Jerry Fahrni

Tag: IV ROOM

  • Automated Medication Preparation for Chemotherapy [PP&P December 2013]

    The December 2013 issue Pharmacy Purchasing & Products features a Q&A session with Anne McDonnell, PharmD, BCOP; Caryn Belisle, RPh; and Josephine Leung, PharmD, MBA from Brigham and Women’s Hospital, Department of Pharmacy

    I had the opportunity to visit Brigham and Women’s Hospital earlier this year while doing some research for a project I’m working on. It’s a very interesting facility that makes use of a lot of pharmacy automation and technology. Based on what you read below you’d think that everything was perfect. What I saw was interesting, but far from perfection.

    Worth noting in the Q&A session is that the products being used are never defined, i.e. what technology is being used. There’s mention of a robot, but which robot? They speak of gravimetic analysis, but don’t say what system they’re referring to. I know because I’ve been there, but other people might like to know as well don’t you think?

    Here are some of the questions and responses I found particularly interesting in the PP&P article.
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  • California State Board master formula and sterile compounding logs

    I’ve been looking through a lot of the California State Board of Pharmacy requirements for sterile compounding logs and accompanying master formula records. The information can be found in the California Lawbook for Pharmacy 2013 [PDF], specifically California Code of Regulation (CCR), Article 4.5 Compounding.
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  • #CareFusion jumps into the IV room with new Pyxis IV system

    You can add another player to already crowded IV workflow management system space.

    I heard a rumor that CareFusion had some new technology in their booth at ASHP Midyear this year. Since I’m at ASHP Midyear I decided to wonder over there to take a look, and lo and behold they did indeed have some new stuff. One of the things that caught my eye was their new IV room system.

    The system is like many that I’ve seen, complete with camera and barcode scanning for IV medication preparation. I didn’t have much time to evaluate the system, and it’s virtually impossible to do so in the span of a short demo, but overall the Pyxis IV system hits all the major safety checkpoints for this kind of stuff.

    CareFusion is playing things pretty smart by moving into the IV room. They’re taking a broad approach to managing the entire inpatient pharmacy, i.e. they now have products that cover medication distribution from back door to the patient, including both IV and non-IV medications. Well played.

    So what’s the over-under on how long it will take Omnicell to build or buy an IV room system?

    From the CareFusion newsroom:

    While the greatest percentage of a hospital pharmacy budget is the cost of IV medication, it is estimated that fewer than 10 percent of hospitals use automation within their IV room where infused medication is compounded. The new Pyxis IV system* helps standardize the workflow in the central pharmacy IV room to securely manage a closed-loop pick, prep and check process, while driving efficiency in pharmacy activities. This standardization also helps improve the accuracy and error rate reduction of the IV compounding process, as well as free up pharmacy staff to redeploy to clinical activities. The new Pyxis IV system consists of monitors in the IV room that walk clinicians through each compounding step. The system organizes all similar orders and recommends the proper vial size to use when compounding to help minimize waste. The system also has video cameras to record compounding components to help facilitate remote checking by a pharmacist, which saves time by eliminating the need for clean room entrance and exit processes

  • Thoughts on implementing #DoseEdge in an acute care pharmacy

    Over the past twelve months or so DoseEdge has become the most popular IV Room Workflow Management System on the market. Why I cannot say, but my guess would be a combination of timing – the NECC tragedy – and name recognition. If you were to ask acute care pharmacy IT folks about IV Room Workflow Management Systems I doubt many of them could name more than one or two, and of those that could, I assure you one of their answers would be DoseEdge. Pharmacy is a small world and word of mouth carries tremendous weight, and DoseEdge clearly has the advantage in that respect.

    DoseEdge System at Boston Children's Hospital
    DoseEdge System at Boston Children’s Hospital

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  • Weighing in on gravimetrics

    I’ve been doing a lot of research lately on i.v. workflow management system. In fact, I’ve been able to spend time observing several of these systems in operation in real healthcare facilities. If you really want to see how something works in a pharmacy spend some time watching a technician work and talking to them about it. You can only learn so much from marketing material, which is, shall we say, less than completely forthcoming with information.

    Each system I’ve reviewed has fundamentally the same concept, but different approaches. One of the most distinct differences I’ve encountered is the inclusion or exclusion of gravimetric analysis during the i.v. compounding process. Some have it, some don’t.
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  • What are you looking for in a “workflow management system” for the IV room?

    A recent “I’ve been thinking…” by Mark Neuenschwander got me thinking; no pun intended. Mark and I have been working on a barcode medication preparation (BCMP) project for the last couple of months. My interest in pharmacy automation and technology coupled with his passion for barcoding in healthcare and patient safety have created a good working relationship. We’re currently looking at the state of BCMP as it relates to compounding in the IV room.
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  • Getting creative with pharmacy labels: dosing calculations

    I was searching for inpatient pharmacy label examples, specifically IV label examples, for a project that I’m working on and came across a site called RxLabelToolkit.com. It’s a neat little site that offers quite a bit of information on label design. I don’t know if the business is still active as the most recent post I can find on their blog is from December, but it’s worth a few minutes of your time to stop and have a look.

    RxLabelToolkit.com: “One of the most valuable features of BarTender for pharmacy, is the ability to perform pharmaceutical calculations right within the label application. This allows us to build a label that can calculate a dose, an infusion rate, expiration date or a taper schedule. Any mathematical formula needed can be performed right in the label application.”

    The site has some pretty cool examples. The ampicillin label below is my favorite. There’s also a brief slide presentation that walks you through all the fields on the example label.

    Ampicillin1gmLabel

     

  • Motion sensing technology in the IV room

    I’ve always been intrigued by motion sensing technology like Microsoft’s Kinect for the Xbox system. My interest was rekindled last week when I came across an article at Fast Company taking about Kinect Hacks.  I do what I always do when I read something interesting, I Tweet about it.

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  • Saturday morning coffee [August 10 2013]: 2 Guns, Office 365, barriers to analytics in healthcare

    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….

    City Brew in a neat little coffee shop in Billings, Montana. I was in Billings visiting the Billings Clinic Hospital for work. That was the last trip I made as product manager for the company I worked for prior to being laid off. City Brew is a pretty cool coffee shop; they roast their own beans! I thought the place was cool enough that I wanted to buy a City Brew Coffee mug. Unfortunately they didn’t offer mugs for sale, but I noticed that they had mugs behind the counter for use by patrons that were planning to drink their coffee in-house. So I asked the girl behind the counter if she’d sell me one. She hesitated, but then I explained that I was from California and I thought City Brew was pretty cool. She relented and sold me a mug, the one you see below. Tah-dah.

    MUG_CityBrew
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  • 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.