Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending...
Transcript of Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending...
![Page 1: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/1.jpg)
Current Concepts in Pharmacy Current Concepts in Pharmacy Current Concepts in Pharmacy Current Concepts in Pharmacy
AutomationAutomationAutomationAutomation
Mike Sanborn, MS, RPh, FASHP
Corporate Director of Pharmacy
Baylor Health Care System
Dallas, TX
![Page 2: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/2.jpg)
Objectives
• Review automation options available for unit dose dispensing in acute care pharmacies
• Assess automation options for IV admixture compounding
• Discuss pros and cons of various automation choices
• Review a variety of other considerations and system issues
![Page 3: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/3.jpg)
Typical Automation Goals
• Expand pharmacy services
• Redeploy pharmacy staff
• Improve medication turnaround time and pharmacy efficiency
• Reduce medication errors
• Improve charging/billing
• Increase formulary compliance
• Reduce cost of drug therapy for patients
• Improve Adverse Drug Reaction reporting
• Improve pharmacy image, morale, and pharmacist job satisfaction
• Take responsibility for medication use in all patients
![Page 4: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/4.jpg)
Key Technology Drivers
• Profits and entrepreneurial spirit
• Cost Effectiveness
• Patient Safety
• Fewer pharmacists allured by dispensing,
compounding, and other manual tasks
• Workforce shortages
• Inherent need for continuity of care
![Page 5: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/5.jpg)
Incorporation of Technology
0%
10%
20%
30%
40%
50%
60%
70%
80%
SmartPumps
BCMA CPOE Robots Cabinets
Am J Health-Syst Pharm. 2006; 63:327-45
KLAS, CPOE Digest 2007
![Page 6: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/6.jpg)
Technology and Automation are
Major Issues
![Page 7: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/7.jpg)
Unit Dose Automation for Unit Dose Automation for Unit Dose Automation for Unit Dose Automation for
Acute Care HospitalsAcute Care HospitalsAcute Care HospitalsAcute Care Hospitals
![Page 8: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/8.jpg)
Automation Options
• Decentralized
• Automated Dispensing Cabinets (ADC)
• Centralized
• Inline Packagers
• Carousels
• Robots
![Page 9: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/9.jpg)
Technology Changes Over Time
Robots vs. ADMs
0
10
20
30
40
50
60
70
80
Robots ADMs
Uti
liza
tio
n %
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Gro
wth
Rat
e 20
02,
2005
1999
2002
2005
Robot Growth
ADM Growth
Pedersen CA et al. Am J Health-Syst Pharm 2006; 63: 327-345.
![Page 10: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/10.jpg)
What is the Future of Automated
Dispensing?
• Currently 73.9% of hospitals have a centralized
system versus 26.1% decentralized ¥
• In the future, 50.1% envision a centralized
system versus 50% decentralized ¥
• The truth is likely dependent upon a variety of
factors
¥ Pedersen CA et al. Am J Health-Syst Pharm 2006; 63: 327-345.
![Page 11: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/11.jpg)
Factors Affecting the Dispensing
Model
• Philosophy (Rx and RN)
• Resources
• Logistics
• Patient Flow/Turnover
• Bed size
Distribution Model by BedsizeDistribution Model by BedsizeDistribution Model by BedsizeDistribution Model by Bedsize
0%0%0%0%
20%20%20%20%
40%40%40%40%
60%60%60%60%
80%80%80%80%
100%100%100%100%
<50
<50
<50
<50
50-99
50-99
50-99
50-99
100-199
100-199
100-199
100-199
200-299
200-299
200-299
200-299
300-399
300-399
300-399
300-399
>400
>400
>400
>400
CentralizedCentralizedCentralizedCentralized DecentralizedDecentralizedDecentralizedDecentralized
¥ Pedersen CA et al. Am J Health-Syst Pharm 2006; 63: 327-345.
¥
![Page 12: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/12.jpg)
Major Players in Decentralized
Automation
Omnicell Pyxis AcuDose
![Page 13: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/13.jpg)
Nursing Battles(Trying to fill cabinets while nurses are vending meds)
Withdrawals by Time of Day(Average and Avg + 1 S.D.)
