badges was introduced on a phased basis. Systems were also put in place to access locks in the event of a power outage or network failure, with an emergency override device and emergency access badges for all clinical areas being available if necessary.

To enhance security, nursing staff were given fourteen hours access and pharmacy staff nine hours access to the drug cupboards and trolleys. Individual staff smart card badges have to be updated to maintain access rights at designated wall or desk mounted updaters on a daily basis, with responsibility for the supervision and operation of the system lying with the pharmacy department.

Results
The traditional bulky bunch of keys that was previously used has now been replaced with smart locks and individual smart card badges. The new locking system has improved access to drug cupboards and trolleys for pharmacy and nursing staff who particularly like the fact that they have individual access to cupboards and do not have to look for the key holder anymore.

Of the 36 nurses surveyed 97 % preferred the smart card access system and indicated that an average of 36 minutes was saved per shift. Over a year, if this equation was used across the hospital, the time gained would equate to an extra 4471 nursing hours for the hospital per year.

Geraldine Colohan, Chief Pharmacist at Portiuncula Hospital says 'Security is now improved as cupboards are not accidentally left unlocked. Of the 38 locks surveyed post introduction of the system 95 % were found to be locked compared to a baseline of 37% prior to the new system. A second re-audit showed that 96.5% of locks surveyed were locked.

The technology has added benefit that allows supervisors to easily amend or delete access rights or to delete lost or stolen smart card badges from the system. It also allows for a computer generated audit trail as to which cupboard was opened by who and for how long.

Feedback from nursing staff using the system has included the following comments: 'No more looking for keys' 'Less time consuming' 'Safer, No keys' 'Quicker, not looking for keys' 'Easier access' 'Can't go home with the keys now' 'Just have to remember to update your badge in the morning' 'Like that you can do a trail of who has opened and closed doors'.'

Conclusion
Restricted access to medication cupboards and trolleys ensures that medications are securely stored as indicated by the audits undertaken since the implementation of this initiative. Nursing staff have indicated that they have increased time to care for patients and are less frustrated trying to access medications. The audit trail ensures responsibility is placed on the staff member opening the cupboard to also lock the cupboard. This helps ensure cupboards and trolleys are not left unlocked. Access to medications has become more secure and efficient as a result.

This innovative SALTO technology has replaced the traditional bulky bunch of keys which was passed between members of staff on a ward. The system promotes responsibility, increases nursing time to care for patients and improves security with regard to medication management.