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.

About 60% of our medication inventory is stored in the AutoCarousel system. Not unlike most acute care pharmacies the remaining inventory is scattered throughout various areas in the pharmacy: refrigerators, freezers, large shelving areas, etc. Items not stored in the carousels aren’t necessarily routed through the AutoPharm system, and thus don’t benefit from the software’s functionality.

Talyst is currently piloting a system that makes use of their AutoPharm software without the need for their AutoCarousel system. The pilot is designed to take advantage of the AutoPharm software in an area with static shelving. I prefer using the automated carousels for storage, but this new idea is ideal for smaller facilities with limited capital resources that might not be able to afford the AutoCarousel system. They get the benefits of AutoPharm at a greatly reduced cost.

Our facility is fortunate enough to be involved in the pilot. For the last several days I’ve been installing AutoPharm workstations at both our sub-acute facility and an additional AutoPharm workstation in our main pharmacy. The installation was quite painless and went amazingly smooth. The process consisted of getting the hardware peripherals connected to the PC, configuring the network connections and entering the inventory into the system; piece of cake.

The stand alone AutoPharm system consists of a POS-X PC117 workstation, a Code CR3 scanner and a Zebra ZM400 printer, and of course Talyst’s AutoPharm software.

According to the Talyst website:

AutoPharm

Inventory and Workflow Manager
The Talyst connected pharmacy uses powerful AutoPharm® software and a suite of hardware components to enable greater patient safety, improved efficiency, and control of your inventory. The unique AutoPharm software platform allows you to manage your complete pharmacy inventory from arrival to delivery. It works throughout your facility, even with multiple locations and multiple hospitals.

Patient Safety
• AutoPharm allows multiple bar code checks to receive, restock, and dispense medications Works with your current bedside verification system and unit-based equipment.
• Supports automated packaging and labeling to bar code virtually 100% of your doses
• Supports Automatic Canister Recognition Systems for accurate pharmacy packaging

Inventory Control
• Enables the creation of a real-time, perpetual inventory system
• Supports your current hospital information system and wholesale relationships
• Enables password-protected security to limit access to medication and data
• Enables centralized ordering and management
• Supports multiple pharmacy inventory locations

Workflow Efficiency
• Automates receiving, stocking, picking, and returns
• Synchronizes user tasks and system components
• Automates wholesale orders driven by actual usage
• Works with centralized or decentralized pharmacy distribution models
• Supports web-based ordering from remote departments or hospitals

According to the MTS website:

OnDemand ® 400 for RxMap ® is the first pharmacy automation equipment system designed specifically for multi-med adherence packaging.

This efficient system uses OnDemand technology to dispense multiple medications for a single patient quickly and accurately and in a fraction of the time it would take to do it manually. This pharmacy automation equipment system utilizes a custom interface to work with your existing information systems, enabling automated workflow management in the pharmacy. This single data input process reduces input time and the possibility of data entry errors. OnDemand ® 400 for RxMap ® uses bar-code technology to accurately dispense multiple medications into one compartment – as many or as few as needed. RxMap ® Adherence Packs vary in size and shape to meet the needs of the customers you serve. The finished product is a patient – specific adherence package filled “just-in-time” for your customer.

The OnDemand 400 system uses some of the same technology as our AutoPack system from Talyst. I’m speaking specifically about the use of bar-coded drug-specific canisters to house and dispense bulk medications.

I’m not necessarily a big fan of dispensing multiple medications into a single unit dose compartment, but this is very popular among nurses taking care of patients in the long-term care setting with multiple medications all due at the same time. I can certainly see where packaging multiple medications this way would save space in nursing carts and reduce the amount of waste associated with using multiple blister cards to package the same number of medications.

Thanks to Todd Eury over at PTR (Pharmacy Technology Resources) for pointing me toward the OnDemand 400 system via his post on LinkedIn.

For more information about the OnDemand 400 system see this case study or the product prochure (PDF)

Anyway, during one of my staffing days last week I found myself spending a lot of time around our AutoCarousels and AutoPack machine. The technicians had an unusual number of items to package in addition to a fair number of new items to teach to the AutoPharm formulary. After my umtenth time logging into the packager, it dawned on me that speech recognition would be a great thing to have; no keyboard, no mouse, just me talking to the machine. I wouldn’t need a password because it would recognize my voice.

Speech recognition isn’t an exotic idea. It comes standard with Windows Vista, and from what I’ve read works pretty well. It’s not even new to healthcare as a quick Google search revealed speech-enabled EMRs.

Speech recognition is based on a statistical approach that provides the probability of a given word sequence. The computer turns your voice into a stream of digital data and compares the signals to words in its dictionary, which is a database of commonly used words found in the English language. It’s not perfect, but it sure is neat.

