Tag Archives: Pharmacy Practice

5 years later, my thoughts on pharmacy practice

I haven’t been a practicing pharmacist in the traditional sense in about five years. I’ve spent the last 19 months as an independent consultant, which has been awesome. Prior to that I was a Product Manager for about two and a half years at a company that dealt in pharmacy automation and technology. Before that I was an IT Pharmacist, which did give me an occasional glimpse of “pharmacy practice”, but overall I figure it’s been at least 5 years since I worked at earnest as a staff pharmacist.

Recently I took a per diem position in a large acute care hospital as a staff pharmacist. I’m completely content being a consultant, and have enjoyed it very much, but I felt that I was losing touch with the daily grind that is pharmacy. I needed to get my hands dirty again and make sure that I wasn’t giving advice to people that was out of touch with reality. I think it’s important for any consultant to be able to relate to the actual problems that they’re being asked to solve. So for the past few months I’ve been staffing about a day a week. Below are some thoughts on what I’ve seen and heard.
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Cool Pharmacy Technology – Intelliguard RFID Solutions from MEPS Real-Time

Last week I spent some time down south in San Diego visiting a couple of hospitals and speaking with the good folks at MEPS Real-Time. My objective for the visit was twofold: 1) see MEPS RFID Solutions in a live environment, and 2) speak with the people at MEPS and get an inside look at their technology. I was able to accomplish both goals.

MEPS Real-Time is a company that specializes in providing RFID solutions for healthcare specifically targeted at acute care pharmacies. Their Intelliguard® RFID Solutions product line currently includes a Kit and Tray Management System, Controlled Temperature Cabinets, and a Vendor Management Inventory (VMI) System.

MEPS_RFID_TAG
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Are we seeing the final days of standalone systems in pharmacy?

I’ve used many standalone systems in the pharmacy throughout my career. There was a time when it was considered the norm, but things are starting to change.

I’ve seen a significant shift in thinking over the past couple of years. Hospital pharmacies are tired of dealing with multiple databases, the inability of one system to easily shuttle information to another, and broken interfaces, i.e. “interface is down”. I’ve talked to several pharmacists over the past few weeks that are no longer looking at functionality, but instead are seeking integrated ecosystems to run pharmacy operations. And they’re willing to give up functionality to get it.
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First time using Epic – initial thoughts and impressions

Epic is an Electronic Health Record (EHR) used in hospitals all over the country. If you work in healthcare you know who they are. Epic is the top EHR system in the U.S. and they continue to gobble up market share.

According to the Epic website, the pharmacy information system (PhIS) inside Epic is officially known as the “Willow Inpatient Pharmacy System”. However, I commonly hear it referred to as simply Willow.

Over the span of my 19 year career I’ve used several pharmacy information systems, but never Willow. For whatever reason the hospitals I’ve worked in have used other EHR and/or pharmacy system vendors; GE, Siemens, MEDITECH, IDX, etc. Recently I had the opportunity to spend a couple days learning how to use Willow. I was pretty excited. I’ve heard a lot of good things about Willow, and some bad. I’ve been wanting to get firsthand knowledge for quite some time.

Disclaimer: These are my initial impressions. Two days of training isn’t nearly enough time to learn all the ins and outs of a pharmacy system. I’ve recently accepted a position where I will be using Epic, albeit not in a full-time capacity, so I’m sure that my thoughts and opinions will evolve over time.
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Should you purchase a robot to help compound sterile preparations in the i.v. room?

The promise of a future where robots handle pharmacy distribution has been around for quite some time. It seems to always be “just a few years away”. I’ve seen my share of robotic distribution systems implemented in pharmacy operations, and the expectation has always been better than the reality.

But what about using robotic systems in the i.v. room to help make sterile preparations? It seems like the perfect place for this type of tool. Activities in i.v. rooms are dangerous and expensive. If one could utilize a robot to increase safety and decrease cost, then it would seem like a no brainer. Unfortunately it’s not as simple as that.

Over the past 16 months I’ve observed several different robots – INTELLIFILL I.V. by Baxter, APOTECAchemo by APOTECA, i.v.STATION by Aesynt, and RIVA by IHS – in several different pharmacy environments – inpatient batch processing for multiple hospitals, inpatient patient specific production for single hospital, inpatient chemotherapy, and outpatient chemotherapy. During that time I’ve formed several opinions about the current crop of i.v. room robots; some good, some not so good.
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Selecting technology for the i.v. room is no easy task

Since In the Clean Room was released in October, I’ve received a lot of questions about i.v. room technology. The questions generally focus on a single product or a particular functionality. However, I get a surprisingly large number of people asking me “what’s the best system for the i.v. room”. A simple question. Unfortunately it’s a question that is not easily answered.

There are several variables to consider when selecting technology for the i.v. room, as well as a number of questions that must be answered during the evaluation process.
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#ASHP Midyear final thoughts

I concluded my time at ASHP Midyear in Anaheim on Tuesday evening. Here are my parting thoughts.

