In the Clean Room: A Review of Technology-Assisted Sterile Compounding Systems in the US [report]

For the better part of the past year I’ve been working on a project with Mark Neuenschwander of The Neuenschwander Company looking at technologies used in pharmacy clean rooms to prepare sterile compounds.

The research into this area took much longer than originally anticipated. We discovered along the way that this subject is much more complex than it appears on the surface. Information is difficult to find, some of the technologies are little more than marketing material on a company website, and the subject matter is in its infancy.
Continue reading In the Clean Room: A Review of Technology-Assisted Sterile Compounding Systems in the US [report]

On demand controlled substances dispensing at the point of care (NarcoMedic®)

NarcoMedic is a product from Pearson Medical Technologies. Pearson is a small company out of Alexandria, LA. They’ve made a business out of bar code labeling and packaging technologies. You’re probably most familiar with their iPackRx unit dose packager and m:Print software; either as the direct product or possibly as an OEM’d version for another company.

A colleague sent me a marketing email a few days ago from Pearson announcing NarcoMedic, a “decentralized management platform” for controlled substances. It caught my attention as I thought about something like this several years ago.

As with other automated dispensing units, NarcoMedic is designed to dispense medications at the point of care, i.e. nursing unit. With that said, what caught my attention were the following points:

  • Tabletop design – 38”H x 23”L x 32”D. Med rooms tend to be cramped. It’s nice to have the option for a small unit.
  • Packages and dispenses in individual patient-specific bar coded packages (packages on demand from storage locations)
  • Packages and dispenses tablets, vials, ampules and syringes in individual packages.

Pretty interesting. As I said, it’s not a new concept, but perhaps it’s time has come. Regardless, it’s nice to see someone out there trying something new.

Continue reading On demand controlled substances dispensing at the point of care (NarcoMedic®)

Cool Pharmacy Technology – Verification by MedKeeper

I had an opportunity to spend some time at MedKeeper headquarters in Westminster, CO last week. I’ve worked with MedKeeper before, but this was the first time I had the opportunity to visit the facility and meet their team.

MedKeeper is a company that makes several products for acute care pharmacy, specifically they develop software targeted at pharmacy operations. Some of you may know them for their medication tracking system, MedBoard.
Continue reading Cool Pharmacy Technology – Verification by MedKeeper

Homegrown medication tracking at Children’s Hospital Boston

Children’s Hospital Boston is a 395-bed children’s hospital located in the Longwood Medical Center area of Boston Massachusetts. It’s a pretty cool place near Harvard School of Medicine as well as the Massachusetts College of Pharmacy and Health Sciences; not to mention that it’s literally right across the street from the famous Brigham and Women’s Hospital.

I’ve had the pleasure of visiting Children’s Hospital and receiving a grand tour of the pharmacy and all its operations. The Pharmacy Director and IT Pharmacist have a great vision for what can be accomplished with the appropriate use of pharmacy automation and technology. They’re both quite practical about their decisions in this area.

The pharmacy itself makes great use of technology like the Cerner Pharmacy Information System, carousels, high-speed automated packagers, DoseEdge IV Workflow Management system, as well as a homegrown medication tracking system, which I found fascinating. The medication tracking system has been in use for some time now. Children’s built the system themselves, which makes it all the more impressive. You just don’t see that kind of thing these days.

The Director of Pharmacy at Children’s Hospital Boston provided me with a link to the YouTube video below. The video shows the nuts and bolts of their medication tracking system. While not detailed, it’ll give you a general idea of what it does.

High-speed unit dose packagers for pharmacy

There are a lot of pharmacies out there that utilize high-speed packagers for one reason or another. Sometimes medications aren’t available in unit-dose packages from the manufacturer, or in one case that I came across recently, a pharmacy may elect to package from bulk bottles for efficiency and/or cost savings.

I haven’t given much thought to high-speed packagers in a while because they seem to be a low priority in many pharmacies these days. But I had reason recently to give them some thought. Someone sent me an email asking me about the various high-speed packagers on the market, who sells them, who they’re made by, etc. So I put together the table below. It covers the basics.
Continue reading High-speed unit dose packagers for pharmacy

Stanford University Medical Center Pharmacy site visit [07 31 2013]

I just rolled in the door from Palo Alto, where I spent most of the morning visiting the Stanford University Medical Center inpatient pharmacy. And why not, I didn’t have anything else to do today. I picked up the phone, connected with the Director of Pharmacy, Mike Brown and was on my way.

First and foremost, the inpatient pharmacy at Stanford is nice. It’s also quiet, which is a bit unusual for a pharmacy servicing such a large facility. Interestingly enough most of the non-IV related medication distribution is handled with the use of very little automation; there’s an interesting story to go along with that.

