Can We Harmonize Medication Management Across Europe?

[00:00:00] Dear listeners, Welcome to Faces of Digital Health, a podcast about digital health and

[00:00:06] how healthcare systems around the world adopt technology with me, Tjasa Zajc.

[00:00:14] Last year I attended the clinical pharmacy congress in the UK and one thought stood out

[00:00:21] to me.

[00:00:22] One of the clinical pharmacists said, We all overestimate the benefits of medicines.

[00:00:31] Medications can cure or kill.

[00:00:35] According to WHO, the global cost associated with medication errors is 42 billion US dollars.

[00:00:42] Errors can happen at the point of prescribing, transcribing from one system to another or

[00:00:48] when medications are administered, when the wrong patient is given either the wrong drug

[00:00:54] or the wrong dose.

[00:00:57] Wrong administration errors can be prevented with the introduction of closed loop medication

[00:01:02] management where all points of medication handling are connected and done electronically.

[00:01:08] Even medication administration is done with the help of barcode scanning, which means

[00:01:13] that the nurse scans the patient, scans the medication barcode and makes sure that

[00:01:19] the right patient gets the right dose and the right medication at the right time.

[00:01:26] Three European specialists from the Netherlands, UK and Belgium recently started a European

[00:01:32] project Asklepius which advocates for the standardization of hospital medication management

[00:01:38] across Europe through the introduction of closed loop medication management systems

[00:01:43] in hospitals.

[00:01:46] Francine Destoplar, Patrick Koch and Patrick Van Oisrot connected with colleagues from

[00:01:53] the UK, France, Iceland, Belgium, Norway, Netherlands and Sweden to strive for the alignment

[00:02:00] on the European level.

[00:02:02] So in today's episode you will hear a little bit more about the challenges with medication

[00:02:09] handling across Europe, potential for improvement and where we need to start to improve patient

[00:02:17] safety when it comes to medications.

[00:02:21] Enjoy the show and if you haven't yet make sure to check out our newsletter which you can

[00:02:25] find at fodh.substack.com.

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[00:02:44] Thank you.

[00:03:02] Hello everyone.

[00:03:03] We're here today to talk about project Asklepius which kind of strives to advocate for medication

[00:03:11] optimization across Europe to improve medication safety and decrease patient harm.

[00:03:17] So maybe just a brief round of introductions from everyone just so we understand what kind

[00:03:25] of draw view to this project.

[00:03:27] Maybe we can start with Patrick van Oschert who I'm going to refer to as Pat in the future

[00:03:34] questions in this discussion.

[00:03:37] So Pat go ahead.

[00:03:39] Yes, I'm happy to.

[00:03:41] I started my career in the hospital pharmacy world 28 years ago in a hospital pharmacy

[00:03:46] doing an internship there.

[00:03:47] I loved this world so much that I stayed there for another year then worked for

[00:03:52] over 14 years at a pharmaceutical wholesaler and since 2013 I'm the owner of good pharmacy

[00:03:59] practice support a boutique consultancy company based in the Netherlands but working across

[00:04:04] Europe always on topics of digitalization, closed up medication management strategy

[00:04:10] and one of my hobby projects is 3D printing of medication in a personalized way.

[00:04:17] Francine please what's your background?

[00:04:21] Hi, so I'm Francine de Stoplaar.

[00:04:23] I have about a 25 year career in healthcare, healthcare leadership.

[00:04:30] I am a pharmacist, hospital pharmacist and also a clinical pharmacologist have worked

[00:04:37] most of my career in hospitals.

[00:04:40] So a deep contact with patients and the clinical experience and the last number of years I've

[00:04:46] worked more into in hospital management and operations and my last eight years I've been

[00:04:54] working on a very special project and it was building an entirely new hospital in the

[00:04:59] centre of London who's in the back garden of Buckingham Palace called Cleveland Clinic

[00:05:03] London.

