Transcript Automation Do`s and Don`ts

PHARMACY AUTOMATION DO’S AND
DON’TS
When Its Good, Its Very, Very Good,
And When Its Bad…
SESSION 139
Marian Daum
Christopher Lambert
Delbert Siegmund
Gay Wall
1
OJBECTIVES
• Evaluating your needs:
• Choosing the right equipment for your
operation
• Other factors to consider – Maximum Output
– Minimum Requirements
– Reliability
– Service Contracts
2
OBJECTIVES
• Develop a Business Case for the
Purchase of the Equipment
– Funding
– Benefits to the pharmacy
– Benefits to the facility
3
OJBECTIVES
• Pre-implementation – who needs to be at
the table
– Within your department
– Within your facility
– Within your medical center
– Are your timelines realistic?
– Are there any other issues?
– What does a good installation look like?
4
OBJECTIVES
• Doesn’t the machine do the work for
you?
• Setting up a Training Program
• Assessing Competence
• Common Training Pitfalls
5
OBJECTIVES
Can the system generate the reports you
need?
Do you have the right medication in the
machine?
Are your par levels set too high or too low?
What else is the system telling you?
6
Automating a Process
Choosing the Right Equipment for
your Program
Why can’t I get a replicator and a
transporter unit ????
Marian Daum
7
AUTOMATING A PROCESS
• What to you want to get out of automating
your process?
• Lower inventory, better turn around time
• The same amount of medication stored
using less space
• Tight control of a process with
accountability at each step
8
AUTOMATING A PROCESS
MANUAL PROCUREMENT PROCESS
9
AUTOMATING A PROCESS
• What are your options?
– McKesson MedCarousel
– SwissLog Box Picker
– Omnicell WorkflowRx
– Talyst AutoCarousel
– Automed FastFind
10
AUTOMATING A PROCESS
EQUIPMENT
CONTROL
MANAGEMENT
SPACE
TOTAL
McKesson MedCarousel
2
2
3
7 (13)
Swisslog Box Picker
3
2
3
8 (17)
Omnicell WorkFlow Rx
1
2
2
5 (8)
Talyst AutoCarousel
1
2
2
5 (8)
Automed FastFind
3
3
2
8 (17)
11
AUTOMATING A PROCESS
EQUIPMENT
INTEGRATE RELIABLE
SERVICE
CONTRACT
INTERFACE
TOTAL
McKesson Med
Carousel
2
3
3
2
10 (12)
Swisslog Box
Picker
2
3
2
3
10 (12)
Omnicell Workflow
Rx
4
4
3
3
14 (18)
Talyst AutoCarousel 2
3
2
2
9 (11)
Automed FastFind
4
4
2
13 (16)
3
12
AUTOMATING A PROCESS
EQUIPMENT
OBJECTIVES
OTHER
FEATURES
GRAND
TOTAL
McKesson Med Carousel
13
12
25
17
12
29
Omnicell WorkFlow Rx
8
18
26
Talyst AutoCarousel
8
11
19
Automed FastFind
17
16
33
Swisslog Box Picker
13
CHANGING EXISTING
AUTOMATION
Why do you want to change your process?
Process time starts out okay in the morning, but
have a processing time of over an hour by 2PM.
Problem prescriptions go into an exception file and
you find this out when the patient comes up to
the pickup window to complain.
14
CHANGING EXISTING
AUTOMATION
• Is it reliable?
• Do you get adequate support from the
vendor’s help desk?
• Is there newer, more efficient technology
out there?
15
CHANGING EXISTING
AUTOMATION
Is this machine still able to handle your current
workload?
- Look at hourly processing time in VistA Bingo
Board Manager Program
- Is your staff waiting for the machine to finish
processing prescriptions?
- Is there work that you can shift to another time?
16
CHANGING EXISTING
AUTOMATION
• Upgrade vs. Replacement
– Cheaper and Less Disruptive
• Newer Version or Higher Capacity Version
of Same Vendor’s Equipment
– Same interface, staff familiarity, disruptive
• Change to another vendor’s equipment
– Most disruptive, staff retraining, patient
inconvenience
17
CHANGING EXISTING
AUTOMATION
• Why are you making the change?
