Transcript Technology & Automation in Pharmacy Practice Part I & II

Technology & Automation in
Pharmacy Practice
Part I & II
PHCL 311
Hadeel Al-Kofide M.Sc
Topics to be covered today..
• Definitions
• Why technology & automation
• Automation & the medication use process
• Applying technology in inpatient pharmacy
• Applying technology in outpatient pharmacy
• Other forms of technology applied all over the pharmacy
• Safety of automation
• Cost
• The impact on pharmacy manpower
Introduction
• As we entered the 21st century, there are many factors that
influence the future practice of pharmacy & delivery of
pharmaceutical care
• Today's health care providers are looking for new ways to
improve the quality of patient care & cut costs, while
enhancing employee retention & patient satisfaction
Introduction
• Technological advances have led to automation, which is of
particular significance to pharmacists. In pharmacy
automation, the machines used to carry out work are
controlled by a computer
• It is very vital that the computer knows & responds to the
purpose for which the system is executed
• Automated systems also promise extra efficiency & accuracy
Definitions
• Technology
• Unit-based dispensing cabinets
• BCMA
• CPOE
• Carousel automation
Definitions
Technology:
• For the purpose of this lecture, this refers to anything that is
used to replace routine or repetitive tasks previously
performed by people, or which extends the capability of
people
Unit dose dispensing cabinets:
• Secure storage cabinets of handling most unit-dose & some
bulk (multiple dose) medications
Definitions
BCMA:
• Bar code medication administration
CPOE:
• Computerized prescriber order entry
Carousel automation:
• A medication storage cabinet with rotating shelves used to
automate medication dispensing
Why we Need To Apply Technology
in Healthcare Systems & What are
Our Goals?!
Why We Need Technology &
Automation
Prescriptions
Vs.
Pharmacists
4 Billion
300,000
3 Billion
200,000
1.5 Billion
100,000
1992
2004
2010
Why We Need Technology &
Automation
Major Areas for Medication Error
39%
38%
12%
Medication Errors Reporting Program US
11%
So The Major Goals From This
Technology
1. Decrease rate & percentage of medication errors (in all
fields including: prescribing, dispensing & administration
errors)
2. Provide pharmacists with more time to apply pharmaceutical
care & patient counseling
3. Improve quality of life for your pharmacists & technicians
4. Increase the number of prescriptions filled in a day
Applying this Technology to The
Medication Use Process
Strategies for Automation
• Automation is now used in all phases of
medication use process
The Medication Use Process
Technologies & automated devices applied
throughout the medication use process
Prescribing
• Clinical decision
support software
• CPOE
Preparing & Dispensing
• Carousal technology
• Centralized robotic dispensing
technology
• Centralized narcotic
dispensing & inventory tracking
• Decentralized automated
dispensing devices
• IV & TPN devices
• Pneumatic tube
• Unit dose repacking system
Administering
• Bar code
medication
administration
technology
• Clinical
support-based
infusion pumps
Monitoring
• Electronic
clinical
documentation
systems
• Web-based
compliance &
disease
management
tracking systems
Prescribing
• Clinical decisions support software: interactive computer
programs, which are designed to assist physicians & other
health professionals with decision making tasks
• Computerized prescriber order entry (CPOE): is a process of
electronic entry of physician instructions for the treatment of
patients. These orders are communicated over a computer
network to the medical staff or to the departments (pharmacy,
laboratory or radiology) responsible for fulfilling the order
Dispensing
1. Applying technology in hospital inpatient pharmacy:
• Unit dose packaging:
 Pyxis
 Centralization vs. decentralization
 Robotics
• Carousel technology
• Pneumatic tube
• IV & TPN robotic devices
Dispensing
2. Applying technology in hospital outpatient or community
pharmacy:
• Automation & robotics
• Automated workflow
Dispensing
3. Other automated systems
• Telepharmacy & self checkout systems
• Interactive voice response (IVR)
• Internet & E-prescribing
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
• Medication that is dispensed in a package that is ready to
administer, directly, to the patient.