[00:05:04] And I was there from the very start employee number three and in addition to doing

[00:05:11] broad clinical operation work I also was director of pharmacy there and headed up the operational

[00:05:19] activation of the entire hospital but also implemented a very challenging but amazing

[00:05:26] closed loop medicine management system as the first in the UK based on the US system.

[00:05:31] I have now left that project because we did it and it was an incredible experience

[00:05:37] and I'm now doing some independent work and delighted to have started the Escapius project

[00:05:43] with my two esteemed colleagues here.

[00:05:48] Thank you Francine, I look forward to hearing more from you about the closed loop

[00:05:53] medication management system that you implemented.

[00:05:56] So just before we go into that, Patrick, where does your passion for medication safety come from?

[00:06:02] Yeah, actually I'm like Francine and Pat I am a veteran in nurse care and especially in

[00:06:09] nurse care IT.

[00:06:10] I spend the first 20 years of my career in medical imaging actually where I started

[00:06:17] with analog environments or film based radiology and I can say that I actively contributed

[00:06:24] to the digital transformation of radiology so I really went through the digitization

[00:06:30] and all organizations needs to adapt.

[00:06:33] And about in 2016 I was recruited by one of the leading pharmacy automation vendor

[00:06:41] where I had a leadership role and so I discovered the hospital pharmacy world

[00:06:46] and discovered, was really surprised that actually the hospital pharmacy and the

[00:06:51] medication management area in hospitals is still I would say at the stone age.

[00:06:56] This might be a little bit hard word, right, but it's compared to medical imaging there is

[00:07:02] a huge gap.

[00:07:03] And so I left that company about two years ago but I felt I still can contribute to the

[00:07:09] digital transformation and automation of medication management and

[00:07:13] nurse care pharmacies and actually I met with Francine as part of my new last job

[00:07:19] and Pat and I also have come in interest and we came up with this idea to create

[00:07:24] this asclepius project and align all the people with us to basically transform the world.

[00:07:32] Thank you and maybe for to better understand the topic so the project aims to improve or just

[00:07:41] encourage the improvements in the medication space on the European level.

[00:07:45] What do we actually know about medication safety in Europe?

[00:07:50] We have some global numbers so for example the cost associated with medication errors has

[00:07:56] been estimated at 42 billion US dollars annually by the World Health Organization.

[00:08:03] Two years ago the UK created this large study that kind of described in a bit better terms

[00:08:10] what the scale of the problem in the NHS is and there's around 1,700 deaths associated

[00:08:16] errors in the UK. What about the rest of Europe? Where are we with that? Who wants to take over this one?

[00:08:26] I'll take this one for now. You've taken the 1,700 deaths words out of my mouth and I was going to

[00:08:32] bring that particular study to everyone's attention. It was done in 2018 UK wide looking at the

[00:08:41] NHS. We're still making 54 million medication administration errors a year and we're losing

[00:08:49] sadly losing quite quite a few people because of medication errors so we need to do something about

[00:08:56] this. I don't know the exact numbers of medication errors in the EU. I know Pat you've got some

[00:09:03] numbers in Germany maybe you can highlight those and then I'll get from there in terms of what

[00:09:10] I think or what we think digital transformation and medication management and automation can do to

[00:09:17] make us safer as patients. Okay thank you. Pat what would you say is the situation in Germany?

[00:09:25] Germany is very specific in terms of healthcare digitalization. There's been large

[00:09:29] investments happening on national levels to digitized hospitals so where are you in terms

[00:09:34] of medication safety? I think that the German market knows that it has to improve. We talk about

[00:09:42] 19,000 deaths per year due to medication errors not just in hospitals but also in the home

[00:09:48] situation so numbers are big enough to say that this market needs a change and needs improvement.

