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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 1
2016 Pharmacy Education Series
May 18, 2016Optimizing Automated Dispensing Cabinets
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Featured Speakers:
Jack Bond, B.S., MHS Melody Barlow, RN, MSHA Market Director of Pharmacy Director of Pharmacy AutomationWesley Medical Center Community Health Systems
Submission of an online post‐test and evaluation is the only way to
Online Evaluation, Self-Assessmentand CE Credit
Submission of an online post test and evaluation is the only way to obtain CE credit for this webinar
Go to www.ProCE.com/CHSRx Webinar attendees will also receive an email with a direct link to the
web page Print your CE statement of completion online
– Credit for live or enduring (not both)
Deadline: June 17, 2016( l bl h d h h )
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CPE Monitor (applicable to pharmacists and pharmacy technicians)– CE credit automatically uploaded to NABP/CPE Monitor upon completion of
post‐test and evaluation (user must complete the “claim credit” step)
Attendance Code
Code will be provided at the end of today’s activity
Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 2
How to Ask a Question
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Accessing PDF Handout
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 3
2016 Pharmacy Education SeriesMay 18, 2016Optimizing Automated Dispensing Cabinets
Featured Speakers:
Jack Bond, B.S., MHS Melody Barlow, RN, MSHA Market Director of Pharmacy Director of Pharmacy AutomationW l M di l C C i H l h S
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It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing education activities. Faculty must disclose to participants the existence of any significant financial interest or any other relationship with the manufacturer of any commercial product(s) discussed in an educational presentation. Mr. Bond has no relevant commercial and/or financial relationships to disclose. Ms. Barlow has no relevant commercial and/or financial relationships to disclose.
Please note: The opinions expressed in this activity should not be construed as those of the CME/CE provider. The information and views are those of the faculty through clinical practice and knowledge of the professional literature. Portions of this activity may include unlabeled indications. Use of drugs and devices outside of labeling should be considered experimental and participants are advised to consult prescribing information and professional literature.
Wesley Medical Center Community Health Systems
CE Activity Information & Accreditation
ProCE, Inc. (Pharmacist and Pharmacy Technician CE)
– 2.0 contact hours
Funding:This activity is self‐funded through CHSPSC
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This activity is self funded through CHSPSC.
Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 4
Optimizing Automated Dispensing Cabinets
Jack BondJack Bond
Market Director of Pharmacy
Wesley Health Systems
Wichita, Kansas
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• 760 Bed Teaching Hospital/Regional Level 1 Trauma Center
• 2 Freestanding EDs• 82 Bed Cardiac Specialty Hospital• Wesley Children's Hospital
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 5
Wesley Pharmacy Operations
Cli i l S i 3 hift d 24/7 Clinical Services 3 shifts per day 24/7
91% of Clinical Staff are Board Certified
5,280,000 doses last year
Central Pharmacy Operations are Staffed with 1 Pharmacist per shift
2 Satellite Locations (Surgery and Pediatrics)
8 Ph R id t 8 Pharmacy Residents
147 Pyxis Locations
All remote Operations served from Central Pharmacy
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Learning Objectives
O tli t t i t t d t i ti i ADC Outline strategies to prevent product expiration in ADCs
List strategies in deciding products to stock and products not to stock in ADCs
Describe the appropriate use of available reporting tools to optimizing ADCsto optimizing ADCs
Discuss the potential financial impact of well managed ADCs
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 6
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 7
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Total Doses from ADUs
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 8
Automation Optimization Goals
R d th ti t i th ADC hil l Reduce the time spent managing the ADCs while also maintaining nurse satisfaction
More effectively utilize medication inventory
Reduce the inventory value maintained the ADCs to enhance cash flow for facilitiesenhance cash flow for facilities
Reduce Outdated inventory in ADCs
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Automation Optimization Expectations
M thl t f “M d N t R d” f l t 90 d Monthly report of “Meds Not Removed” for last 90 days should be evaluated and execution of removals for all stations
Quarterly analysis of Min/Max levels should be conducted
Ensure Outdate Tracking is utilized and technicians are Ensure Outdate Tracking is utilized and technicians are checking outdates while loading and refilling new medication via audits
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 9
Strategies to Prevent Product Expiration and Optimize Medication
Management in ADCs Technician Engagement and
Ownership
Teams
Certification and Promotion
Technician Leads
Expectation Setting
Assign a Pharmacist for Delivery
Data Tracking with Goals
ifi i Verification
Pocket Min/Max
Automate Process
Stock Rotation
BORING!!