Wouldn’t it be nice to walk up to my AutoPack and say “fill-sevelamer-800mg- tablets-quantity-fifty” and simply walk away? I think so. We could even give the packager a cool voice to answer with. How about a pirate: “Yarr matey, packagin’ fifty, 800mg sevelamer tablets. Argh.” Or maybe the voice of HAL from 2001 A Space Odyssey: “Good morning, Jerry. Initializing packaging sequence. Your sevelamer tablets will be available in approximately 2 minutes, 36 seconds.” Now, that would be cool. If only.

I can tell you from personal experience that the economic downturn is creating a negative impact on the implementation of pharmacy technology and automation. Several projects I’ve been working on didn’t make it past the chopping block for the next fiscal year. They include:

All the projects above were part of an overall plan to increase patient safety through the use of automation and technology. Unfortunately automation and technology is expensive and decisions must be made where to best use limited financial resources, no matter how painful. Luckily for me I still have plenty of work to do.

Northwestern Memorial Hospital provides a total of 873 beds in the Feinberg Pavilion, Prentice Women’s Hospital and the Stone Institute of Psychiatry. Northwestern has a very busy inpatient pharmacy that has worked through several obstacles to create a very efficient system of drug distribution. I spent about 90 minutes talking with their pharmacy automation manager, Dennis.

Pharmacy System – Cerner Pharmacy:  Northwestern uses Computerized Provider Order Entry (CPOE) with their Cerner Pharmacy System and are very happy with the combination. CPOE has given the pharmacists additional freedom to move out of the pharmacy to the bedside where they should be. Cerner offers a unique function called “automated pharmacist review”. When the physician utilizes a pre-programmed medication entry that meets a host of rules in the pharmacy system, the order is automatically marked as reviewed and doesn’t require additional pharmacist verification. An example of this might be acetaminophen 650mg orally every 4 hours as needed for mild pain. The order is checked against allergies, maximum acetaminophen per 24 hours, the most recent liver enzymes, etc. If the order passes all the rules, it’s automatically marked as reviewed and placed on the patient’s profile as an active medication. Northwestern is in the process of implementing this feature now.

Automated Storage / Packaging – AutoCarousel, AutoCool (soon), AutoPack (500 canister model – utilizing just about a quarter of the packager’s capacity): Northwestern utilizes their AutoCarousel and AutoPack in much the same fashion as Kaweah Delta does with one major exception. They choose to store both unit-dosed items packaged by AutoPack and bulk bottles of the same medication in their carousels. Kaweah Delta chooses to package on demand and store unit-dosed medication from AutoPack in the carousel only when absolutely necessary. I can see pros and cons to both methods. Like Kaweah Delta, Northwestern has difficulty controlling inventory and dispensing refrigerated medications. There is no way to force users to go through the AutoPharm software for dispensing items stored outside the carousel. AutoCool offers a nice solution. I’ll be calling Dennis in a few months to get his take on the new hardware.

Automated Dispensing Cabinet (ADC) – Omnicell: I felt that Omnicell was an interesting choice for Northwestern’s automated dispensing cabinets (ADC) as Pyxis appears to be the de facto ADC among hospitals at the moment. However, it appears that several features offered by Omnicell may prove more advanced than Pyxis, including single, vending machine style dispensing of controlled substances. Dennis described Pyxis architecture as “antiquated” and had several examples to back it up. My lack of knowledge regarding Omnicell left me at a disadvantage. It will be interesting to see whether or not Omnicell will overtake Pyxis in the near future as the ADC of choice for hospitals.

Overall, Northwestern has designed a very efficient drug distribution model that takes full advantage of their automation.

ADUs provide varying degrees of access to medications for distribution to patients. The machines are located on the nursing units for obvious reasons and offer great advantages to pharmacy. Some of these advantages include:

ADUs are filled with medications in ready to use, unit-dosed packages. Pharmacies don’t always receive medications in unit of use packaging and will often times unit-dose the items from bulk containers prior to placing them in the dispensing machines. Our bulk packager of choice is AutoPack from Talyst. There are other, similar products on the market, but none offer the same cluster of conveniences as Talyst.

Talyst has a system similar to AutoPack called InSite that is used specifically in Long Term Care (LTC) facilities and prison systems. With InSite loose tablets are placed in a medication canister fitted with a computerized chip used to identify the medication contained inside. Instead of unit dosing the bulk tablets prior to placing them in an ADU, the canisters are placed directly into InSite where they are unit-dosed on demand. For all intents and purposes, InSite becomes the ADU (more information can be found at the Talyst website). In LTC this eliminates the need for the familiar “punch cards” thus reducing waste, and makes access to medications much easier for nursing. The system reminds me a lot of our AutoPack unit.

