Pharmacy Automation » Jerry Fahrni

Going cartless

Jan 242011

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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S.A.L.A.D.

Medication Safety 3 Responses »

Jan 042011

Sound-Alike, Look-Alike Drugs (SALAD) have recently floated to the top of my attention with the release of the Institute for Safe Medication Practices (ISMP) recommended list of Tall Man Letters for look-alike drugs. I mentioned the new list on Twitter which resulted in a short, but interesting conversation with some colleagues.

SALADs have been problematic for quite some time and many solutions have been proposed, including Tall Man Lettering, physical separation of look-alike drugs, printing of both brand and generic names on packaging and storage bins, use of colorful warning labels, and so on and so forth. The problem with all these solutions is human involvement. Working in acute care pharmacy has taught me over and over again that all the above systems may decrease error, but certainly don’t eliminate them.
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Cool Technology for Pharmacy – Pentapack HP500

Cool Technology 4 Responses »

Dec 172010

There really aren’t too many machines out there designed to unit dose liquids on a scale small enough for the needs of an acute care pharmacy in a hospital. So when I came across the Pentapack HP500 in the ASHP Midyear exhibit hall I took notice. As demonstrated at ASHP Midyear, the machine is capable of unit dosing both oral solids and oral liquid medications. That’s rather unique functionality that deserves some attention.

Unfortunately the Pentapack website is void of useful information, which is really a shame because the HP500 is a neat little device.
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#ASHPMidyear 2010 part deux

Pharmacy Informatics 2 Responses »

Dec 062010

Today was a great day to be at ASHP Midyear 2010. Things really got going as the sessions were kicked into high gear and the exhibit hall officially opened.

I spent the day tracking down pharmacy automation and technology. Did you really expect me to do anything else? I don’t ever recall being as excited as a clinician as I am being an informatics pharmacist. Anyway, here are some things I found interesting:
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Cool Technology for Pharmacy – Baxa Repeater Pump

Cool Technology 4 Responses »

Sep 022010

The Baxa Repeater Pump is a pretty cool piece of pharmacy technology. The device automates many of the repetitive processes used in filling oral syringes, oral dosage cups, syringes used for injection and reconstituting medications used to mix intravenous medications in the acute care setting. I remember working in a pediatric facility and watching the technicians fill thousands of oral syringes with liquid acetaminophen and ibuprofen for use in automated dispensing cabinets throughout the hospital. With the use of the Syringe Filling Fixture, and the automated pump setting on the Repeater Pump, the technicians could fill a phenomenal number of syringes in a very short period of time. Other times the technicians used the foot pedal on the Repeater Pump in order to control the rate at which the process moved; art in motion. Either way it was a bummer when they were finished as I had to check all those syringes. Regardless, the pump was a valuable piece of equipment when repetitive fluid transfer was required.
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Automated unit-dose packagers for acute care pharmacy

Automation, Barcoding 22 Responses »

Aug 222010

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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Slow progress in pharmacy automation and stale technology creates ho-hum interest

Pharmacy Informatics, Technology 4 Responses »

Aug 022010

Recently I’ve been in bit of a blogging slump. The world of technology suddenly appears a little less exciting. In fact, I find myself thinking of current technology as boring. I read lots of blog posts and articles that refer to new technologies as “revolutionary”, but I haven’t seen much revolutionary technology lately. In fact, most of the new technology is simply an iteration of the same theme; or worse, recycling of an old theme.

Consumer technology is clearly ahead of healthcare with the exception of scanning devices like MRIs, which are pretty cool when you stop to think about what they do. However, some of the most recently vaunted consumer technologies are devices aimed at information consumption like the iPad or devices designed to access data and social media while on the go, i.e. the new crop of smartphones. It’s not really new technology per se, but rather a new application of already available technology.
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Cool Technology for Pharmacy – PharmaTrust MedCentre

Cool Technology 2 Responses »

Jul 222010

The PharmaTrust MedCentre is a fully automated remote dispensing machine similar to the InstyMeds Prescription Medication Dispenser I mentioned back in October of 2009. We were evaluating the InstyMeds machine when it died a slow agonizing death during budget talks.

The idea is simple really. Load the MedCentre machine with a few hundred of the most commonly prescribed medications in ready to dispense, pre-packaged bottles, have a patient insert a prescription, or “voucher” depending on what country or state you’re in, and sit back and wait for the prescription to pop out. Just like a vending machine. Of course the patient has the option to consult a pharmacist by simply picking up a telephone attached to the machine, but I don’t assume that happens too often. Most people want their medications as quickly as possible.
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Update on AutoPharm software only pilot

Automation, Barcoding 2 Responses »

Jun 022010

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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Carousel technology article in AJHP

Automation, Barcoding 2 Responses »

Jun 012010

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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