  • The show felt more lively this year than the past couple. It’s hard to explain, but it felt like people were interested in everything around them; a good sign.
  • There was an infusion of new products in the exhibit hall. The “normal” stuff was there, but it is clear that the vendors are once again ramping up. The introduction of meaningful use several years ago put a stranglehold on pharmacy budgets and projects. Everyone put all their eggs in one basket, i.e. all resources redirected to a single goal. During that time hospital pharmacies entered a black hole in regards to the implementation of new technology. It appears that equilibrium has been restored.
  • The “Pharmacy of the Future” Pavilion was anything but the pharmacy of the future. It was nothing more than a giant advertisement for the vendors. Nothing stood out as futuristic.
  • There was virtually no discussion/exhibits for track and trace. Given the state of H.R. 3204, the Drug Quality and Security Act (DQSA), this is going to be a big deal over the next several years. I expected to see more. Then again, the exhibitors have to reserve their booths a year in advance. Hard to plan around that.
  • Didn’t see much to do with Telepharmacy. In fact, I can only think of a single exhibit and that was an outpatient system.
  • The acquisition of CareFusion by BD is interesting for several reasons, but I wonder how the two companies will handle their i.v. workflow management systems. CareFusion has PyxisPrep and BD has BD Cato. Given the limitations of PyxisPrep in its current state it would be hard for me to imagine them not going with BD Cato as their flagship system in the i.v. room. Only time will tell.
  • The acquisition of CareFusion wasn’t the only big move that BD made this year. Apparently BD has partnered with Aethon for medication tracking outside the pharmacy.
  • Envision’s exit from the i.v. workflow management space should be interesting. With their intellectual property for image capture/remote verification going to BD, I wonder what will become of the rest of the product, i.e. the software. The product had a solid foundation and some nice functionality. Hmm, gives me a couple of ideas.
  • APOTECA was conspicuously absent from the exhibitor floor. I found that odd considering that they are one of only two manufacturers of hazardous compounding robots in the U.S. The company also introduced a semi-automated i.v. workflow management system, APOTECAps earlier this year. I fully expected to see the products on display at ASHP Midyear. Not the case.
  • Omnicell entered into an agreement with Baxter to both sell and integrate with DoseEdge. This should allow Omnicell to track CSPs prepared with DoseEdge throughout their suite of products. Everyone is scrambling to get into the i.v. room.
  • As mentioned previously, Closed System Transfer Devices (CSTDs) seemed to be popular among the exhibitors. At least three separate companies – EQUASHIELD, BD, ICU Medical – were showing off their products. I’m not surprised with USP <800> looming in the not too distant future.
  • RFID seems to finally be picking up some steam in pharmacy practice. Several companies were displaying RFID solutions. Several others announced partnerships with those same companies. The most popular areas for RFID appear to be refrigerated inventory management, anesthesia, and medication trays/carts.

More from #ASHP Midyear

Yesterday was more of the same, i.e. I spent several hours in the exhibit hall yesterday trying to make my way through my “game plan”. And again I failed to complete my mission. I spent a lot of time speaking to various people about some of the things I saw on Monday.

Some of my stops and thoughts from yesterday:
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CareFusion announces partnership with Kit Check at #ASHP Midyear

Last night I attended the first ever CareFusion Insider Event held at ASHP Midyear. The event was designed to spotlight CareFusion and their product line. Some new things were announced like the introduction of a Pyxis Mini and a new focus for the Rowa Dose System. CareFusion has had the Rowa Dose System for a while, but it was initially targeted at markets outside the U.S.

Something I hadn’t expected was an announced partnership with Kit Check. I have written about Kit Check and Anesthesia Check before.

According to the press releasetoday announced the companies will partner by connecting their hardware, software and RFID solutions to offer improved efficiency and accuracy in medication handling from pharmacy dispensing to OR point of use”.

It’s unclear how deep the integration will run, but it’s clear after last night’s event that CareFusion is pushing a more integrated approach across the entire healthcare continuum.

I’ll be stopping by both the Kit Check and CareFusion booths over the next couple of days to find out more.

Cool Pharmacy Technology – Eyecon Visual Counting System

It’s hard to imagine that pharmacies still manually count medications and pour them into bottle for distribution to patients, but it goes on all the time. Even large pharmacies that have robotic dispensing systems still have to manually dispense a fair number of medications for one reason or another.

Eyecon by RxMedic is an automated counting system for oral medications that uses barcode scanning technology and “machine vision” to ensure accurate medication dispensing.

Some things that I thought were interesting about Eyecon:

  • It uses barcode scanning technology to ensure that the correct medication is being used, i.e. Eyecon scans the medication barcode against the prescription label. When used properly this a good way to prevent putting the wrong drug in the patient’s bottle.
  • Use of “machine vision” to perform counting. I’m not entirely sure what “machine vision” technology is, but I hear the term often enough; especially when looking at compounding robots. According to the company, Eyecon can “detect pill fragments or foreign matter in the counting platter and alert the operator”. That’s a nice feature.
  • There are separate trays for “sulfa” and “penicillin”. You frequently see tray segregation like this in outpatient pharmacies due to fear of cross contamination and patient allergies. This little feature tells me that the person that designed Eyecon has practical experience in a pharmacy.

Couple of Eyecon videos below. The first shows a general overview of Eyecon from 2010. The second shows Eyecon being used to fill a prescription using barcode scanning technology. There are several videos posted on YouTube. Just search for “Eyecon”.
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