Make it FUN! 17
Strategies to Prevent Product Expiration and Optimize Medication
Management in ADCsN A d P k t Non Accessed Pockets
Knowledge Portal
Standard Stock Management
Standards around Standards
Clinical Review of Cabinets
Involve your clinical specialists
b d h d l Review based upon schedule
Purchasing Impact
Economic Order Quantity
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 10
Strategies for Product Selection for Stocking in ADCs
H M H lth S t Ph i i th US? How Many Health System Pharmacies are in the US?
Major System Decisions
Minimalist
All doses
Evaluate “I can’t find” “Where’s my med” “Have you sent” callscalls
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Strategies for Product Selection for Stocking in ADCs
Wesley’s Systems
Load everything that can fit inside a pocket or tower
Update every 1-2 hours around the clock
Manage by 80-20 Rule
A_B_C Items
A Class– 20% of products that account for 80% of the drug budget
B Class - 15% of products that account for 15% of the drug budget
C Class– 65% of products that account for 5% of the drug budget
Daily Responsibilities for Technicians Daily at Cabinet Refill
Refills with Barcode scanning
Stock Rotation
Outdates
Medication Unloads from Provided Reports
Patient Specific Med Removal
Cleaning
Refrigerator QA
Cabinet QAs 20
Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 11
Reporting Tools in Optimization of ADCs
Knowledge Portal
Executive Summary
# Meds > 2 loads and Unloads
# pockets without Vend > 90 days
Avg # of Stock Outs per Station
Avg. Removed Outdates per Station
Stock Out %
Less than 0.5% GREEN
Approaching Goal 0.5-1.5% YELLOW
BAD Greater than1.5% RED
Vend to Refill Ratio21
Meds Without Removal for Greater than 90 Days
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 12
Meds Without Removals 90 days
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Med Removals for Outdates
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 13
Vend to Refill Ratios
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Pocket Min/Max Recommendations
MedID DrawerSubdrawerPocket MedDescription DosageFo NumberO NumberOfRefills VendRefillRatio CurrentMin CurrentMax SuggestedMin SuggestedMax
ACETOT2505 11 | 2 | E6 acetaZOLAMIDE 250 MG TAB TAB 1 0 0 8 16 3 10
ASAC800T 10 | 2 | C6 MESALAMINE *HD* 800 MG TABLET.DR TABLET.DR 2 0 0 8 16 3 10
ASCOOT5007 9 | 2 | D4 ASCORBIC ACID 500 MG TABLET TABLET 1 0 0 4 10 3 10
ATROOL.2 20 | G IPRATROPIUM 0.5MG 2.5 ML INHAL.SOL INHAL.SOL 1 0 0 6 12 3 10
COLC0.6C 10 | 2 | E3 COLCHICINE 0.6 MG CAPSULE CAPSULE 4 0 0 6 12 3 10
COU3. 9 | 1 | D6 WARFARIN 3 MG TABLET TABLET 4 0 0 10 20 3 10
COUMOT10 1 16 | 2 | D3 WARFARIN 10 MG TABLET TABLET 1 0 0 2 4 3 10
COUMOT7.51 18 | 1 | E6 WARFARIN 7.5 MG TABLET TABLET 2 0 0 3 6 3 10
CYTOOT25 1 8 | 1 | D2 LIOTHYRONINE 25 MCG TABLET TABLET 1 0 0 4 8 3 10
D5‐0IPM20 28 | 22 D5W/0.45%NACL/20MEQ KCL 20 MEQ 1000 ML BAG BAG 2 0 0 6 12 3 10
DEMAOT1001 8 | 2 | C5 TORSEMIDE 100MGTABLET TABLET 1 0 0 2 4 3 10DEMAOT1001 8 | 2 | C5 TORSEMIDE 100 MG TABLET TABLET 1 0 0 2 4 3 10
DEP500ER. 8 | 2 | A2 DIVALPROEX ER 500 MG ER.TAB ER.TAB 1 0 0 5 10 3 10
DEPAOT2501 10 | 1 | D5 DIVALPROEX DR 250 MG TAB TAB 4 0 0 8 16 3 10
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 14
Min/Max/RemoveProcess Improvement
Q t l i f All L ti Quarterly review of All Locations
Break Down Locations
Assign Leaders
First time through will be difficult
Subsequent times through will be easier and less time required
Evaluate from Clinical and Distribution points of viewp
Standard Meds
Stat Requirements
Cost
Variation in Population severed
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Meds with Greater than 2 Loads/Unloads
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 15
System Improvement Opportunities
20% Dollar volume decrease in ADC inventory ($503 240 First year) 20% Dollar volume decrease in ADC inventory ($503,240 First year)
30% Reduction in Refills done per day (240 Lines per day not picked)
Technician Time Savings
Stock Outs of Less than 0.5% (Reduction of 45 stock outs/day)
Technician Time Savings
Decrease in Outdated Medications (Decrease of $425,310 in Outdates)
HAPPY NURSES
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 16
OPTIMIZING INVENTORY IN AUTOMATED DISPENSING CABINETSDISPENSING CABINETS
Melody Barlow, RN, MSHA
Director Pharmacy Automation
Community Health Systems
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LEARNING OBJECTIVES
Explain the need for initial optimization
Identify steps and tools to assist in initial optimization process
State where to find the most concise reports for changes needed
State the process for continued ADC inventory management
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 17
Complexities to Consider:
Multiple Sized Hospitals
M lti l Ph H
COMPLEX SYSTEM OF HOSPITALS
Varying sizes
Varying hours of Pharmacy Services
Staffing Constraints
Multiple Pharmacy Hours of Services
Varying Services Offered
