Don’t dismiss the value of an operationally sound pharmacist

As pharmacists begin to move out of the physical pharmacy to the patient bedside I think it will become important not to forget the value of a pharmacist that is well versed in how to handle the operational side of pharmacy. Don’t get me wrong, I think pharmacists should be used more for therapeutics than for the role of physically dispensing medications. However, consider a practice model for pharmacy where technicians are more involved with the day to day operations and automation plays a bigger role in the dispensing process. In this instance a pharmacist will be needed for technician oversight as well as to control the workflow of the pharmacy. In addition that pharmacist will need to have intimate working knowledge of the automation and technology used in the pharmacy space. I don’t believe that a pharmacist needs to see every single item dispensed from the pharmacy, but I do think global oversight is necessary. There are opportunities for positive interventions in all aspects of acute care pharmacy practice.

I began my career as a “operational specialist”. The hospital where I was employed used a hybrid model of satellites and centralized dispensing. They needed stability in the dispensing area secondary to the pharmacist shortage. The pharmacy manager came to me and offered me a unique opportunity to handle the workflow in the main pharmacy from an operational standpoint. The hours were’t great, working Monday through Friday from 1:30pm until midnight, but it gave me a chance to try something new. I spent about a year in this role and found great value in the lessons learned through trying variations on the age old themes of cart fills, ADC replenishment, IV batches, etc. It was worth it.

Do I see the need for an operational specialist in acute care pharmacy? Perhaps, but not in the traditional sense. I see the need for a pharmacist trained in automation and technology with additional skills to manage people and workflow. After all, it is still important that patients receive their medications as safely and efficiently as possible. I envision a role similar to the one I’m in now, with the only difference being less focus on the clinical application of technology for a more mechanical one. Most informatics pharmacists handle both areas of technology now, but as clinical decision support, rules engines, computerized provider order entry, and so on become more prevalent it may become necessary to split the jobs into separate specialties; clinical pharmacy software and pharmacy automation and technology. There’s plenty going on in pharmacy informatics to justify such a design. Similar to pharmacists that have chosen to specialize in Cardiology or Infectious Disease, I think we’re headed for a time when informatics pharmacists will begin to tease out specialized roles in healthcare information technology.

Just a thought.

Imprivata OneSign Secure Walk-Away Technology

While at Innovations a couple of weeks back I stumbled across the Imprivata booth at the vendor expo. There were quite a few people gathered around the booth so I obliged my curiosity and squeezed in among the crowd. The Imprivata representatives were giving a demonstration of the company’s OneSign 4.5 application with Walk-Away technology. There must be something compelling about the Imprivata line of products as I found myself blogging about their OneSign Platform about this time last year.

The Walk-Away technology was impressive. As long as a user was standing in front of the computer camera they remained logged in. However, as soon as the user turned to walk away they were immediately logged out of their session. This is a significant step forward in managing those unattended workstations that one often finds throughout the hospital.

From the Imprivata website: “OneSign Secure Walk-Away closes a critical security gap in the protection of confidential information assets by automating the process of securing the desktop when a user ‘walks away’. Once a user has securely authenticated to the desktop using OneSign Authentication Management, OneSign Secure Walk-Away uses a combination of computer vision, active presence detection, and user tracking technologies to identify an authenticated user and automatically lock the desktop upon their departure.”

You can read more about the system here (PDF). Try as I might I could not find a video demonstration of the Walk-Away system; too bad really as the system has to be seen to be appreciated. I’m not a big fan of single sign-on systems (SSO) in general for various reasons, but I’m willing to reconsider my position when SSO is used in combination with biometric identification, voice recognition or facial recognition technology. It’s just too cool to ignore.

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Lots of Interest for the Samsung Galaxy Tablet

A small video showcasing some of the features of the Samsung Galaxy Tablet made its way around the internet this week. The slate tablet includes a 7 inch screen, Android 2.2, video calling – which I think will become more important as we move forward in healthcare – plus other features. The device is scheduled to make its official appearance on September 2, 2010 at the IFA in Berlin, Germany. Boy, would I like to attend that event.

