A couple of months ago we became a beta site for a Talyst AutoPharm software only solution. It’s not really a “software only” solution as it consists of a POS-X PC117 workstation, a Code CR3 scanner and a Zebra ZM400 printer, and of course Talyst’s AutoPharm software, but there are no carousels attached to it.
We currently utilize software and hardware from Talyst to manage a sizable chunk of our inventory by running it through two automated carousels. If you’re interested you can see photos of the installation back in 2008 here. As we use a decentralized pharmacy model and dispense a majority of medications directly from automated dispensing cabinets, i.e. Pyxis, our entire pharmacy workflow revolves around these two carousels. However, there are still some areas of the pharmacy inventory that are not easily managed with the carousels, including the refrigerators, the freezers, items in the IV room and some of our large volume products that require a significant storage area. Talyst offers a solution for the refrigerated areas called AutoCool that we chose not to use, but the other areas remain a challenge. With the availability of the AutoPharm software only solution we’re able to place a workstation strategically in the pharmacy to cover some of these areas by creating static “carousel” shelving where there are no physical carousels; same idea as the carousels, they just don’t move.
Two areas that were of particular interest to me were an area in the main pharmacy affectionately called “the wall“, and our two offsite satellite locations, especially the sub-acute facility which is just down the road from the main campus. The pharmacy on the main campus and the sub-acute pharmacy couldn’t be more different. The pharmacy at the main campus is a busy acute care pharmacy that processes over a thousand orders and dispenses several thousand unit-doses each day for a census of nearly 400, while the sub-acute pharmacy processes less than 50 orders per day for a census of less than 30. The main campus pharmacy is open 24/7, while the sub-acute pharmacy is open Monday through Friday 8:00am-12:30pm. The main campus pharmacy is responsible for nearly 100 Pyxis med stations throughout the hospital, while the sub-acute pharmacy maintains only a handful. And so on.
The installation at the main campus was a breeze as we were simply adding to the existing system. Once installed, the technicians quickly integrated the new area into their workflow. There was no confusion and it took less than a day for the technicians to become comfortable with the location of the new workstation. With the addition of the workstation we’ve been able to shave about 30 minutes off our a.m. Pyxis fill, which is our largest fill of the day. In addition the number of items that are pulled from the wall on a daily basis without going through the AutoPharm system has decreased. I attribute this to the new workstation being in line-of-sight of the pick area. In addition, during the installation of the new AutoPharm workstation we uncovered an interface problem that may have never been discovered; can you say serendipitous. The HL7 message for several of our  premixed piggyback medications was arriving at the AutoPharm system with a quantity of zero. It had something to with custom programming in the HL7 within Siemens Pharmacy that was erased when we upgraded in late 2009. I wonder how something like that could have gone on for several months without being noticed. Since discovery, the item has been added to the test plan for future upgrades. I’ve found no appreciable difference in Pyxis fill errors, although there were very few to begin with. I’ll probably have to collect 6-12 months worth of data just to make a realistic comparison.
The sub-acute facility has been a different story altogether as the installation completely changed their workflow. The sub-acute pharmacy consists of a single pharmacist and a single technician that had their workflow ironed out prior to installing the AutoPharm system. Over the past several weeks, and with a little bit of hand-holding, they’ve integrated the new system into their operations pretty well. It took a little getting used to, but they’ve adapted. The ordering appears to be slightly smoother than before secondary to the tight inventory control offered by the combination of limited personal, AutoPharm’s inventory tracking and integration with the wholesaler. In addition I’ve turned on the Pyxis PARx feature at the sub-acute facility to close the loop between the pharmacy and the Pyxis. No problems so far. In my opinion the PARx system works quite nicely when combined with liberal use of Cubies in the Pyxis med drawers.
The only thing that appears to be less efficient for the sub-acute pharmacy is the re-stocking process. At the main campus the orders arrive in various totes that are separated on to carts and taken to their prospective areas to be put away. The system works well as the AutoPharm workstations are in close proximity to the storage areas so the technicians can see the computer screen while putting the order away. However, the sub-acute facility is slightly different as the screen on the AutoPharm workstation is either too far away or obscured as the technician moves around the pharmacy while restocking.
I’ve had several calls with Talyst since the pilot project started and one of the possible solutions to the line-of-sight issue at the sub-acute facility is to use a handheld computer with a small screen that the technician can view in place of the larger monitor while putting the order away. There are no immediate plans for testing, but the idea seems plausible. The technology appears to favor this solution as I’ve found a few scanners that might fit our needs. Examples of scanners with this functionality include the Motorola MC3100 series mobile computer and the Intermec CK31ex. The other option would be to mount the AutoPharm workstation on a mobile cart, a.k.a. COW. The workstation already has a small enough footprint we would just have to ensure wireless connectivity for it to work.
Other than that things have been going quite smoothly. The AutoPharm software has several potential uses throughout the facility. In addition to implementing in several other areas of the main pharmacy, I see the system being beneficial in a satellite setting. Considering the addition of our new tower and the probable addition of at least one pharmacy satellite in the next 12 months, that’s a good thing.
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