Free Standing EDs Staffing Constraints
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COST CONTAINMENT
Rising drug costs Rising drug costs
New drugs launched into the market
Pharmaceutical reps detailing the latest and greatest new medications
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 18
ADVANTAGES TO ADC INVENTORY REDUCTION
Readily available pockets for assigning newly needed medications in the ADCs
Reduction in restock/refill/outdating times
Less inventory to count for both pharmacy and nursing
> 149 000 Pockets Without Vend Transactions in Q1 2016 > 149,000 Pockets Without Vend Transactions in Q1 2016 in Pyxis ADCs alone
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REPORTS AVAILABLE
Under-utilized Medications
CareFusion Knowledge Portal Meds Not CareFusion Knowledge Portal-Meds Not Removed in > 90 Days
Aesynt- Stock Management by Station (30 days)
Omnicell- Inventory Aging Report
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 19
SUGGESTED PAR LEVEL REPORTS
Let the ADC systems do the calculations for you
ADCs recommend minimums/maximums/par levels based upon vending historyvending history
CareFusion-Knowledge Portal--Vend/Refill Ratio
Aesynt -- AcuDose RX Optimization Report
Omnicell– Par vs Usage Report
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REVIEW INITIAL SET-UP
•Revisit “Standard” stock designations with nurse managers for each station
Change as minimums/maximums
Reduce ADC locations at which under-utilized medications are stocked if located in two ADCs in relatively close locationsy
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 20
MONITOR OUT DATES
Use Out Dating function of the ADC system Patient safetyReduction in waste dollars
Set with at least 90 day lead time for Expiration Dates
Review and act on reports monthly
Return out dates with 90 day lead time for credit or relocation to facilities in need
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INPHARMICS REPORTS
InPharmics performs the valuation of ADC stock for semi-annual inventories for our hospitals
Access to InPharmics Inventory Interactive Application is beneficial to our hospitals-blends the multiple reports necessary from ADC systems for ADC inventory optimization to a single place for review and decision-making
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 21
InPharmics® Inventory Interactive Operation
Entering the application
Select:• INVENTORY• INTERACTIVE• HOSPITAL
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Step 1
Click to sort in descending order to “work smart”
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 22
Step 2
Click on an item to OPEN the item and display all ADC Stations
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Step 3
Re-sort from lowest to highest VEND QTY
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 23
Step 4
Model changes for an ADC cabinet
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Step 5
Model changes for an Model changes for an ADC cabinet“what if” I change the MIN, MAX, or UNLOAD this med from this cabinet?
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 24
Step 6
Edited quantities for the model
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Step 7
Edited Cabinet
Running total on the impact of the modeled changes
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 25
Step 8
Edited 2nd Cabinet
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Step 9
Two edited cabinets
See increase after editing the 2nd
cabinet
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 26
Step 10
Generate a report to execute your modeled plan within your ADC system
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Step 11Example Summary Report
Includes:• All items modeled for change• Existing MIN—MAX—CURRENT QTY• Existing MIN—MAX—CURRENT QTY• Modeled MIN—MAX—QTY• Impact on MAX VALUE• Impact on INV VALUE
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 27
LEARN MORE!!
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SUMMARY
Inventory Reduction and Management in ADCs is an important project that can yield high dollar savings
Prioritize actions by high cost medications with low y gusage
Assign ADC Inventory Control to a “role” and monitor results with scheduled frequency
Capitalize on Out Dating Function in your system for credits or transfers of appropriate medications to sister hospitals with needsister hospitals with need
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Optimizing Automated Dispensing CabinetsCHS Pharmacy Education Series
ProCE, Inc.www.ProCE.com 28
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U d t C tU d t C t PhPhUpdate on Current Update on Current Pharmacy Pharmacy Initiatives and StrategiesInitiatives and Strategies
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Jerry H. Reed, MS, RPh, FASCP, FASHP
Corporate Director, Pharmacy Operations
Community Health Systems
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