0.0
5.0
10.0
15.0
20.0
25.0
0:00
0:45
1:30
2:15
3:00
3:45
4:30
5:15
6:00
6:45
7:30
8:15
9:00
9:45
10:3
0
11:1
5
12:0
0
12:4
5
13:3
0
14:1
5
15:0
0
15:4
5
16:3
0
17:1
5
18:0
0
18:4
5
19:3
0
20:1
5
21:0
0
21:4
5
22:3
0
23:1
5
With
draw
als
per
15 m
in s
egm
ent
![Page 14: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/14.jpg)
Maximize Restock Activities
Restock Activity for the Top 15 Units
0
5
10
15
20
25
30R
7
T4N
R11 R6
R12
R4N J4
R4W T6
W
R4S
BSH
2B H4
ED
RE
D
R13 J3
ADM Location
Nu
mb
er o
f R
esto
cks
Per
Wee
k
Restocks Before Restocks After
![Page 15: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/15.jpg)
Centralized Systems
• Inline Packagers
• Multiple vendors of JVMedi
• Carousels
• Multiple vendors
• Software is key
• Robots
• Swisslog
• McKesson
![Page 16: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/16.jpg)
Inline Packagers
• Essentially an oral solid packager
• Similar concept to the original ATC-212
• Both canister and on demand
• Utilizes bar-codes
• Can include 100-500 line items
• Can fill patient-specific strips
• Allows for bulk drug utilization
• Canister calibration, returns, and incompatibilities
![Page 17: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/17.jpg)
Carousels
• Great for inventory control• 2000-3000 line items
• Easily integrated to fill ADMs
• Can be used for first doses
• Integrated barcode capabilities
• Minimal training required• Lighted prompts are very helpful
• Handles virtually unlimited package sizes
• Returns and restocking a challenge
![Page 18: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/18.jpg)
Centralized Dispensing Robotics
• Picks patient-specific meds to envelope, ring, or bin
• Bar-coded individual doses
• Very good inventory control
• Generally error free
• Simple crediting and restock process
• Limited pharmacist check
• Will likely reduce technician labor
• Space considerations and packaging
![Page 19: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/19.jpg)
The Trade Off
Pharmacy
ConvenienceNursing
ConvenienceRobots ADMs
Hybrid
![Page 20: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/20.jpg)
The Hybrid Option
PROS• Can take advantage of different
technologies
• Synergies do exist
• Especially effective for larger hospitals (>200beds) and IDN’s
• Flexibility of dispensing methodology, based on the drug
• Can maximize the benefits of each type of automation
CONS• More equipment to justify
• More equipment to manage
• Interfaces
• Integration can initially be time consuming
![Page 21: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/21.jpg)
Patient Safety Concerns
• Decentralized Automation• Misfills
• LASA
• Stockout delays
• Matrix drawers
• Overrides (errors have been reported as high as 11.7%, with 1.7% resulting in actual patient errors¥)
• Centralized Automation• LASA
• Bar-coding errors
• Return/Discontinue accuracy
• Bin restocking with Carousels
¥ Kester Ket al. Hosp Pharm. 2006;41:535-537.
![Page 22: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/22.jpg)
Anesthesia Workstations
• Automated medication
documentation
• Some incorporate bar-code
scanning
• Can improve documentation
and charge capture
• Mixed provider feedback, but
generally positive
• Can be configured with most
stereo systems and iPods
![Page 23: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/23.jpg)
Additional Considerations
• Automation integration with • CPOE
• “Smart” Infusion Devices
• BCMA
• Bedside scanning and ADMs may not be the best mix• Nurse servers are somewhat attractive again
• Inventory space requirements (due to barcoded meds) may increase
• Company’s have experienced consolidation, and this will likely continue• Multiple solutions from one vendor
• Still opportunities for price negotiation
![Page 24: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/24.jpg)
IV Admixture Robotics for IV Admixture Robotics for IV Admixture Robotics for IV Admixture Robotics for
Acute Care HospitalsAcute Care HospitalsAcute Care HospitalsAcute Care Hospitals
![Page 25: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/25.jpg)
Robotic Systems
• Historically limited to TPN compounders
• Intellifill was first to market with syringe filling robotics
• Cytocare available in the US in November for chemotherapy compounding
• Currently functioning in Italy and the UK
• Riva is soon to be available for standard admixtures or chemotherapy
![Page 26: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/26.jpg)
Major Players for IV Robotics
IntelliFill Cytocare Riva
![Page 27: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/27.jpg)
Pharmacy AutomationChemotherapy Robot Video
![Page 28: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/28.jpg)
Robotic Admixture Systems
PROS
• Can automate very complex
tasks and manipulations
• Precision is significantly greater
than human capabilities
• Very high throughput
• Employee exposure reduction
• Reduced opportunities for
contamination
• Enhanced 797 compliance
CONS• IntelliFill requires adoption
of syringe program
• Can be costly, although ROIs are generally good
• Space considerations and potential construction
• More equipment to manage (downtime, interfaces, etc.)
• Riva and Cytocare are not tested in the U.S.
![Page 29: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/29.jpg)
Additional Automation Additional Automation Additional Automation Additional Automation
ConsiderationsConsiderationsConsiderationsConsiderations
![Page 30: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/30.jpg)
Single Vendor Advantage?
• Many vendors are leveraging their multiple
technologies to improve integration
• Omnilink to Omnicell ADM Example
• McKesson Robot, Carousel, and Cabinet Example
• Some have argued that best of breed is a better
solution
• Advantages and Disadvantages
![Page 31: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/31.jpg)
Vendor Selection Considerations
• Functionality
• Is an ADM an ADM?
• Total Product Offering
• Ongoing Product Development
• Service and Support
• Market Penetration and Growth
• Facility and System Considerations
• Cost and Value
![Page 32: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/32.jpg)
Return on Investment
• Vendors can assist with calculations, but they should always be validated internally
• Business plans are helpful
• Many installations will have a reasonable ROI• Personnel
• Tangible
• Intangible
• Mixed results in the literature• Depends on implementation effectiveness
![Page 33: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/33.jpg)
Pharmacy Automation
• Continued automation of manual tasks
performed by pharmacists and/or technicians.
• Refinement of existing technologies
• Automation outsourcing
• Packaging facilities, compounding facilities, etc.
• Health-system initiatives and co-ops
![Page 34: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/34.jpg)
Conclusion
• Important to understand advantages and disadvantages
of each type of automation
• Health-systems should develop an overall automation
plan based on current and future automation needs
• Optimization is critical to the success of the department
and improvement of the medication use process.
• A positive experience is dependent upon lots of work
and lots of data analysis (and lots of time)
![Page 35: Current Concepts in Pharmacy · PDF file(Trying to fill cabinets while nurses are vending meds) ... • Returns and restocking a challenge. ... chemotherapy compounding](https://reader031.fdocuments.in/reader031/viewer/2022030418/5aa503107f8b9a1d728c9bfc/html5/thumbnails/35.jpg)
DiscussionDiscussionDiscussionDiscussion