– Table of requirements and desires ranked
from most to least important
• Map out the process
• What are the holes in your system?
18
CHANGING EXISTING
AUTOMATION
Biggest requirement
- Prescription filling capacity during peak
hours of operation
ScriptPro SP200 is the existing equipment
- Upgrade with RCM model
19
Developing a Business Case
If you try sometimes….You just
might find….You get what you need.
Marian Daum
20
DEVELOPING A BUSINESS CASE
• Funding your equipment
– Local Funding can be used for a purchase
most smaller items and upgrades to existing
equipment
– An equipment purchase of over $250,000
may have to be submitted to the VISN’s high
cost/high tech equipment fund
21
LOCAL EQUIPMENT REQUEST
•
•
•
•
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•
•
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Robotic Cell Multiplexor with Field Conversion of SP200
This is an add-on to our SP200 robot that is used to fill outpatient prescriptions. Currently the
machine can only fill one prescription at a time and our technicians are frequently waiting for the
machine to finish. This will allow the machine to fill faster decreasing our wait time for
prescriptions at the Outpatient Pick-up window
Lionville 800 Series Medication Cart with Computer & Scanner
(6 Carts) – do not have price quote yet.
These are small medication carts that will be used to bring the domiciliary units into compliance
with new medication standards requiring nursing administration of controlled substance and for
nursing administration of medication to those veterans who are unable to manage their own
medication regimen. This model is currently used in the medical center and the drawer in the unit
is able to accommodate the punch cards being manufactured by the Pharmacy.
Omnicell Auxiliary Cabinet
This is an add-on to the existing unit on 59B. The Omnicell cabinet there is full and the additional
cabinet will allow for the storage of stock that does not currently fit in the existing unit.
•
22
DEVELOPING A BUSINESS CASE
• Added Value
– Acquisition Cost Savings
– Better Use of FTEE
– Better Service for the Veteran
23
LOCAL EQUIPMENT REQUEST
• ScriptPro Upgrade Request
• The service was able to save $9,572.00 in one month of operation.
Annualized, this savings could be up to $114,864.00. The upgrade
to the unit, purchase of the multiplexor and installation cost 19,179.
The service would like to expand this process to other identified
medications that we are able to purchase locally at a significant
savings over CMOP. If the service experienced a similar rate of
savings through the use of the requested 5 multiplexor canisters, the
Medical Center would realize an annual savings of $300,000.00 on
the $20,160.00 investment without an erosion in the quality of
service provided at the outpatient pharmacy pickup window or the
requirement for additional FTEE to service the machine.
24
HIGH COST/HIGH TECH
REQUEST
• This funding is used for equipment that
costs over $250,000. (VHA Directive 200917)
– The funding comes directly from the VISN and
not the local facility
– Your request must compete with other high
cost/high tech requests throughout the VISN
25
HIGH COST/HIGH TECH
REQUEST
•
Identify equipment to be replaced (EE#, Mfg, Model, Serial#,
etc) and explain reason for replacement (if applicable)
Omnicell unit in 1B, AMCU, 138A, 138B, 138H are currently
inadequate to store all the items necessary to provide
effective patient care on these units. CVAMC needs to
purchase upgraded storage capacity for these areas to allow
CVAMC to make stock readily available to staff while being
stored in a secured manner. Additional items are needed to
meet the directive of the Undersecretary; this directive
requires all facilities with Domicilaries to begin to have staff
administer controlled substances to patients in the DOMS on
an around-the-clock basis. CVAMC plans to use the omnicell
equipment currently used in the acute medical areas, noted
above, to meet the need in the DOMS. The existing units will
need to be upgraded to be repurposed for use.
26
HIGH COST/HIGH TECH
REQUEST
• We were also required to submit a return
on investment (ROI) analysis.
– How long will it take the equipment to “pay for
itself”
– How much of a cost savings will be realized in
10 years.
27
BUSINESS CASE
• Other factors to strengthen your request
– Network with other services
– Work with your service’s business manager
and/or quadrad to smooth the way
28
Implementation &
Installation: Avoiding the Pitfalls
Christopher Lambert
29
YOU BOUGHT IT: NOW WHAT?