[00:09:55] The project that we are discussing is actually very international. There's several countries

[00:10:02] UK, France, Iceland, Belgium, Norway, Netherlands, Sweden that the members are from. You are thinking

[00:10:08] beyond just one or two countries. Absolutely we are. If you allow me to jump here there is no

[00:10:18] certain numbers and this is one of the issues. Medication errors are not always tracked and

[00:10:26] not always recorded in a significant way. Those are only estimates that we have

[00:10:34] and they vary obviously country by country but what is clear this is a significant

[00:10:40] population issue because the number of people impacted is significant.

[00:10:48] Absolutely I totally agree it's not just that medication errors happen. They can also

[00:10:56] cause harm, they cause complications, prolonged hospitalizations and consequences or costs to

[00:11:02] the healthcare system not to mention the harm for patients and their families because

[00:11:07] yeah complications have a really broad impact. So let's talk about the impact of

[00:11:12] technology. Healthcare systems are strained on several levels. Why would decision makers

[00:11:20] prioritize investing in technology for medication safety and where should they begin

[00:11:27] according to your insights and analysis? It's a great question Chaja and if I may return to what

[00:11:36] you said about the impact of medication safety and medication errors whereas readmissions

[00:11:42] and returns to theaters and therefore higher costs. If you look at the closed

[00:11:46] look management circle you have the prescribing, the verification by pharmacists,

[00:11:51] then the distribution elements everything all the logistical stuff,

[00:11:55] then we have the unit doses and the scanning at the bedside and all of these digital and

[00:12:00] automated processes have an impact on making sure that the right medication gets to the

[00:12:08] right patient at the right time in the right dose. So I understand that that can be a huge

[00:12:16] investment for hospitals but reducing harm to patients at any element and any time during

[00:12:23] the medication journey is absolutely key. So if we look at the various elements of that

[00:12:29] medication journey a lot of hospitals are already electronically prescribing which

[00:12:35] has a huge impact on picking the right medication and as a safety impact and verification by

[00:12:40] pharmacists in the real time but I think that scanning at the bedside which involves individually barcoded

[00:12:49] unit doses, medications not only tablets and capsules but also infusions and injections

[00:12:54] and nose drops and all the other formulations is absolutely key that is done at the bedside

[00:13:02] and for that we do need a certain level of digital transformation and digital processes

[00:13:09] and automated processes as well. And then we make it safer but we also make it more efficient

[00:13:16] and we are less reliant on the workforce and we all know that there is a global workforce crisis

[00:13:22] which is something we can talk about for a long time and luckily I think not to forget

[00:13:28] sustainability is absolutely key and it's a real relevant topic moving forward globally and

[00:13:36] across the EU and these processes reduce medication waste and therefore make our processes and our

[00:13:42] systems more sustainable as well. If I may add something to this, it's not just about

[00:13:50] making things safer and having track of what medication is used where and when

[00:13:55] or due to the shortages that we face in Europe and having a transparency over the whole chain of

[00:14:01] medication makes us using the medication in the right way more efficiently. We do not throw

[00:14:06] medication away so medications where we have shortages are they are used for the right patient

[00:14:13] for the right treatment and this also improves the medication therapy within the hospital. So

[00:14:19] I think it's more than just about the medication safety although that's already the most

[00:14:24] and the fiercest driver for our escapist project. Before we continue maybe just a few

[00:14:29] clarifications for the listeners so when we talk about closed loop medication management and bar

[00:14:34] scope scanning that means that the nurse when she's administering the drugs scans the barcode

[00:14:40] on the patient scans the barcode on the drug to make sure that the right drug goes to the

[00:14:46] right patient in the right dose because everything is prescribed electronically and when

[00:14:51] we talk about the whole closed loop medication management for each to work several hospital systems

[00:14:57] need to be connected from the prescribing system to the pharmacy system to the pharmacy robot

[00:15:02] stock management there's ward cabinets sometimes that are involved in this whole story clinical

[00:15:08] decision support systems that are integrated in the prescribing system so a whole range of

[00:15:15] systems that basically hospitals need to to have in order for all this to work and in case