As I look at the InSite system I wonder if a similar system could be used in the acute care setting. Some customization would be necessary, but it would eliminate the intermediate step of having to unit-dose bulk medications prior to loading them in the ADU. Currently we not only unit-dose medications on demand, but store them in our automated carousel as well. Placing the packager on the floor would eliminate the need to store the unit-dosed items in the pharmacy. We currently stock our ADUs with enough medication for between 14 and 30 days, so placing an entire bottle of something in a canister for use on the floor wouldn’t be excessive. Of course this is dependent on the medication, the nursing unit and typical use patterns.

I immediately see three advantages to using an on demand unit-dose dispensing system on the nursing unit:

1. Decrease the amount of technician and pharmacist time in the pharmacy. The process of unit-dosing a medication in the pharmacy currently consists of a technician filling the medication canister, a pharmacist checking the canister, the technician unit-dosing the item and finally the pharmacist signing off on the final product (not including the pull and check prior to loading in the ADU). The item is then taken to the floor and placed in the ADU. If the bulk packager was taken out of the pharmacy and placed on the nursing unit, the process would look something like this: the technician would fill the canister, the pharmacist would check it and it would be taken to the floor and placed in the packager at the nurses station. The location of the canister in the packager is irrelevant because the canister and medication are identified via the embedded computer chip. In other words, you can’t put the canister in the wrong location.

2. Increased storage space. There would be no need to store unit-dosed medications in the pharmacy that were already available in bulk on the nursing unit.

3. Increased safety by eliminating a step in the distribution process. If you want to increase efficiency and increase safety, simplify the process. Adding steps can only increase your risk for mistakes. See the AHRQ website for an interesting piece on safety and unit-dose packaging.

A system like this would not be without it’s difficulties. Adding yet another dispensing machine to each nursing unit would be costly as well as create integration issues. Also the space needed for this scenario will likely be larger than current methods. However, the dynamics of a system that provides the access of a current AUD like Pyxis, combined with the on demand unit-dose dispensing capabilities of a system like InSite would be pretty slick. It’s just a thought.

Below are some of the responses I’ve received from readers:  

Me: Free text comment field in the formulary that prints on the AutoPharm labels. Simple things like ** look-alike-sound-alike ** or ** do not tube to floor **, etc. 

Them: I’ve added this to our requirement list for our next version.  Our final scoping is happening over the next few days so I’ll keep you in the loop on whether it gets in.

Me: The ability to place filters on items from within the AutoPharm software. If an item will never be filled in Pyxis, then I don’t want it showing up on my Pyxis fill. A small check box in the AutoPharm formulary that reads “do not include in Pyxis fill” or “do not fill” would be greatly appreciated. I really don’t need to see another label for “Pharmacokietics Protocol”. AutoPharm currently has options to exclude non-formulary items, but the function needs to be more flexible. Currently I work directly with our Pyxis engineer to filter items as necessary.

Them: We have a feature that may satisfy your need, as long as you want to filter drugs at a system level and not at a MedStation level. In your Pyxis console, assign the meds you don’t want to fill through AutoPharm with specific med classes (e.g. narcotics) .  Then in the Talyst ADUI configuration screen, filter out these med classes.  These won’t be fulfilled by AutoPharm.

Me: The ability to track incorrectly scanned medications. Knowing how often the AutoPharm software prevents the pharmacy from sending the wrong medication to a patient is important. It is also important to understand under what circumstances (i.e. increased workload, staffing shortage, etc) this occurs. There is literature to support attaching a dollar amount to these “near misses” and the people that write the checks around here love that type of information.

Them: I’ve added this to our requirement list for our next version.  I’ll keep you in the loop on whether it gets in.

Me: Lot number and expiration tracking. This information is valuable for tracking FDA recalls and for keeping outdated medications off the floor.

Them: This is scoped for our upcoming Patient Safety release!

Me: 2-D barcode option for AutoPack and AutoLabel.

Them: We are currently able to print 2D labels.  Please work with Technical Support on this.

Me: Large touch screen monitors for the carousels. It appears this may already be an option. I look forward to trying them out.

Them: Yes, touch screen monitors can be used.  However, the AutoPharm application has not been written with touch-screen in mind, so some of the interface may be challenging to use in a touch-screen situation.

Me: Smaller CPUs for the carousels. I’ve heard rumors that this has already been done, however I have not seen them myself.

Them: Yes, you are correct.  This is underway.

Me: Light sensitive packaging for AutoPack. It doesn’t happen often, but occasionally we are forced to use other, less reliable methods of unit-dosing our medications secondary to light sensitivity of the tablet in question (ondansetron comes to mind).

