Information on the Baxa website is lacking to be sure, but they do list the following:

The Repeater Pump is the first step to automating your pharmacy. It features motor strength and programming to pump even viscous fluids easily. With a delivery range from 0.2 mL to 9.9 L, The Repeater Pump is the market leader for pharmacy fluid transfer applications. Includes power cord, foot pedal and Technical Manual. One-year warranty.

Specifications:

Volume Entry Range: 0.01 to 9,999 mL
Water Flow Rate Maximum: 13.5 mL/second(16G needle)
Accuracy: ± 10% at 0.2 mL
Accuracy: ± 5% at 0.4 mL
Accuracy: ± 2% at 1 mL
Accuracy: ± 1% at 2 mL
Minimum Dispensing Volume: 0.2 mL

More information can be found here (PDF).

Baxa offers a nice set of videos for demonstration here. Unfortunately there was no option to embed them in this post.

One Nucleus: “The technique will allow faster identification and resolution of any manufacturing quality problems but will also prove invaluable as an anti-counterfeit measure because the specific coding and validation systems are almost impossible to copy.

Currently most components within diagnostic kits, medical devices and other healthcare products and equipment are ‘stamped’ with a lot code at the point of manufacture. However, these codes are of limited use for quality improvement unless products are produced in very small batches. As a result, regulatory bodies across the world are now putting manufacturers under increasing pressure to invest in much more sophisticated traceability systems, while manufacturers are looking for effective ways to prevent the growing problem of counterfeiting of pharmaceuticals and other healthcare products.

The breakthrough approaches being developed by Innomech will enable manufacturers to mark products with a code that is either unique to the item or shared by only a small number of items produced together.

The codemark is an unobtrusive two-dimensional dot matrix identifier that is linked to a look-up database. In effect the matrix code acts as a ‘key’ to access much more detailed information, such as the specific batch codes of raw materials used during production, the time of manufacture, the production line and so on. A version of the database could be accessible online for anyone to verify the item is genuine.

The codes can be printed or laser etched onto products, applied to virtually any substrate and can even be added onto the surface of pharmaceutical capsules or coated tablets. Matrix codes can be as small as 2 mm by 2 mm holding the code for up to 10 billion numbers. The codes can be read by widely available readers or in many cases from a picture taken with even the simplest camera phone, making them ideal in the battle against counterfeit medicines.”

This is an interesting approach to an age old problem. I wonder if this technology could be used to embed drug information directly on the medication as well, an idea that I hijacked from the Nursetopia website where Joni Watson muses that “Both companies and pharmacies could add a QR code/Microsoft Tag to the medication label for patients and/or healthcare professionals to scan and directly access the patient medication information sheet.” Why not put the QR code directly on the medication itself? Why not indeed.

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.

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.

Most read posts over the past 7 days:

1. Automated unit-dose packagers for acute care pharmacy
2. Best iPhone / iPod Touch Applications for Pharmacists
3. Cool Technology for Pharmacy (June 18,2009 – Alaris Smartpumps)
4. Unforeseen barrier to tech-check-tech endeavor
5. It may be time to consider robotic IV preparation at the bedside
6. Musings on the “cloud”
7. Is the 30-minute rule for medication administration good or bad?
8. Using the concept of the iPad to further pharmacy education
9. Moving storage around in the “cloud”
10. Barcodes on patient wristbands

Top searchterm phrases used over the past 7 days:

1. “alaris pump”
2. “transparency ”
3. “black cloud”
4. “cloud computing cartoon”
5. “alaris iv pumps”
6. “robot rx“
7. “pharmacy informatics
8. “example admitting order“
9. “ipod applications, pharmacist“
10. “patient wristbands“

.

.

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.

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.