How to Build an Implementation Team
• Identify the Pharmacy Project Manager
• Identify the Departments Involved /
Departments Impacted
• Identify Responsible / Key Staff within
Each Department
• Schedule Implementation Meetings
• Distribute the Timeline
30
Identify the Pharmacy Project
Manager (That’s you, sucker)
31
IDENTIFYING THE DEPARTMENTS INVOLVED
• Manufacturer Implementation Manager
• Information Resource Management (IRM)
– Data Drops / Telephone Lines / Server Housing
• Information Security Officer (ISO)
– If equipment is on the VA network
• Engineering / Interior Design / Biomed
– Prepare space for equipment
– Infrastructure upgrades (electricity – compressed
air)
32
IDENTIFYING IMPACTED
DEPARTMENTS
• Nursing
• Procedure Changes
• Medication Packaging Changes
• Pharmacy Staff
• Assignment/Responsibility Changes
33
IDENTIFY RESPONSIBLE / KEY
STAFF WITHIN EACH
DEPARTMENT
Request that each involved
department assign a staff
member and a back-up
contact for the project.
34
IMPLEMENTATION MEETINGS
Good Communication is Key to a Successful
Project
• All involved departments and
Manufacturer Implementation manager
• Clarify each departments responsibility
• Review Manufacturer Timeline
• Schedule follow-up meetings
• Keep and distribute minutes
35
TIMELINE-DELEGATE BUT
VERIFY
-Each assignment is assigned to a specific
Implementation Team Member.
-Completed assignments Verified by
Pharmacy Project Manager.
-Verify Manufacturer is staying on schedule
36
PHARMACY IMPLEMENTATION
PREPARATION
• How will the work get done during
implementation?
• Plan contingencies
• Schedule for off peak periods
• Limit annual leave
• Prepare for implementation to take much
longer than planned
37
What Can Go Wrong:
Don’t Let this Happen to You
38
Automation Training
and Competency
Does anybody know how to work this
thing????
Delbert Siegmund
39
FALLACY: AUTOMATION
EQUIPMENT DOES THE WORK
Truth is real live human beings do the work,
and the automation equipment is just a
tool they use to do the work, either:
Faster
In greater volume
More accurately etc.
40
TYPICAL ENTHUSIASM STORYLINE
•
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•
•
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Vendor states equipment can fix all problems = High enthusiasm
Getting $$ appropriated to buy gizmo = Less enthusiasm
Coordinating delivery and installation = Significant dent in enthusiasm
Fixing and solving all interface issues, populating databases, assigning
privileges = BIG drain in enthusiasm
Discovery that the installed equipment didn’t solve all problems as promised
= Last drops of enthusiasm drained
Desire to train staff on equipment use = ENTHUSIASM TANK EMPTY 
DON’T FORGET TO TAKE A BREATH, REGAIN YOUR
COMPOSURE AND FUEL
UP FOR TRAINING!
41
STAFF TRAINING: THE
PENULTIMATE INSTALLATION STEP
Frequently used and high value pieces of
equipment all have the same thing in
common:
• Competent staff who really know how to
use the equipment
• Confident staff who know what they are
doing with the equipment
42
THE MOST EFFECTIVE STAFF
HAVE OFTEN BEEN….
• Trained by the vendor at the time of
installation at least once 
• Trained yet again shortly after by the local
super user (someone they know and trust)
• Trained yet again by themselves where
they can practice using the machine and
answer their own questions by trial and
error in private
43
THE WORST TRAINING
POSSIBLE
Whatever staff in attendance that Friday are gathered
during lunch break for an un-announced training session
on new equipment. The installer runs through the
equipment use, point to an operating manual and a CD
that also contains the manual. The 1-800 number on the
machine is referenced. The installer smiles at the group,
asks if there are any questions on what they just
demonstrated and when there are no questions has the
group sign the training sheet……….