[00:15:22] that hospitals want to start somewhere and don't just have one monolith hospital system that takes

[00:15:31] care of everything laboratories patient record observations medications where would you suggest

[00:15:38] that hospitals or decision makers start when they think about improving a medication safety

[00:15:47] workforce efficiency and sustainability that you mentioned because sometimes it goes gradually we

[00:15:52] especially see that in the UK it started with epma now it's going to the electronic

[00:15:57] prescription service and it might go to closed loop medication management next as a kind of

[00:16:03] national requirement or desire followed by investments as well what we did at Cleveland

[00:16:10] Kinney which I didn't really elaborate on was go live with a big bang because we were a new hospital

[00:16:16] and you may have made just as well it was a totally paperless and fully digital hospital

[00:16:22] you may just as well implement the entire system at once very different from a transformation

[00:16:28] process to from an existing situation and then it is about deciding your rights are where what to

[00:16:35] tackle first and you are right in the UK they have looked at electronic prescribing they've

[00:16:40] done that in the Netherlands as well and other countries that is something that absolutely

[00:16:47] needed to be tackled first there are so many prescribing errors being made but then secondly

[00:16:53] there are a lot of administration errors being made so in my opinion the administration side

[00:17:00] the safe secure storage and picking and then scanning at the bedside is something is the only

[00:17:07] way to really close that loop on and reduce those medication errors when it comes to efficiencies

[00:17:15] and traceability as well it's absolutely key that we digitalize and automate our distribution

[00:17:22] and logistical processes within the hospital as well and it's a matter of what you want to

[00:17:28] prioritize first whether safety is the top of your list of priorities or whether efficiencies

[00:17:35] and less reliance on the workforce is the list the top of the list of your priorities and then

[00:17:40] of course as Patrick also or Pat also said sustainability is is an absolutely key topic at

[00:17:46] the moment so it is a little bit up to where the hospital's priorities lie but I would say that safety

[00:17:54] and efficiencies are probably the top of the list and then if you look at the closed loop cycle

[00:18:00] then you know where to start and what processes you need to automate and digitalize first

[00:18:06] you to start with something is much better than having nothing that's the principle here

[00:18:12] sorry Pat you go ahead no that's the thing I already would jump in in 1996 I was working in a

[00:18:19] hospital pharmacy where they did have an electronic health record system already in the 90s

[00:18:24] they did have something like a medication management system but there was no closed loop

[00:18:28] or there was no digital closed loop what they did was is create a closed loop by a doctors and

[00:18:35] pharmacists working together on establishing the best medication therapy by talking to each other

[00:18:42] they registered all the medication that has been given to a patient not by scanning because of

[00:18:47] that time Doug Ernaw-Bakot's yet so what they did was they had unit doses but they had unit doses

[00:18:53] made with a sticker the sticker when the medication was administered by the nurse was

[00:18:58] put into the patient record a paper record and this paper record was then transformed

[00:19:02] into the health record system by data typists so even when it's not fully digitalized and it's

[00:19:09] not optimal it all depends okay you have a process you can work in the process you can optimize a

[00:19:15] process and key element in this is the knowledge that medication safety is for the benefit of all

[00:19:21] and secondly the working groups have to work together like the doctors the nurses and the

[00:19:25] pharmacists so it depends a bit on on the situation of a hospital or a country where

[00:19:30] it stands and where to begin but since it's a loop it doesn't matter where you begin you will

[00:19:34] end up with the whole loop yeah eventually definitely you have a network from several

[00:19:42] countries in europe what can you share in terms of how what's the variability in medication

[00:19:48] management across europe what are the country specific challenges that you may have uncovered

[00:19:55] when you all got together are the members mostly coming in from private hospitals or is it also

[00:20:02] public hospitals because that also makes a huge difference in terms of how the hospital is financed

[00:20:08] and how much they can invest in new technologies i think the difference between what community and