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I like the look of the device, but only official reviews will tell me if the it’s any good. I’m concerned that the 7 inch screen might be too small, but this is consistent with recent tablet designs like the Cisco Cius and rumors of a new 7 inch Apple iPad. For me it makes more sense to design a tablet about the size of a standard legal pad, but there must be something to this 7 inch design as I assume manufacturers don’t waste their time and money on baseless design. I would really like to get my hands on this device.

Unforeseen barrier to tech-check-tech endeavor

I’ve been on a mission, however small it may be, to get pharmacy technicians more involved in the operational aspect of acute care pharmacy. And by more involved I mean using a tech-check-tech model to free pharmacists up for more patient related clinical activities. I’ve posted my thoughts on the use of tech-check-tech before.

The reason for rehashing the issue is due to a conversation I had with a colleague last week. This particular colleague and I were having a light hearted discussion over the possibility of using a tech-check-tech model with automated packagers like those I described in a post earlier this week.
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Automated unit-dose packagers for acute care pharmacy

State of Pharmacy Automation. Pharm Purch Prod. 2010; 8

I was doing a little Sunday morning reading and came across an interesting set of slides at the Pharmacy Purchasing & Products (PPP) website  (registration required to access the slides). I haven’t spent much time reading PPP Magazine, but I should because they always seem to have something good about pharmacy automation and technology in just about every issue.

Anyway, I’ve been looking at various automated packaging machines lately and thought the information at the PPP website was rather timely. According to information found at the site “After a slight dip in the number of facilities packaging medications in bar coded unit dose in 2009, this process realized a significant rebound in 2010. Nearly three quarters of all facilities now have such an operation in place. Hospitals taking advantage of the increased data capacity offered by two-dimensional bar codes also bounced back this year. In conjunction with these improving adoption rates, pharmacy directors are also reporting rising satisfaction rates with their operations. Despite a staunch minority that sees no need for a unit dose packaging operation, the vast majority of those without such a system plan to implement one shortly.” The graph in this post is from the PPP slide deck and shows the percentage of facilities using bar-code unit dosed packaging for medications over the past several years. This comes as no surprise when you consider the relative inexpensive nature of this technology when compared to other pharmacy automation, the ease of which it can be implemented and the push for BPOC in healthcare. Call it a perfect storm.
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“What’d I miss?” – Week of August 15, 2010

As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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Cool Technology for Pharmacy – Spiroscout Inhaler

The Spiroscout Inhaler Tracker by Asthmapolis is a small device that attaches to the top of an inhaler. The unit is GPS capable so that each time the inhaler is used, the GPS unit records the time the medication was taken and the patients location.

What a great tool to not only help asthmatics control their disease, but provide physicians with great real-time data. I suppose the next step would be to integrate devices like this into the electronic health record similar to what has been done with me blood glucose and blood pressure monitoring devices.

The Spiroscout Inhaler Tracker is used in conjunction with the Asthmapolis mobile diary to help patients map and track their asthma symptoms, triggers and use of medications.
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It may be time to consider robotic IV preparation at the bedside

Hospitals make a lot of intravenous (IV) preparations. That makes sense when you consider that most people admitted to the hospital are there because their acute illness requires more care than can be administered at home; not always, but in most cases. This is especially true for patients in the intensive care unit, i.e. the ICU.

A fair number of the medications used in the ICU are prepared on demand for a host of reasons including stability, differences in concentration, difficulty in scheduling secondary to rate variability, etc. Any pharmacist or nurse reading this will understand what I’m talking about. Example medications that fall into this category include drips like norepinephrine, epinephrine, phenylephrine, amiodarone and nitroprusside.

Last year I mused about using devices on the nursing stations designed to package oral solids on demand at the point of care. I still like the idea for several reasons, all of which can be found in the original post.  Based on currently available technology the same concept could be applied to preparation of IV products at the bedside. Robotic IV preparation has come a long way and these devices could be used at the point of care to make a nurses, and patient’s, life a whole lot easier. The use of robotic IV preparation at the bedside could reduce wait times for nurses and lesson the workload on pharmacy.
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