The 2010 Lawbook For Pharmacy, which is available at the California Board of Pharmacy website, has provisions for the use of tech-check-tech in certain situations. I’m referring to Title 16, Division 17, Article 11, Section 1793.8 –Technicians in Hospitals with Clinical Pharmacy Programs, which reads:

(a) A general acute care hospital, as defined in Health and Safety Code 1250 (a), that has an ongoing clinical pharmacy program may allow pharmacy technicians to check the work of other pharmacy technicians in connection with the filling of floor and ward stock and unit dose distribution systems for patients admitted to the hospital whose orders have previously been reviewed and approved by a licensed pharmacist. Only inpatient hospital pharmacies as defined in 4029(a) that maintain a clinical pharmacy services program as described in 4052.1 may have a technician checking technician program as described. The pharmacy shall have on file a description of the clinical pharmacy program prior to initiating a technician checking technician program.
(1) This section shall only apply to acute care inpatient hospital pharmacy settings.
(2) Hospital pharmacies that have a technician checking technician program shall deploy pharmacists to the inpatient care setting to provide clinical services.
(b) Compounded or repackaged products must have been previously checked by a pharmacist and then may be used by the technician to fill unit dose distribution systems, and floor and ward stock.
(c) To ensure quality patient care and reduce medication errors, programs that use pharmacy technicians to check the work of other pharmacy technicians pursuant to this section must include the following components:
(1) The overall operation of the program shall be the responsibility of the pharmacist-in-charge.
(2) The program shall be under the direct supervision of a pharmacist and the parameters for the direct supervision shall be specified in the facility’s policies and procedures
(3) The pharmacy technician who performs the checking function has received specialized and advanced training as prescribed in the policies and procedures of the facility.
(4) To ensure quality there shall be ongoing evaluation of programs that use pharmacy technicians to check the work of other pharmacy technicians.

The problem with the above section of pharmacy law is the part that says “(b)Compounded or repackaged products must have been previously checked by a pharmacist and then may be used by the technician to fill unit dose distribution systems, and floor and ward stock” because in the previous section of the law book – Title 16, Division 17, Article 11, Section 1793.7 – Requirements for Pharmacies Employing Pharmacy Technicians – it states that “(a) Except as otherwise provided in section 1793.8, any function performed by a pharmacy technician in connection with the dispensing of a prescription, including repackaging from bulk and storage of pharmaceuticals, must be verified and documented in writing by a pharmacist.” It’s kind of a circular reference, but basically says you can’t use tech-check-tech on tablets packaged by an automated packager.

I originally thought I could get an exemption to the rule, but my college was kind enough to point me to the January 2005 issue of The Script Newsletter from the California Board of Pharmacy. That particular issue addresses tech-check-tech related to items packaged through the use of automation. In the article the Board states that “Any licensee implementing such a protocol will be subject to discipline for any errors that do occur (as would any licensee responsible for errors from any other delivery system). It is possible the severity of the violation may even be greater where the error could have been caught had not such a sampling protocol been in place.” The article goes on to say that “In the absence of any statutes or regulations exempting a dispensing pharmacist or pharmacy working with an automated drug delivery system from the general requirements pertaining to prescription accuracy and propriety of drug delivery, it is the responsibility of the dispensing pharmacist and pharmacy to ensure 100 percent accuracy of the dispensing. Licensees electing to save costs by reducing their level of error checking do so at their own risk and that of the patient.”

I have to say that the opinion of the Board makes absolutely no sense. To assume that having a pharmacists eyes look at something is better than a technicians eyes is ignorant. In addition, the use of an automated packager is a safe and effective way to unit-dose tablets. The use of an automated unit-dose packager with tech-check-tech combined with a well-developed QA audit process is a win-win situation for both pharmacy practice and patient safety. I just don’t understand the logic of the Board.

I plan to contact the California Society of Health-System Pharmacists (CSHP) to see what they can do to help me correct this egregious oversight in the law. I’m also hoping that the American Society of Health-System Pharmacists (ASHP) will address issues like this at the upcoming Pharmacy Practice Model Initiative Summit in November. Don’t let me down boys and girls.