[00:20:14] public hospitals private hospitals is of less importance since we all challenge we have

[00:20:20] the same challenges in this countries might be a little bit ahead when it comes to fulfilling

[00:20:26] the close to medication management as i said in the Netherlands we had unidose management already

[00:20:31] in the 90s we had legislation for e-prescribing coming in 2014 that didn't mean that then only

[00:20:38] then the hospital started to e-prescribe because i think almost 50 percent of the hospitals were

[00:20:44] already on e-prescribing but this new legislation catalyzed and accelerated the implementation of

[00:20:51] closed of medication management and if you look at a country like Germany where they

[00:20:57] the former minister of health has published a new hospital future act acknowledging that

[00:21:03] digitalization is of key importance and that all the people within the hospital

[00:21:08] all the professionals have to work together and supported this new law or this new act by

[00:21:14] massive funding which made it possible for many hospitals to invest into the right

[00:21:21] resources that were needed things like so software or being at hardware and so the

[00:21:27] funding was also there it doesn't come easily of course but having the law and legislation

[00:21:33] catalyzes and having the funding makes it actionable yeah that from the Netherlands and

[00:21:39] Germany but perhaps francin and and patrick can complete this for product and other countries

[00:21:45] yeah i do see that there are two two general methods of dispensing medication and i would

[00:21:53] call it the first one the traditional one where basically the central pharmacy is delivering

[00:21:59] packs of medication to the wards and the nurses are preparing themselves the patient treatment

[00:22:06] before administration is the traditional method and and the preparation work is done by nurses

[00:22:13] of being interrupted and basically creating the possibility of medication erogs some countries

[00:22:21] i think pat and francin you may say that uk and germany for instance are countries where

[00:22:26] this method is still the dominant method the other method we talked already a little bit about

[00:22:32] that the closed loop based on unit dose on our patient specific therapies and started in the

[00:22:37] nordics also in in france and benelux and here we see that the role of the pharmacy is quite

[00:22:42] different it's more important all the preparation of patient specific therapies is done in the

[00:22:47] central pharmacy which leaves actually the opportunity to automate to automate that

[00:22:53] preparation and dispense into the wards only the patient specific therapy is ready to administered

[00:23:00] by the nurses so what it's almost a philosophical situation between people or pharmacists leading

[00:23:07] towards the unit dose patient specific dispensing and the other countries and in some countries

[00:23:13] like in belgium where i am from this is now by law where you need to to dispense patient

[00:23:18] specific unit doses so it's very valuable actually stay between those two methods and some countries

[00:23:25] especially in the in the sort of europe are transitioning progressively into the unit dose

[00:23:32] dispensing and how do you see that this whole transition could further be encouraged

[00:23:39] across europe like how are you going to do that with your project that actually one of the main

[00:23:47] obstacle is the lack of standardization the lack of harmonization not only on workflows and works a bit

[00:23:54] but also on on information if you take for instance the very basic building block which

[00:24:00] is a medication database every single country in the world and in europe has his own medication

[00:24:07] database and not only the medication themselves are different so like the names or the dosage

[00:24:14] but also the structure of those database is different so from a vendor point of view whatever

[00:24:20] you are software vendor or a robot manufacturer you need to adapt and recreate every time a local

[00:24:27] environment discreet complexity discreet additional cost and also risk into the deployment of those

[00:24:35] projects so one of the goal of of us clip use is to to contribute to the identification of harmonized

[00:24:46] best practices and promote those best practices through tenders for instance to push the industry

[00:24:52] towards a standardization and some simply a project to deploy okay i think sorry if i may go ahead

[00:25:01] yeah just i think touching on what pat and patrick have already said it isn't really about the difference

[00:25:09] between private and public hospitals it is really about local regulations as well for example we're

[00:25:17] held back a little bit in in the NHS in the uk i must say that NHS is loved by many people

[00:25:23] but there are digitization or electronic prescribing is not a regulation at the moment so