The pharmacy at Stanford has a large investigation drug service (IDS) area, which is responsible for handling approximately 300 active drug trials at the moment. Impressive. They use IDS management software called Vestigo integrated with Epic to manage everything. It’s pretty slick.

My reason for the visit wasn’t for the non-IV medication distribution or IDS, however. What I really wanted to see was their IV room, and the associated distribution process. I’d heard through the grapevine that they were using a product called Phocus Rx to manage their chemotherapy preparation. I wrote about Phocus Rx in March of 2012. I’ve heard a lot about the system over the past year, but had yet to see it action.

The IV room didn’t disappoint, it was great. They let me change into scrubs, gown up and spend about 90 minutes in the cleanroom watching the pharmacist and technicians run through the process. It’s been a long time since I’ve done anything like that. It felt good. There was something right about it.

As far as Phocus Rx goes, in my mind it’s basically a less feature-rich version of DoseEdge (post Feb 2010). Both systems use cameras and software to manage workflow, but that’s about where the similarities end. Phocus Rx uses a different camera setup than DoseEdge, i.e. the camera is located outside the hood versus inside the hood, respectively. The other differences include how information is sent to the IV workflow system, different approaches to barcode scanning, inclusion/exclusion of clinical decision support tools, and their inclusion/exclusion of gravimetric analysis for dose verification. Phocus Rx is “considerably less expensive” than DoseEdge, although the exact dollar figures remain a mystery. Which one is better? Impossible to say. That question is completely subjective and depends on your needs.

The visit was interesting, and eye opening. The pharmacy personnel in the cleanroom were courteous, professional, and quite knowledgeable about the system. It was impressive to watch. I also learned a lot, which I will now add to my ever expanding personal database of IV room technology.

Saturday morning coffee [July 27 2013]

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

It’s been a while. I feel a bit rusty.

The coffee mug below is from the ASHP Summer Meeting Twitter contest in Minneapolis, MN in June. I took third place, which is a bit of a disappointing as I was the reigning champ for a couple of years back in the day. I’ve had the mug for a few weeks, but haven’t felt like posting so it’s just been sitting in my cupboard. Thanks to ASHP, I’m certainly happy to add it to my ever growing collection.

ASHP SM 2013 Twitter Contest Mug
Continue reading Saturday morning coffee [July 27 2013]

Fresh application of older healthcare technology

I came across an interesting article in the July issue of Pharmacy Practice News. The article describes some of the posters presented at the 2013 ASHP Summer Meeting in Minneapolis. The technology covered is relatively old, and a little antiquated when you look at much of the technology floating around the world these days. Nonetheless, this technology still represents opportunity in healthcare.
Continue reading Fresh application of older healthcare technology

Automating the oral pediatric syringe filling process [idea]

oral syringeThe distribution process in pediatric acute care can be quite a bit different than its adult counterpart. The basics are the same on the surface: 1) receive medication orders, 2) fill medication orders, 3) dispense medications. The big difference however is how those medication orders are filled. Pediatric patients require a lot medications in liquid form pulled into oral syringes with patient specific dosages. The bummer is that a vast majority of these syringes are not manufactured in unit of use syringes. In other words you have to do most of the work yourself. It’s a bit of a hassle, but it has to be done. The process of pulling liquid doses into oral syringes has more in common with work done in the IV room than it does with traditional oral solid distribution.

Recently I was visited a pediatric hospital and watched this process in action. Based on what I witnessed I started to wonder if it was possible to automate the process. And if you could automate it, would it offer any benefit? I suppose it could increase the safety of the process as well as potentially eliminate the need for a pharmacist, freeing them to do something else. Maybe. Maybe not. Regardless, it was worth more thought.

I started breaking down the process and realizes that it’s more complex than it appears on the surface; it always is. Automating the process would be difficult. Several pieces of the puzzle are already available today, but as completely disparate systems.

Just thinking out loud, or in writing as the case may be, the process would look a little like this:
Continue reading Automating the oral pediatric syringe filling process [idea]

Pharmacy tabletop unit-dose packager comparison [table]

Tabletop unit-dose packagers don’t get much respect, but have you ever been in a hospital pharmacy servicing more than 100 beds that doesn’t have one? I haven’t. Not to say that every pharmacy out there has one, but they’re certainly prevalent.

The Cadet by Euclid is pretty much synonymous for “tabletop unit-dose packager” in the pharmacy world. It’s akin to how people use the term Xerox to refer to any copy machine, or iPod for any mp3 player. So don’t be surprised if someone refers to your tabletop unit as a “Euclid” regardless of which one you have.

Anyway, I was doing a little research on the subject and thought I’d share my findings with you (table below). The one piece of data I don’t have is price; companies aren’t exactly transparent with that type of thing.
Continue reading Pharmacy tabletop unit-dose packager comparison [table]