Them: For a 70 x 70 mm packet, USP [Section 661 on Containers and light transmission] states the container cannot allow more than 10 % of light of any wavelength between 290 and 450 nm into it.  The UV light spectrum has an upper limit of 400 nm, so in essence we are focused on UV.  Typically, a yellowish brown tint is added to plastic vials and containers in various degrees for just such a purpose, but as you’re aware our current film does not incorporate such a feature.  Such a feature would need to be investigated for feasibility.

Me: A monthly news letter from Talyst detailing new ways to use their products would be great. There is always someone smarter, harder working, more motivated and better informed than me, and those are the people I want to hear from.

Them: Great idea!  I love it.  Talking with the folks here about this.

Me: The one recommendation I have for Pyxis is to allow for scanning of the medication barcode in leu of the PARx barcode. Scanning the label creates an additional step and introduces an opportunity for error (i.e. wrong label attached to the drug). Pyxis says that it’s not possible due to the number of medications on the market, but I say it is possible because our entire barcode database resides in the AutoPharm formulary.

Them: This functionality is available. What you would need to do is get a hold of your Pyxis engineer and have them do Scanned Code Maintenance in the Procar. They have to teach all the medications scans to Pyxis (similar to you scanning barcodes into AutoPharm). This would allow the technicians to scan the medication at the station. A few things to know is that I believe you need to have the new resident scanners at the stations. These would be with 3500 or 4000. The older scanners cannot read some of the RSS stacked 14 barcodes or some 2D barcodes that manufacturers are printing now. The other thing is that I believe if you use this functionality it will not populate the qty picked. - This reply is great because I have asked Pyxis about this very thing and always been told it couldn’t be done. All I could ever say was “oh”. Now that I’ve been educated the conversation will be a little bit more interesting.

Maybe this whole “internet thing” is worth while after all.

Overall, we have been very pleased with our barcoding system. I wish all platforms ran as smoothly as our Talyst products. However, there is always room for improvement. I understand that Talyst is currently working on a “big” new release of their AutoPharm software that is focused on patient safety. I don’t have specifics, but it is possible that some of the items listed here are already in the works.

Things I would like to see in future AutoPharm/AutoPack/AutoLabel products include:

♦ The ability to modify the time limit for Ordered Meds Not Loaded (OMNL) reprints. Our facility is > 90% Pyxis for medication distribution. We do a lot of OMNLs each and every day. AutoPharm is smart enough to tell us we have an OMNL, just not patient enough to give us time to fill them before spitting out a duplicate request. This results in the same medication getting stacked on the counter before the first can  be loaded. We ended up turning the OMNL notification feature off.

♦ Better integration among AutoPharm, AutoPack and AutoLabel. I would like to have a single formulary to manage and be able to manage it from any location.

♦ Free text comment field in the formulary that prints on the AutoPharm labels. Simple things like ** look-alike-sound-alike ** or ** do not tube to floor **, etc.

♦ The ability to place filters on items from within the AutoPharm software. If an item will never be filled in Pyxis, then I don’t want it showing up on my Pyxis fill. A small check box in the AutoPharm formulary that reads “do not include in Pyxis fill” or “do not fill” would be greatly appreciated. I really don’t need to see another label for “Pharmacokietics Protocol”. AutoPharm currently has options to exclude non-formulary items, but the function needs to be more flexible. Currently I work directly with our Pyxis engineer to filter items as necessary.

♦ The ability to track incorrectly scanned medications. Knowing how often the AutoPharm software prevents the pharmacy from sending the wrong medication to a patient is important. It is also important to understand under what circumstances (i.e. increased workload, staffing shortage, etc) this occurs. There is literature to support attaching a dollar amount to these “near misses” and the people that write the checks around here love that type of information.

♦ Lot number and expiration tracking. This information is valuable for tracking FDA recalls and for keeping outdated medications off the floor.

♦ 2-D barcode option for AutoPack and AutoLabel.

♦ Customization of AutoPack and AutoLabel barcodes. Currently the AutoPharm system does not recognize the difference between a unit-dosed, barcode ready medication generate from AutoPack and a bulk bottle of the same medication stored in the carousel. The barcodes both utilize the NDC number as the unique identifier.

♦ Customer defined reports. I would like to see Talyst build a robust report writer or give customers access to the data tables. The model reports are good, but there is always more information I would like to have. Anyone can collect data, but few people actually know what to do with it.

♦ Large touch screen monitors for the carousels. It appears this may already be an option. I look forward to trying them out.

♦ Smaller CPUs for the carousels. I’ve heard rumors that this has already been done, however I have not seen them myself.

♦ Light sensitive packaging for AutoPack. It doesn’t happen often, but occasionally we are forced to use other, less reliable methods of unit-dosing our medications secondary to light sensitivity of the tablet in question (ondansetron comes to mind).

♦ A monthly news letter from Talyst detailing new ways to use their products would be great. There is always someone smarter, harder working, more motivated and better informed than me, and those are the people I want to hear from.