[00:25:29] it's not being driven by by the government it is driven but it's not it doesn't need to be implemented

[00:25:34] by law same for aseptic production we have a very stringent regulatory body the mhra that sort of

[00:25:41] prevents us from awarding longer expiry dates and therefore it's really operationally very complex

[00:25:48] to implement these unit dose productions for infusions but then taking back to going back

[00:25:54] to the membership of the aslapeus project i think what is really key is that we have invited people

[00:26:01] and they're gladly accepted to be part of this that are chief pharmacists in large hospitals with a

[00:26:07] tremendous amount of experience and also country-wide experience so some of us are presidents or

[00:26:16] ex presidents or key stakeholders in a professional organizations on a country level

[00:26:21] so we did go about carefully choosing and inviting people so that we have a good representation across

[00:26:29] europe so this is not something that we're coming up with ourselves of course this is our initiative

[00:26:35] but it is very much supported by some really key influential chief pharmacists and other key

[00:26:43] stakeholders do you already have any milestones set up that you would like to achieve we have

[00:26:51] defined the three subgroups to work on so one is on the harmonization of the workflows so the processes

[00:26:58] standardizing them and and making them happen and it is in this one where franzine takes the

[00:27:06] lead in together with some other hospital pharmacists chief of pharmacists to work on that

[00:27:13] patrick is taking the lead in defining and but also measuring relevant kpis where we can see

[00:27:20] impact of those closed-loop medication management processes and compare them to each other the

[00:27:27] true belief behind this is of course that what you can measure you can improve

[00:27:32] and i'm in the lead of the return on investment subgroup where we try to monetize the effect

[00:27:39] of having a closed-loop medication management implemented to be used by either the ones

[00:27:45] that have already invested in it but mainly also for those who are going to invest in it and have to

[00:27:50] convince for instance their management that it does make sense to go into closed-loop medication

[00:27:55] management and instead of trying to to invent the wheel all by themselves for all these three

[00:28:01] initiatives we will spread the lessons learned and the best practices over the european

[00:28:06] countries of the european participants so what has been the most difficult thing for you

[00:28:11] so far in convincing the decision makers about the importance of this because that's

[00:28:17] that's the thing right digital transformation there's always this challenge of first convincing

[00:28:22] the decision makers then you have to get the buy-in from the end user so it's a it's a big thing

[00:28:27] yeah we were really positively surprised when we started to reach out to those to those leaders

[00:28:34] and opinion leaders in our respective network we were really positively surprised by the by

[00:28:40] their response and so actually almost everyone agreed to participate and now we have already

[00:28:46] achieved a couple of meetings including a face-to-face kickoff meeting at during the european association

[00:28:53] of hospital pharmacist congress in in bordeaux the the main challenge that we face is getting

[00:29:00] people to take this this load this work on top of the of their all the common duties that

[00:29:07] they need to accomplish for the responsibilities that their respective responsibility so it or can we

[00:29:14] get them to free up the time and so we can really create that solid foundation of of

[00:29:23] information and deliverable that's really i think the most challenging part of of the project

[00:29:29] okay is would anyone else like to add anything

[00:29:34] yes i can add to that this taking this work on top of the daily routine is something that every

[00:29:40] hospital pharmacist doctor nurse faces also in reality a implementation project for

[00:29:45] close of medication management comes on top of treating the patients doing the prescribing

[00:29:50] preparing the medication so having the time free to do these kind of projects and to do them

[00:30:00] seriously is something that we also would like to help out with and we have within our

[00:30:07] asclepia initiative over 12 people joining us and also providing those who want to implement with

[00:30:17] support knowledge experiences best practices and later on also tooling and so it's helping

[00:30:24] helping them out on all kinds of levels not just the strategic level but also on

[00:30:28] let's say the more routine boring but still most importantly the implementation parts

[00:30:34] that you get it done and get it running yeah Francine which part was the most difficult at