• Medication currently being unit dose packaged & bar coded:
1. Solid dose
2. Liquid unit dose
3. Oral dose syringe fill
4. Sterile Injectable syringe fill
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
• Unit-dose dispensing was developed in the 1960s to support
nurses in medication administration & to reduce waste
• Today there are numerous companies that will convert your
bulk medications & products into unit dose packages
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
• There are numerous fast & efficient automated unit dose
packaging systems that can be installed & operated in the
pharmacy
• Pyxis system
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
Pyxis system
• Automated dispensing system (ADS) primarily affects
nursing, pharmacy & information systems personnel
• ADS are drug storage devices or cabinets that electronically
dispense medications in a controlled fashion track medication
use. Their principal advantage lies in permitting nurses to
obtain medications for inpatients at the point of use
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
Pyxis system
• Most systems require user identifiers & passwords, & internal
electronic devices track nurses accessing the system, track the
patients for whom medications are administered, & provide
usage data to the hospital’s financial office for the patients’
bills
• These systems can be stocked by centralized or decentralized
pharmacies
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
Centralized vs. Decentralized
• Centralized pharmacies prepare & 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
• Decentralized pharmacies usually receive their medication
stock & supplies from the hospital’s central pharmacy
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
Centralized vs. Decentralized
Decentralized Automated Dispensing System
Advantages
Disadvantages
Ability to allow access to a single dose of
medication
Nurses may access medications before a
pharmacist reviews the order
Accommodates multiple dosage forms
with flexible drawer configurations
Unable to accommodate all medications
Faster reach to medications
Take large space in word than usual carts
Provide detail electronic dispensing &
usage report
Inspection & removal of expired
medications usually must be done
manually
Dispensing
Hospital Inpatient Pharmacy
Unit dose packaging
Centralized vs. Decentralized
Centralized Automated Dispensing System
Advantages
Disadvantages
Reduce pharmacist time
Less nurse satisfaction (delay in first dose)
Reduce technician labor required to fill
carts
Require large space & usually needs
physical renovation
Facilitates pharmacists review of orders
before the nurse can use the medication
Accuracy depends on accurate computer
order entry
Automates medication restocking &
removal of expired medications
Usually does not accommodate
refrigerated items
Dispensing
Hospital Inpatient Pharmacy
Robotics & Unit dose systems
• Now robots can be used to help inpatient pharmacies dispense
thousands of medications It uses an electromechanical head
coupled with a pneumatic system to capture each dose &
deliver it to its either stocked or dispensed location
• During this process it uses barcode technology to verify its
pulling the correct drug
Dispensing
Hospital Inpatient Pharmacy
Carousel Technology
• Medication storage cabinets with rotating shelves used to
automate medication dispensing
• The carousel uses barcodes & pick-to-light technology
• It helps reduce error of look-a-like & sound-a-like, HOW?
Dispensing
Hospital Inpatient Pharmacy
Pneumatic Tube System
• Pneumatic tubes (or capsule pipelines) are systems in which
cylindrical containers are propelled through a network of tubes
by compressed air or by vacuum. They are used for
transporting physical objects, solid objects, compared to the
more generic pipelines which transport gases or fluids
Dispensing
Hospital Inpatient Pharmacy
Robotics in IV Room
• Now robots can prepare IV & chemotherapy medications
• Automating the preparation of IV syringes & bags
Dispensing
Outpatient & Community Pharmacy
• Prescription Medication, for patient self administration, that is
dispensed in multi dose format, generally in a vial, bottle or
unit of use package, with labeling that includes:
 Patient’s name
 Physician’s name
 Drug name, strength, & quantity or volume
 Usage Instructions & warnings
 Bar code
Dispensing
Outpatient & Community Pharmacy
• What do patients want when they come to the pharmacy?
 The best from their medicines
 Safe passage
 Information
 Flexibility
 And FAST!