44
BETTER TRAINING
•
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•
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•
•
All staff (including nights/weekends/part time) are included
Training time is after breakfast, but well before lunch
Groups for training are smaller and more intimate when possible
Extra staff coverage is provided during trainings sessions, so staff do not
feel they are falling behind with their regular work
Staff know what equipment is, what it does and have questions prepared in
advance
HANDS ON, HANDS ON, HANDS ON!! Staff should be using equipment
during training, and each member should repeat the same training, not just
one brave volunteer.
Vendor trainer is available after training sessions are complete for one-onone questions and mini demonstration during the rest of the day
45
THE INSTALLER IS GONE…NOW
WHAT?
• Somebody at your site needs to be a designated Super
User. It can be ANYBODY and you would be surprised
at who that might be. Consider EVERYBODY in your
staff as a potential super-user
• For physical use of the machine, vendor provided video
can be a very good reference
• For equipment with a computer interface, strongly
consider SCREEN SHOTS of the interface as an aid for
navigation through screens and menus.
46
PROVE YOUR GOOD TRAINING WITH A
COMPETENCY ASSESSMENT!
When boiled down, most assessments are the same
• Employee can start up and shut down the equipment
• Employee can calibrate/prepare the equipment
• Employee can load and replace “consumables” in the
equipment
• Employee can demonstrate use of the equipment
• Employee can clean and maintain the equipment
• Employee knows both local support and technical
support contacts in the event of a malfunction.
47
SIMPLE IS BETTER
Remember the following points about competency
assessment forms and documentation:
• Most regulatory/internal reviews focus on “missing” competency
assessments - not their content. Make them simple and executable.
• Manufacturer provided “competency” forms have gotten much better
(though many stink ). Don’t overlook them as a source (vs.
making your own from scratch.)
• Keep the competency assessment separate from Policy and
Procedures. Competency assessment shows staff can operate the
equipment, and that is it.
48
AVOID THE FOLLOWING AT ALL
COST OR YOUR EQUIPMENT WILL
SURELY DIE
• Nobody knows what equipment is going in, or why they are
getting it, or what it is supposed to do when they get it
• Everyone is scared of the equipment due to cost, or damage
risk, or complexity
• Only one person in the pharmacy knows how to run the
equipment and there is no staff rotation on operating the
equipment.
• There is no reference material or “how to use” sheets available
for individuals to look at
• Harsh or punitive measures when the equipment breaks or an
“accident” happens (well, at least the first time )
49
Maximizing Use
Using Reports to Increase
Efficiency
Its all in the report…
Marian Daum
50
MAXIMIZING USE
• Automation will expose any weakness in
your processes
• Gaps in the database
– Stock out/stock not moving
• Too many manual processes
– Not looking at usage data
• Operator Error
– Don’t forget to push the green button….
51
MAXIMIZING USE
• Reviewing the Use of Narcotics
• Setting up a Surveillance Program
Poor Practice vs. Diversion
Involve key staff
Follow through to reinforce good
Practice and stop poor practice
52
MAXIMIZING USE
• Misadventures in Narcotic Use
– You found What above the false ceiling?
– 15 minutes of fame that you can do without
53
MAXIMIZING USE
• Other Narcotic Surveillance Reports
– Usage Compared to Other Personnel
– Witness Pairs
– Number of Discrepancies
54
MAXIMIZING USE
• What about that installation?
– What did you get out of the change in
process?
• Better Inventory Management
• Better Turn Around Time
55
MAXIMIZING USE
• Unexpected Benefits
– The law of unintended consequences can
sometimes be a good thing.
– Are you able to demonstrate additional benefits to your
recent upgrade?
56
MAXIMIZING USE
• What if I want to kick it up a notch?
• Advanced Report Writing
• Custom Reports
• Combining VistA and the automation reports
57
MAXIMIZING USE
• Please share with the entire class
• http://vaww.national.cmop.va.gov/pre/default2
• Please post your best practices on the
automation Sharepoint discussion board
58
AUTOMATION
• Choosing the best equipment for your
service
• Developing an implementation plan for a
smooth installation
• Developing a comprehensive training and
competency assessment program
• Evaluating the performance of the
equipment on an on-going basis
59
Questions??
60