may 18 2016 webinar combined presentation slides...

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



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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 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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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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Total Doses from ADUs

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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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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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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



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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Meds Without Removals 90 days

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Med Removals for Outdates

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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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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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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 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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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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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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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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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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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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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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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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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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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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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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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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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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may 18 2016 webinar combined presentation slides...

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