Automating the Pharmacy Automating the Pharmacy Medication Cycle in Medication Cycle in Acute Care Settings Acute Care Settings Enterprise Information Systems Steering Committee Nursing Informatics Committee and Pharmacy Task Force January 2010 Costs, Benefits and Potential Costs, Benefits and Potential Unintended Consequences Unintended Consequences
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Automating the Pharmacy Automating the Pharmacy Medication Cycle in Medication Cycle in Acute Care Settings Acute Care Settings
Enterprise Information Systems Steering Committee Nursing Informatics Committee and
Pharmacy Task Force
January 2010
Costs, Benefits and Potential Costs, Benefits and Potential Unintended Consequences Unintended Consequences
Goals
• Rationale and strategies for automating inpatient medication movement and related asset tracking
• Costs, benefits, unintended consequences • Potential business case for pharmacyrelated automation in acute care settings
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Pharmacyrelated Automation Technologies
• AutoID • Inventory Management • Unit Dose Packaging • Barcoding/Labeling • IV Compounding, Bag/Syringe Filling, Infusion Robots
• Pharmacy Robotic Dispensing Systems
• Decentralized Automated Dispensing Cabinets
• Barcode Medication Administration
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Inpatient Medication Management
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Automating Medication Movement in Acute Care Settings
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Beginning with the End in Mind…
• “Five rights” of medication administration – right patient – right drug – right dose – right time – right route
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AutoID: Identifying People and Things
• Barcode scanning – mature, cost effective, in common use
• Radiofrequency identification (RFID) – emerging technology, beyond lineofsight – identifies every tagged item in range – read/write, realtime location – Proximity card authentication, access
• Documentation accuracy, completeness – Manufacturer, lot number, expiration date, formulation, date/time, etc.
• Workflow efficiency – System sign on/off time – Identify, authenticate items, persons – Location, flow of patients, equipment, supplies
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Potential Adverse Consequences of AutoID
• Bad tag – Wrong data entered originally – Data not readable (smudged, faded, wet)
• Bad placement – Wrong item, place, patient
• Bad reader – Malfunction, misplacement, interference
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AutoID: Costs and Business Case
• Cost varies widely (scope, technology) – Can be in the millions for large, multipurpose deployments
• Business case strongest for barcodes, magnetic strip badges, fingerprint readers, proximity cards – RFID costs still high
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Automated Pharmacy Inventory Management (PIM)
• Continuous drug quantity monitoring • Electronic ordering based on “MAXimum” and “MINimum” levels
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Benefits of PIM
• Right wholesaler orders, right time • Tighter inventory dollar control • Adequate drug supplies at all times • Better inventory turns, fewer expired meds • Improved staff efficiency • More accurate drug expense reports
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Potential Adverse Consequences of PIM
• System information accuracy – Monthly cycle counts needed – Backups in case of data corruption
• Interface challenges – Data feeds to/from other med cycle solutions
• Repackage bulk meds à single doses • Available for tablets, capsules or liquids • USPcompliant unit dose packages • Facilitycompatible barcodes • Pharmacy IS interface capability • “Robotready”
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Benefits of Drug Unit Dose Packaging
• Staff efficiency – Solid packaging labor reduced by 65% – Reduce ADC fill time by 70%
• Inventory control – When used with inventory carousels
• Wholesale drug costs – Bulk medications vs. single unit doses
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Potential Adverse Consequences of Drug Unit Dose Packaging