Dispensing
Outpatient & Community Pharmacy
• Automation & technology in outpatient & community
pharmacies includes:
 Automated counting
 Automated fillers
 Other automated machines
 Automated robotics
Dispensing
Outpatient & Community Pharmacy
Automated counting
Different pill counters
Dispensing
Outpatient & Community Pharmacy
Automated fillers
Automed
Dispensing
Outpatient & Community Pharmacy
Other Automated machines
Right now there are lots of different automated
machines which can act as either dispensers,
counting pills, & fillers
Parata
Dispensing
Outpatient & Community Pharmacy
Automated robotics
Other Forms of Technology
• Telepharmacy
• Self checkout system
• Interactive voice records
Other Forms of Technology
Telepharmacy
• Telepharmacy enables pharmacists to provide pharmaceutical
services from a remote location
• Telepharmacy means a central pharmacy, either retail or
associated with a hospital, with one or more remote sites in
which all sites are connected via computer, audio, & video link
Other Forms of Technology
Telepharmacy
• Prescriptions that are issued at rural hospitals are electronically
sent to an urban medical center pharmacy, where they are
reviewed, processed, & verified
• The hospital pharmacist has access to the patient’s electronic
medical records, & checks the prescription for proper dosing,
allergies, duplications & drug interactions
• Then the pharmacist electronically authorizes the dispensing
through a specialized Automatic Dispensing Device (ADD)
Other Forms of Technology
Telepharmacy
• The prepackaged medication is released electronically via the
ADD
• A nurse (or a technician) in the rural hospital, with password
authorization to the ADD work station, double checks the
medication & label, prior to administering the medication to
the patient
Other Forms of Technology
Telepharmacy
• The pharmacist at the urban medical center is able to
electronically monitor the verification process & to oversee the
restocking of the ADD via a videoconferencing link
• The video conferencing system is also used for consultations
between the patient, nurse or physician with the urban hospital
pharmacist
Other Forms of Technology
Telepharmacy
Technician
/Nurse
Patient
Other Forms of Technology
Telepharmacy
• It also has been used recently in preparing chemotherapy
preparation
• In hospital pharmacies, chemotherapy preparation is a highrisk process
• Critical components of this practice include selecting the
correct drug, using the exact medication volume, & injecting
the medication into the IV bag for the correct patient
Other Forms of Technology
Telepharmacy
• Pharmacist supervision is vital for the safe preparation of
chemotherapy medications. However, limited pharmacist
resources & complications of clean room operations hinder the
step-by-step verification procedure of the chemotherapy
preparation process
Other Forms of Technology
Telepharmacy
• Using the Telepharmacy system, a technician scans the bar
code on the drug vial to ensure that the correct medication has
been selected
• The technician captures electronic images of the vial label &
the filled syringe in the preparation room before injecting the
drug into the IV bag
Other Forms of Technology
Telepharmacy
• Prior to completing the preparation process, the technician
presses a button on the Telepharmacy screen to receive
verification by a pharmacist
• From outside the preparation room, a pharmacist reviews the
images of the vial, the pullback on the syringe, the IV bag, &
the patient's medication order
• The images & confirmation of these steps are documented &
available for future reference
Other Forms of Technology
Telepharmacy
Other Forms of Technology
Self Check-out System
• In about a minute, customers can pickup & pay for their
prescriptions. It gets them out of line & lets the pharmacy staff
spend extra time with customers who really need it
• Consumers can shop on their own schedule & conveniently
pickup their prescriptions even after the pharmacy has closed
• It comes with barcode technology to ensure each consumer
receives the prescription they ordered
Other Forms of Technology
Self Check-out System
• When installing the machine, consumers sign up to have their
prescriptions placed in the self checkout system if they want
• Consumers enroll using a touch screen. After this one-time
enrollment, its like using an ATM
• Consumers log in, confirm their prescriptions, then sign & pay
• As soon as the payment is approved, it delivers the
pharmacist-prepared prescriptions. It takes about a minute
from start to finish
Other Forms of Technology
Self Check-out System
Other Forms of Technology
Interactive Voice Response
• Automated telephone answering system giving customers the