Most read posts over the past 7 days:

1. It may be time to consider robotic IV preparation at the bedside
2. Cool Technology for Pharmacy (June 18,2009 – Alaris Smartpumps)
3. Best iPhone / iPod Touch Applications for Pharmacists
4. Update: Siemens Innovations 2010 final day
5. Musings on the “cloud”
6. Update: Siemens Innovations 2010 parting thoughts
7. Is the 30-minute rule for medication administration good or bad?
8. Musings on poor resource management in healthcare
9. About
10. Moving storage around in the “cloud”

Top searchterm phrases used over the past 7 days:

1. “black cloud”
2. “transparency ”
3. “medication reconciliation”
4. “cloud computing cartoon”
5. “cool pharmacy”
6. “capsule machine”
7. “alaris iv pumps”
8. “lxe 8650 + “ipad” –ipod”
9. “medscape mobile”
10. “alaris pump”

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.

Among the methods for unit dosing medications 36% of respondents in the PPP presentation were using high-volume unit dose packaging machines. A cursory internet search revealed the following key players in the high-volume unit dose packaging race:

PACMED by McKesson

“The PACMED™ high-speed packager automates bar-code packaging of oral solid medications, improves packaging accuracy and pharmacy workflow efficiencies, and facilitates the transition to scanning bar-coded medications at the patient’s bedside.
Key Benefits

• Shrinks cabinet fill time by 70%(1).
• Reduces oral solids packaging labor by 65%(1).
• Reduces medication costs through bulk buying.
• The ROBOT-Ready™ model:
  • Increases ROBOT-Rx® system packaging productivity by 300%.
  • Optimizes ROBOT-Rx inventory by reducing offline inventory.
  • Facilitates the pharmacist check via the Drug Image Library.

Automated packaging uses significantly less labor, optimizes inventory levels, and enables bulk medication buying. The intelligent PACMED packager works virtually unattended to fulfill orders electronically, replenishing for carts, cabinets, pharmacy stock and multiple sites.

The PACMED packager automatically tracks medications by lot numbers and expiration dates, ensures refilling and perpetual inventory through bar-code verification, and standardizes bar-code formats to facilitate bedside scanning.

It also is highly scalable, accommodating from 100 to 500 line items, flexible with three sizes of storage canisters and two sizes of packages with the ROBOT-Ready model.”

(1) Weizer, Michele (June 2006) The bigger packaging picture.Pharmacy Purchasing & Products, pp. 14, 16.

ATP High-Speed Tablet Packager by Swisslog

“Swisslog’s ATP system(available only in North America) is a versatile packaging solution that provides easy filling and refilling of medications through high-speed dispensing, accurate labeling of medication pouches, flexible printing package sizes and bar-coding. The packager interfaces with pharmacy information systems for automatic replenishment of unit-based cabinets, patient carts or nurse servers.”

Additional information can be found here and here (PDF)

AutoPack by Talyst

“AutoPack Oral Solid Packaging System

AutoPack™ integrates easily with your pharmacy system to provide a fully automated packaging system for oral solid medications.

• Automate 100-500 oral solid medications with a single AutoPack
• Delivers unit-dose or multi-dose packages in a compact footprint
• Provides 19 lines of user-defined label space
• Processes up to 60 doses per minute, recognizing priority orders for immediate packaging
• Supports packaging other oral solid medications not stored on the AutoPack with an easy-to-use Special Tablet System tray
• Works seamlessly with AutoCarousel to expedite cart fills, order replenishment, and canister refills

Comprehensive

• When used with AutoLabel, supports barcoding virtually 100% of your medications
• More affordable than contract or outsourced options
• Scaled to support any size healthcare organization
• Barcodes can be defined to assure readability by your bedside scanning system

Easy to Use

• Pharmacy staff can readily support proven, effective barcoding methods
• Nurses appreciate labeling that is easy to read and scan
• Administrators, clinicians and patients are assured that a scan-ready bar code makes it all the way to the bedside

ATP Series Automatic Tablet Packager by TCGRx

“ATP SERIES AUTOMATIC TABLET PACKAGER

The industry’s most advanced pouch packaging solution, incorporating TCG’s exclusive SkipMed functionality. The ATP Series takes control of the automation of your entire stock of oral solids by dispensing current and new batches or fill external tray medications on the same screen simultaneously. The system permits narrow dose packaging to fit into nurse carts and cabinets as well as larger, multi-dose dispensing.”

