Transcript 10-Automation_Part_2..


Automated dispensing devices (ADD)
◦ ADD requirements
◦ Examples of ADDs

Bar code enabled medication administration

Becoming a pharmacy informaticist

Role of the pharmacy informaticist

ADDs are drug storage devices or cabinets that
electronically dispense medications in a controlled
fashion and track medication use

ADDs are located in hospital patient care units,
surgical suites, emergency rooms, long-term-care
facilities, physicians’ offices, and other settings

These automated dispensing systems can be stocked by
centralized or decentralized pharmacies

Centralized pharmacies prepare and distribute medications
from a central location within the hospital

Decentralized pharmacies reside on nursing units or wards,
with a single decentralized pharmacy often serving several
units or wards

These decentralized pharmacies usually receive their
medication stock and supplies from the hospital’ s central
pharmacy

Medications are contained in, and administered
from, single-unit or unit-dose packages

Medications are dispensed in ready-to-administer
form to the extent possible

Medications are available for administration to the
patient only at the time at which they are to be
administered, according to the institution’s policy
ASHP. Am J Health-Syst Pharm.2010; 67:483-90

An electronic patient medication profile is
concurrently maintained in the pharmacy for each
patient and made easily accessible to the
pharmacist

Medications are accessible to different categories
of health care professionals with the ability to limit
access based on policy or law
ASHP. Am J Health-Syst Pharm.2010; 67:483-90

Small systems:
◦ Pyxis medstation
◦ Baxter ATC
◦ Script-pro 200

Large systems:
◦ Baker cells
◦ Baxter international

Are automated dispensing devices kept on the
nursing unit

These machines are often compared to automatic
teller machines (ATMs)

The Medstation interfaces with the pharmacy computer

Physicians’ orders are entered into the pharmacy
computer and then transferred to the Medstation where
patient profiles are displayed to the nurse who accesses
the medications for verified orders

Each nurse is provided with a password that must be
used to access the Medstation

Many Pyxis MedStations are configured with a medication
profile for each patient

When selecting a patient, only active medication orders
that have been reviewed by the pharmacy can be
accessed at the MedStation

Certain MedStations do not have patient profiles available:
◦ Medications are removed by selecting the necessary
medication
◦ Non-profile units include the Emergency Department,
Radiology, and Surgery

Pharmacists or technicians keep these units loaded
with medication. Charges are made automatically
for drugs dispensed by the unit

Earlier models had sufficient memory to contain
data for about one week, and newer models can
store data for longer periods
1.
Nursing staff are guided to the correct drawer and pocket
to access required medicine. Medicines which sound
similar or have multiple strengths are loaded indifferent
drawers of the machine
2.
Access is restricted to only one drawer/door at a time
3.
Ward stock levels are monitored by the pharmacy
computer and stocks topped up before drugs run out,
reducing delay to patients and staff frustration
4.
Management of controlled medication
5.
Possible to add additional safety features for individual
high risk drugs. For example,
◦ must be authorized by two staff members
◦ soft lock outs to prevent duplicate administrations (reduces
risk of multiple administrations when staff forget to sign for
medications)
6.
Advice given or required information recorded at time of
dose removal
7.
Use of profile mode enables constant monitoring by
pharmacist of drug dosages/interactions. It also reduces
the amount of interpretation required by nursing staff at
time of dose removal
8.
Real time data collection for drug usage which can be
advantageous for audit and other quality improvement
processes
1.
May be frustrating to get drugs in an emergency
2.
Requires additional staff training and technical help
3.
Downtime, system failure and inflexibility
4.
Cost and space issues


Uses a microcomputer to pack unit- dose tablets
and capsules for oral administration
It is usually installed at the pharmacy

Medications are stored in calibrated canisters that are
designed specifically for each medication

Canisters are assigned a numbered location, which is
thought to reduce mix-up errors upon dispensing. When
an order is sent to the microcomputer, a tablet is
dispensed from a particular canister
The drug is ejected into a strip-packing
device where it is labeled and sealed





Installed in the pharmacy
Contains 200 universal dispensing cells and three
vial dispensers
Fills vials directly from dispensing cells
Prints prescription and auxiliary labels



Installed in the pharmacy
Counts a 30-count vial in 3-5 seconds
When a prescription is dispensed, information is
sent to the Baker Cell. The Baker Cell counts the
correct number of units of the medication

Are inventory control systems that uses barcodes
to prevent human errors in the distribution of
prescription medications at hospitals

The goal of BCMA is to make sure that patients are
receiving the correct medications at the correct
time by electronically validating and documenting
medications

It ensures adherence to the “5 Rights” of
medication administration
◦
◦
◦
◦
◦

Right Patient,
Right Route,
Right Dose,
Right Time,
Right Medication
It visually alerts staff when the proper parameters
are not met

Stocking of inventory both in pharmacy & in other
locations from which medications may be dispensed (e.g.
automated dispensing device)

Manual packaging of oral solid and liquid medications

Compounding, repackaging, and labeling processes (e.g.,
scanning of source ingredients)

Retrieving medications from automated dispensing
devices

Dispensing from the pharmacy to any location
A. Patient name
B. Medication name and strengths
C. Time of administration
D. Bar code for bedside scanning





Bar codes mismatch with drug, dose and patient at
times
Bar code sometimes function erroneously
Unable to scan bar codes properly at times
Unreadable bar codes
Time consuming

The typical pharmacy informaticist is a pharmacist who
has knowledge of:
◦
◦
◦
◦
◦
computer systems
medication-use processes
safety issues
clinical management of medications
drug distribution, and administration
AND

Has developed extensive expertise in using technology to
support these activities.
ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

Three options are available:
◦ Take specific courses or obtain a degree in computer
science, information systems or business information
technology
◦ Complete an advanced residency
◦ Volunteer to assume an informatics role at one’s current
place of employment by:
 Volunteering to take responsibility in aspects of informatics
 Obtaining as much on-the-job experience as possible
 Attending courses, conferences & learning form colleagues

Work closely with information systems and pharmacy staff
to develop system programming requirements

Develop and oversee databases related to medication
management systems

Identify, suggest solutions to, and resolve system or
application problems

Assess medication-use systems for vulnerabilities to
medication errors and implement medication-error
prevention strategies

Assist in mining, aggregating, analyzing, and interpreting
data from clinical information systems to improve patient
outcomes

Collaborate with other health care technology and clinical
leaders to ensure that medication-related systems
support safe and effective medication use

Training pharmacy staff in the use of medicationrelated computer systems

Performing research to expand informatics
knowledge and its use in supporting patient care