New Automation & the Pharmacy Buyer

Laurie Price RPhT, CPhT Mercy San Juan Medical Center

Background

260 Bed Hospital with new construction adding 110 new beds

New Electronic Health Record system installed prior to completed construction

8 new Automated Dispensing Machines in addition to 41 existing ADMs

2 new Carousels

Pharmacy Automation

There have been numerous automation devices introduced into pharmacy with in the last twenty years all designed to provide an efficient and safer way of dispensing medication to patients. They include, but are not limited to: Pre-packaging machines Unit based cabinets Robotics Carousels

Over the years more Companies and Vendors have entered the marketplace providing more comparisons and choices to meet the needs of the Pharmacy, governing standards, and patient safety goals.

Objectives

Description: Pharmacy Inventory Management Automation

Advantages/Disadvantages Expectations and establishing a timeline Preparations: Testing and building the Database Loading the Carousel, training and establishing the

Workflow Implementation and Adjustments Ordering Maintenance Final Thoughts

What is a Carousel?

What is the Carousel?

A computerized and automated inventory management system consisting of machinery, a network of computers, printers, scanners and hand-held devices

Why? Inventory

Management Quick Annual and

Semi-Annual Physical Inventory Count Reports

Time Medication Safety Space Utilization

Advantages Provides comprehensive inventory management Contains 90% of Inventory Tightens Inventory and decreases shrinkage Reduces cart fill times (saves 2+ hrs/day) Provides smart queues Decreases med errors through bar-coding

-Has the potential to capture expiration dates and lot numbers

Provides reports on inventory adjustments for ordering

Documents discrepancies Controls access via usernames/passwords

Disadvantages Only one person at a time controlling

each carousel Missing Bar-codes Items not accurately counted and

adjusted especially remote items Increased potential in technical

problems-Reliance on remote servers-Potential server shut downs

Tedious for Put-Backs

Expectations and Establishing a Timeline Initial plans

-more than a year in advance Meetings with project managers

-builders: Specs-vendors: Requirements

Estimation of completed construction and “Go-live” date set

Database Entry and IT testing-starting 6 months prior to Go-live

Teambuilding and Extensive Setup

Preparations: IT Testing and Building the Database Simultaneous IT testing and Database Build Core Team Development

-Pharmacy Technician/Buyers-Pharmacists-Facility IT Specialist-Automation Vendor Interface Analyst-Automation Vendor Implementation Specialist-Automation Vendor Training Specialist-IT Implementation Team/Facility Electronic Health Records System Liaison

Weekly Progress Meetings

Building the Database in the Vendor’s Automation Catalog and gathering information Vendor Specifications Excel Format Time consuming

manipulation of data Weekly transfers of

database information to Vendor Training Specialist

Why the Buyer?

Where to get information? Wholesaler reports (3 years of purchase history

recommended) Hospital Formulary Databases GPO Reports Wholesaler item look-up Buyer’s knowledge Combination of reports and programs

Special Circumstances and Considerations Wholesaler change with less than 3 years

purchase history Bid Role-Out Using correct NDC numbers Meeting established timeline goals Mandatory data Communication with Pharmacy Informatics

Specialist 1000 hours of data entry

Gaining access to the Carousel

Construction Access to pharmacy

areas Installation of

machinery prior to Go-live

Set-up

Loading the Carousel Assigning locations, levels, totes and bins Determining space needed Fast-movers

-levels 1 and 2 Separating “look-alike/sound-alike” Using “tall” shelves Using scanners Printing labels for bins

-Bar-coded item number for locations Minimal amounts of product and empty

packaging used for initial loading Using PBC (Product Bar Code)

-Case Bar Code-Package Bar code-Individual Item Barcode

Training Buyer’s were trained on the Ordering Process Minimal amounts of product was ordered via carousel

workflow computer and used for initial stocking of carousels

Pharmacy Buyer experience to help facilitate training A team of Pharmacists and Technicians were assembled

to help with the initial load of the carousels Repetitive actions used to familiarize Pharmacists and

Technicians with carousel The team members were utilized to train other staff The team presented their ideas on workflow Sign off sheets and training overviews were used.

Implementation and Adjustments

Capture and identify potential problems and workflow changes before Go-Live-Inventory split by use, not alphabetical

Setup model as Technician-centric

Timing is Everything

Set to move all medication from old pharmacy into the new pharmacy overnight

Go-Live day limited to filling all orders from the new pharmacy and Carousels

Workflow Adjustment

Enforce Communication-Flyers

-Meetings-Written Instruction aids

Computer or People Problem? Verify Interfaces

-Staff and Missing labels Reports

Post Implementation Surprises“Whenever we computerize a medical process to reduce

errors, there is always the risk that new errors will be introduced”- Larry Ozeran, MD

Wrong item loaded into bins Missing Barcodes Wrong Item associated with Barcode Items not loaded into Carousels

Post Implementation Fixes

Establish Remote Access to Carousels Adding Hand-Held Devices Adding the Carousel computer program

and Scanners to more computers Rescheduling cart fills and batch picks

Ordering Process Orders can be Automatic or

Manual All items are set with

Min/Max levels Distributor item numbers Pricing Packaging information Quantity levels

Orders can be manipulated in the order manager program

Orders can be interfaced with the distributor’s ordering program

Receiving Process

Order Invoice can be received Electronically or Directly

Product Bar Codes are used for receiving directly

Received items are stocked to a queue in the Carousel for efficient restocking

Order status on items are displayed while carousel is being used

Has capabilities to return items to Distributor

Ordering Process Limitations

Once a purchase order is sent it must be received and restocked before another order is placed to avoid double ordering

Large order restocking can disrupt workflow

Remote area items may be missed due to incorrect inventory adjustments

Maintenance Buyers designated for formulary maintenance of database-New item entry and associations-Maintain price schedules-Interfacing

Inventory-Set par levels-Efficient stock qty management

Export inventory needs to specific distributors

Reporting functions

Getting it right

Organization Communication Teamwork Not only building a good relationship with

vendor, IT, and construction, but the individual people representing those entities

Final Thoughts

“We are continually doing formulary maintenance to make sure that we are compliant with

formulary standards. However, the benefits of the carousel for inventory management and workflow have outweighed this extra task.

Before we used to over order too many items, but now we have a much leaner inventory and a

faster safer workflow.” -Kelly Huang, CPht

Questions