Jerry Fahrni

Pharmacy Informatics and Technology

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Category Archives: Automation

Going cartless

Posted on January 24, 2011 by Jerry Fahrni
5 Comments

I spent some time recently speaking with the director of pharmacy (DOP) from a large acute care facility about operations and various dispensing models. In this particular instance, the hospital utilizes a cartfill model, decentralized pharmacists in satellites to handle first doses, batched IV’s and automated dispensing cabinets for pain meds and other “PRN” medications.

At one point the conversation drifted toward a discussion of using a cartless dispensing model. The DOP wasn’t a fan. The reason cited was a fear that utilizing automated dispensing cabinets in a cartless model would create a workflow logjam in the pharmacy as the entire day would be dedicated to “massive ADC [automated dispensing cabinet] fills”. I understand the thought process, but have found through experience that this simply isn’t true. In a well-constructed workflow a cartless model is quite efficient.
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Categories: Automation | Tags: ADC, Pharmacy Automation, Pharmacy Technology, PPMI, Workflow

Who’s to blame for the lack of advancement in pharmacy automation and technology?

Posted on November 14, 2010 by Jerry Fahrni
4 Comments

Without question there is a lack of advanced automation and technology in the acute care pharmacy setting. Spend some time in several acute care pharmacies if you don’t believe me. There’s clearly a need for it, but it’s just not being used.

I am a fan of automation and technology in any setting, but especially in the acute care pharmacy. I believe that the continued use, development and advancement of pharmacy technology should be a key component of any plan to change the current pharmacy practice model. Unfortunately, the situation is problematic because current pharmacy technology is either poorly designed for the needs of the pharmacy or the pharmacy in which it is used has a poorly designed workflow that doesn’t take advantage of it. Why is that? Who’s to blame; someone, anyone, no one? Valid questions.
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Categories: Automation, Technology | Tags: ASHP Midyear, Pharmacy Informatics, Pharmacy Technology, PPMI

Why automated medication kiosks could be good for pharmacy practice

Posted on September 14, 2010 by Jerry Fahrni
3 Comments

I followed a little banter on Twitter this weekend regarding the use of automated dispensing kiosks to dispense medications to patients instead of using a physical pharmacy. There are many pharmacists out there that believe the use of automated medication dispensing in the outpatient arena is bad practice and separates patients from their pharmacists. I don’t share their sentiment. I’ve blogged about these devices before, here and here, and believe they could be used to improve the pharmacist-patient interaction. I actually had the opportunity to watch an InstyMeds Prescription Medication Dispenser in action under a physician dispensing model late last year and thought it was well done.

It is unclear to me why pharmacists fear these machines, but it reminds me of the fear surrounding automated dispensing cabinets during their inception back in the day.  Now they’re an integral part of acute care pharmacy practice. Perhaps pharmacists believe that patients won’t get the necessary consultation and instruction that they would had they visited their local retail pharmacy. As one that has worked in a retail pharmacy environment, albeit briefly, I don’t buy into that belief. Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.

I would argue that placing kiosks in certain locations could improve medication therapy management and patient compliance. The odds of a mother with a tired, cranky, ill child going out of her way to visit a local retail pharmacy at midnight is much lower than grabbing a prescription at an automated dispensing machine in the urgent care clinic following the child’s exam. It certainly couldn’t hurt. Now throw in a consultation from the pharmacist prior to going to the medication kiosk and you have a winning combination.

Kiosks certainly wouldn’t fit every situation, but there is certainly room in the pharmacy practice model for their thoughtful use. Think about it.

Categories: Automation | Tags: Automation, Medication Safety

Unforeseen barrier to tech-check-tech endeavor

Posted on August 25, 2010 by Jerry Fahrni
No Comments

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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Categories: Automation | Tags: Bad, Pharmacy Technology

Automated unit-dose packagers for acute care pharmacy

Posted on August 22, 2010 by Jerry Fahrni
27 Comments

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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Categories: Automation, Barcoding | Tags: AutoPack, BCMA, BPOC, Pharmacy Automation

It may be time to consider robotic IV preparation at the bedside

Posted on August 17, 2010 by Jerry Fahrni
4 Comments

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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Categories: Automation | Tags: Automation, Cool Stuff, drug delivery, Patient Safety, Pharmacy Technology, RIVA, Robotics

Participating in the ASHP Summer Meeting from afar #ashpsm10

Posted on June 5, 2010 by Jerry Fahrni
2 Comments

The inability to physically be in Tampa, FL shouldn’t stop someone from participating in the ASHP Summer Meeting. Technology doesn’t care that I’m 2700 miles away or that I’m sitting in my home in my bunny slippers with Diet Pepsi in hand. With a webcam and speaker phone I was able to join a user group discussion held by Talyst.
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Categories: Automation, Barcoding | Tags: ASHP, ASHP Summer Meeting, AutoPharm, BCMA, BPOC, Talyst

Update on AutoPharm software only pilot

Posted on June 2, 2010 by Jerry Fahrni
2 Comments

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.
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Categories: Automation, Barcoding | Tags: AutoPharm, BCMA, Pharmacy Automation, Talyst

Carousel technology article in AJHP

Posted on June 1, 2010 by Jerry Fahrni
2 Comments

AJHP: “Implementation and evaluation of carousel dispensing technology in a university medical center pharmacy (Am J Health Syst Pharm 2010 67: 821-829)

Results. The estimated labor savings comparing the preimplementation and postimplementation time studies for automated dispensing cabinet (ADC) refills, first-dose requests, supplemental cart fill, and medication procurement totaled 2.6 full-time equivalents (FTEs). After departmental reorganization, a net reduction of 2.0 technician FTEs was achieved. The average turnaround time for stat medication requests using CDT was 7.19 minutes, and the percentage of doses filled in less than 20 minutes was 95.1%. After implementing CDT, the average accuracy rate for all dispense requests increased from 99.02% to 99.48%. The inventory carrying cost was reduced by $25,059.

Conclusion. CDT improved the overall efficiency and accuracy of medication dispensing in a university medical center pharmacy. Workflow efficiencies achieved in ADC refill, first-dose dispensing, supplemental cart fill, and the medication procurement process allowed the department to reduce the amount of technician labor required to support the medication distribution process, as well as reallocate technician labor to other areas in need. ”

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Categories: Automation, Barcoding | Tags: AutoCarousel, BCMA, BPOC, Carousel, Pharmacy Automation

Today’s presentation on pharmacy automation

Posted on April 30, 2010 by Jerry Fahrni
10 Comments

The health care system I work for, Kaweah Delta Health Care District, uses quite a bit of automated technology from Talyst in our inpatient pharmacy. Well, today I spent the day in Bellevue, WA with the good folks from Talyst talking about all kinds of pharmacy automation and technology.

The day started with me giving a brief presentation at their quarterly meeting about Kaweah Delta’s experience installing Talyst equipment, and ended with a tour of their warehouse facility in Preston that included a peak at their process for managing and testing canisters for their AutoPack Oral Solid Packaging System; very interesting stuff.

Talyst was a wonderful host and I had a great time visiting their facilities and speaking with a bunch of very intelligent and interesting people. I learned a lot and had fun at the same time. You can’t ask for more than that.

View more presentations from Jerry Fahrni.
Categories: Automation, Barcoding | Tags: Pharmacy Automation, Talyst
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