[00:30:40] the Cleveland clinic in London what was the biggest challenge of them all and maybe you can also

[00:30:46] talk about the impact in the end on the results and on patient safety that you've

[00:30:51] then observed when the clinic was opened to four patients yeah i think we can look at

[00:30:58] a couple of categories but one of them was because if you want to truly implement this 24-7

[00:31:03] real-time verification real-time making infusions etc you need to be open 24-7 so to work to

[00:31:09] workforce plan around this was extremely difficult but we did it and we found the right

[00:31:15] people to work overnight and to make sure that we could run 24-7 so the model that we

[00:31:21] implemented could run secondly it's about getting the people on board and teamwork so for

[00:31:28] an example is that we had our we were the first to implement automated dispensing cabinets at wards

[00:31:36] level in at the in the perioperative areas the anesthetists found that very difficult

[00:31:41] but it was about having good conversations with them convincing them hold their hands

[00:31:46] whilst we were going live to make sure that these processes do actually work in their areas and

[00:31:51] they're now really enthusiastic and then thirdly again teamwork the nurses really needed to get on

[00:31:58] board they we took away the making of infusions from them because we brought that back to pharmacy

[00:32:04] in order to create those infusion unit doses they found that difficult they thought we were

[00:32:09] taking some pieces of work away from them and then secondly to get good compliance of barcode

[00:32:16] scanning at the bedside and also to make them use the automated dispensing cabinets in the correct

[00:32:21] way was difficult as well so training holding hands at the elbow support is absolutely key

[00:32:28] to make this successful now when it comes to safety aspects we are currently reviewing

[00:32:36] all the medication the reported medication incidents over the last two years now two years

[00:32:40] post opening and we have some preliminary results to present at Hymns in Rome in the next couple of

[00:32:47] weeks so yeah but we're still there's still a lot of analyzing to be done can you already share

[00:32:54] any of the results that are going to be presented there

[00:32:57] um

[00:33:02] either rough numbers we've had about approaching a million bedside medication administrations

[00:33:12] we have had quite a significant number of maybe not administering in time incident because of

[00:33:20] but particularly the beginning because of everyone getting used to the processes and therefore

[00:33:25] maybe not things being ready in time very limited to time critical medicines we made sure that those

[00:33:31] were there at the right time but if it comes to the six r so the right dose right documentation the

[00:33:38] right patient the right meds and the right route they have missed one we probably or most likely

[00:33:44] but i'm still analyzing have had two incorrect administrations which is if you compare that

[00:33:50] to the e-pro report in the NHS that was published in 2018 we you cannot really compare it it's it's

[00:33:59] so low that it's it's pretty pretty significant so yes it does work but it's it does need a cultural

[00:34:07] shift to be able to operate this more i could add that in the midst of zero so we did also a

[00:34:12] closer medication management project that by the prescribing part we were able to reduce

[00:34:17] the medication errors by 50 percent and by the bedside verification we could even reduce it by

[00:34:23] another 50 of the remaining 50 percent so we reduced by the project alone 75 percent of all the

[00:34:30] medication errors which is also a significant number driving us enough to keep doing this is

[00:34:36] good work thank you everyone for all the thoughts that have already been shared is there anything

[00:34:43] else that you would like to add before we conclude the the discussion anything that you think might

[00:34:51] move the needle further yeah maybe as a conclusion i'd like to come back on on the sentence

[00:34:59] that once in summarize as our mission make an impact really the the goal of this project

[00:35:06] a Sclepius project is really to to drive to drive the change and initiate actually an acceleration

[00:35:14] of the adoption of digital transformation and automation in the medication management at the end

[00:35:19] providing higher patient safety and better efficiency so resulting in a positive contribution

[00:35:27] for everyone to really make an impact and we want to bring all good all all good will

[00:35:33] on board to drive this across across europe you've been listening to faces of digital health a proud

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