The ATP scalable series is available in 128, 256, 320 and 384 medication canister models.”

More information is available here (PDF). In addition, the website had the nifty little video below. The ATP system by TCGRx offers some nice features that I haven’t seen before. Take a look for yourself.

ATP Series from TCGRx on Vimeo.

It’s interesting to note that the PACMED system from McKesson and the AutoPack system from Talyst are remarkably similar, while the Swisslog and TCGRx system resemble one another.

I found several other systems for bar-code unit dose packaging, but they were smaller units that wouldn’t fall into the same category as those above. An example of these smaller units would be the ever popular Cadet by Euclid. Every acute care pharmacy I’ve ever worked in has a Cadet. In fact, many facilities have both a high-volume unit-dose packager as well as a smaller unit like the Cadet secondary to need.

Feel free to leave information in the comment section below on any other high-volume automated packaging system you’re aware of. I would be happy to update the post with the information.

Update August 28, 2010
===================================

Based on feedback received over the last week I have additional information to share regarding automated unit-dose packagers.

In the original post above I mentioned that it was interesting that PACMED from McKesson and AutoPack from Talyst were remarkably similar, while the Swisslog and TCGRx systems resembled one another. It turns out that the reason for the similarities is that both Talyst and McKesson distribute the JVM packaging system while Swisslog and TCGRx distribute the Sanyo packaging system. To go one step further it appears that the TCGRx ATP series packagers are distributed through Swisslog, and are in fact the same machine.

Two additional packagers to add to the list thanks to reader comments:

Medication Packager from Omnicell

The Omnicell® Medication Packager is a bar code system for the central pharmacy that enables pharmacists to improve dispensing accuracy, increase their productivity, and lower their overall costs.
Features

• Automated unit-dose medication packaging.
• Intelligent Order Routing option establishes picking processes based on user-defined settings.
• Automatic packaging resume capability allows replenishment of medications or packaging supply without restarting the batch.
• Supports patient-specific dispensing with labeling and contiguous medication packaging.
• Adapts to any distribution model.
• Automated Canister Recognition System (ACRS).
• Special Tray System (STS) allows preloading of infrequently used medications into a universal tray for in-line packaging with other canister medications—there is no need to stop production.
• WorkflowRx server available in physical server and virtual server platforms (VMware Ready).

AutoPharm by CrePharm

This can be a little confusing as CrePharm refers to their system as AutoPharm, which is same name used by Talyst for the medication management software used on their carousels here in the US.

The English is a little rough on the CrePharm site as it is a translation from Korean, but you can get the idea by reading through the information for yourself.

A couple of things that caught my eye about this packager was the use of “Free Shape Packaging” (FSP) and CrePharm’s “T slider system”. According to the manufacturer’s website the FSP technology allows automated packaging of “half tablet and all shapes of tablets, and medicines without cassette. When you fill FSP with all sorts of tablets such as half, specific shapes, or low frequency tablets and only put the container on a cup holder at the lower part, AutoPharm automatically completes dispensing and leftover tablets will be automatically collected.” It sounds like a concept similar to the STS system used by AutoPack from Talyst, but appears to use a different methodology. Unfortunately I couldn’t find more specific information at the CrePharm website.

The “T slider system” gives users access to a small number of canisters at one time instead of having to open large shelving units to access a single canister. It’s nothing earth shattering, but it is a neat concept.

- The Expendables was #1 at the boxoffice last weekend. My wife and I saw it today. Good movie. My family and I took in The Other Guys last weekend. It wasn’t great, but it wasn’t bad either. You really have to be in the right mood for Will Ferrell’s brand of humor.

- It looks like HP has finally confirmed the rumors that there will be a webOS tablet. “In their earnings call today, HP responded to a question about whether or not tablets (read: iPad) were hurting netbook sales. In reponse, HP publicly confirmed that a webOS Tablet is coming in the timeline we were expecting, saying they will release “a webOS-based product in Early 2011.” While it’s good to hear that the webOS tablet will indeed make it to market, I fear that “Early 2011” will be too late. The technology would be a welcome addition now, but who  knows what Apple and Android tablet manufacturers will be doing twelve months from now.

