During my recent trip back east I had the opportunity to drop in on the inpatient pharmacy at Northwestern Memorial Hospital in downtown Chicago. The reason for the visit was simple. I was already in Chicago for the ASHP Summer Meeting and Northwestern utilizes some of the same pharmacy automation as Kaweah Delta. One would think that the same automation would equal the same procedures, but nothing could be further from the truth. This is one of the fundamental problems with hospital pharmacy in general. Lack of standardization equates to the inability to share information across multiple facilities. Best practice is elusive when talking about automation in pharmacy.
Northwestern Memorial Hospital provides a total of 873 beds in the Feinberg Pavilion, Prentice Womenâ€™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:Â Â 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 â€œautomated pharmacist reviewâ€. 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 doesnâ€™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, itâ€™s automatically marked as reviewed and placed on the patientâ€™s profile as an active medication. Northwestern is in the process of implementing this feature now.
Automated Storage / Packaging – AutoCarousel,Â AutoCool (soon), AutoPack (500 canister model – utilizing just about a quarter of the packagerâ€™s capacity):Â 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:Â I felt that Omnicell was an interesting choice for Northwesternâ€™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.