- Check out the new Dragon Medical Mobile Search App at the Apple App Store. The application allows clinicians to dictate a search query. Check out the video below for a demo. It reminds me a lot of the search functionality built into the Droid.

- GigaOM has an interesting article on the use of the term “cloud”, and insinuates that it may have outlived its usefulness. “Cloud computing as a term is misplaced, problematic and unhelpful.” I’m not sure I agree with that statement completely, but I see where the author is coming from. The popularity of “cloud computing” is forcing the vocabulary to evolve. That’s nothing new. I recommend we just roll with it.

- Speaking of the cloud, Symantec “announced the successful compatibility testing between Symantec Health, a cloud-based medical image archiving solution, and Siemens Healthcare’s picture archiving and communication system (PACS) solutions.” Radiology gets all the cool stuff.

- PhysOrg.com: “As part of its new iMedEd Initiative, the medical school has developed a comprehensive, iPad-based curriculum, reinventing how medicine is taught in the 21st century and becoming the first in the nation to offer entering students a completely digital, interactive learning environment.” – The article makes several general references to what is included on the iPads received by new medical students, but doesn’t really go into specifics. Two things come to mind:

1. I would really like to get my hands on one of the iPads supplied by UC Irvine to see how it’s set-up.
2. Pharmacy schools should pay attention and keep an eye on the UC Irvine iPad experiment. They might just learn something.

- An article in the Archives of Internal Medicine (Arch Intern Med. 2010;170(15):1331-1336) discusses the benefits of using Clinical Decision Support with CPOE in patients greater than 65 years of age. The article concluded that “Specific alerts embedded into a CPOE system, used in patients 65 years or older, can decrease the number of orders of PIMs quickly and specifically.”

- The Toshiba Libretto W100 is a little dual screen UMPC multi-touch computer. It’s a slick machine that can be yours for the low, low price of $1,100. But you better hurry as the Libretto W100 is a limited run. You can read more about it in this Engadget preview from July of this year or see some great photos of it at the Pocketables website.

- EMR Daily News: “Researchers from Boston University School of Medicine (BUSM) report that physicians who use an automated, electronic medical record (EMR) tracking system to follow-up on patients with an abnormal Pap test could increase the number of women who achieved diagnostic resolution and have women achieve resolution in less time than using traditional methods.” – The use of EMRs for information like this will become more prevalent as ARRA funds start trickling in.

- KevinMD has an article talking about the indiscriminate use of healthcare resources, in this case lab work, driving up the cost of healthcare. When I was a pharmacy student we had one simple rule for ordering labs: only order a lab if you need it to direct therapy. If the outcome of the lab won’t make any difference in how you treat the patient, then don’t order it. Simple.

- HealthCare IT News: “A small pilot study at Nationwide Children’s Hospital in Columbus, Ohio, found that sending text reminders to adolescent diabetes patients about their insulin treatments improved treatment adherence and blood glucose levels.” – It makes sense that texting teens is an effective way of communicating, just ask my kids.

- Download Squad is reporting that we may see a Google Tablet running Chrome OS as soon as November 26th, i.e. Black Friday this year. One can only hope.

- Some guy named Rolf Potts is trying to travel around the world without carrying any luggage; just a ScottVest tropical jacket and cargo pants. Talk about packing light.

- San Diego Business Journal: “Pairing tablet computing and wireless communication has the potential to push health care into new realms of quick and portable access to information and response, and San Diego stands to be at the epicenter.” – At least someone gets it. The article goes on to say some pretty interesting things.

- AJHP News reports on the positive impact that pharmacists can have on The Patient-Centered Medical Home (PCMH). I mentioned the idea of pharmacist involvement in PCMH back in June 2009. The idea is as good now as it was then.

- Finally, the NFL season has officially started. Pre-season is in full swing. I’ve been watching replays on the NFL Network all week. It’s going to be a great season.

Have a great weekend everyone.