option of calling for refills while allowing the pharmacist to
continue other services
• A touch-tone telephone to interact with a database to acquire
information from or enter data into the database
• IVR technology does not require human interaction over the
telephone as the user’s interaction & access with the database
is predetermined by what the IVR system will allow
Other Forms of Technology
Internet
Other Forms of Technology
Internet
Other Forms of Technology
Electronic prescribing
Other Forms of Technology
Electronic health record
• An individual patient's medical record in digital format
• Electronic health record systems coordinate the storage &
retrieval of individual records & they are accessed on a
computer, often over a network
• A variety of types of healthcare-related information may be
stored and accessed in this way
• Linked directly to e-prescribing
Other Forms of Technology
Electronic health record
Other Forms of Technology
Barcode or BCMA
• One of the high risk areas for medication error is drug
administration
• Bar coding identifies medications for preparation, dispensing
& administration
• By taking action to ensure all medications used in the hospital
include a bar code, pharmacists can set a strong foundation for
patient safety
Other Forms of Technology
Barcode or BCMA
• The FDA investigated bar code medication administration
processes and concluded they would reduce medication errors
by 50% if fully implemented
• This study led the agency to require pharmaceutical
manufacturers to apply bar codes at the unit-of-use packaging
level & to all drugs April 2006
Benefits of Automation
• Necessity is the mother of invention
• The demand for reliable & flexible prescription dispensing
services has brought about many improvements in the area of
pharmacy automation
• Robotic prescription dispensing systems are breathing new life
into an industry where time is a luxury & space is at a
premium
Benefits of Automation
• Automation plays a role in saving time
• Automation can improve patient safety
• Although in other industries automation had led to losses in
jobs but in pharmacy, automation has not involved replacing
people. Instead it has enabled the profession to focus on
pharmaceutical care
Safety Issues Regarding Automation
• Very little data is available on their appropriate use & safety
• Technology can introduce a new source of error
• But if properly integrated all these systems show promise in
reducing medication error
Safety Issues Regarding Automation
• Automation reduces medication error by:
 Reducing complexity
 Simplifying & standardizing processes
 Avoiding overreliance on human memory
 Improving efficiency
Safety Issues Regarding Automation
• Technology by it self will rarely reduce medication error,
rather it needs to be effectively integrated into the medication
use process & appropriately managed to insure patient safety
• If not used properly it can produce more dangerous errors
• Implementing this technology takes years to accomplish with
the need of dedicated employees
Safety Issues Regarding Automation
• Automation can instill a false sense of security leading to
carelessness by health care professionals
• All health care professionals & patients must understand that
the technology can not completely substitute for human
checking
Safety Issues Regarding Automation
Desired safety features for incorporating automation in the
medication use process:
1. The system must have a bar code technology for drug
restocking, retrieval & administration
2. A system must force the user to specify a reason whenever
medications are accessed or administered outside of the
scheduled administration time or dosage range
Safety Issues Regarding Automation
Desired safety features for incorporating automation in the
medication use process:
3. Identification bar codes or passwords must be assigned for
each user
4. Bar code administration systems must be able to identify &
document the patient, the medication, & the person
administering using the scanning technology function
Safety Issues Regarding Automation
Desired safety features for incorporating automation in the
medication use process:
5. Devices are interfaced with the pharmacy computer system
only allowing the nurse to view & access those medications
that are ordered for a specific patient
6. Devices need electronic reminders to nurses when a
medication dose is due
Safety Issues Regarding Automation
Desired safety features for incorporating automation in the
medication use process:
7. CPOE are interfaced with automation devices to provide
warnings about allergies, interactions, duplication &
inappropriate dose at the point of dispensing & administration
8. Real time integration or interfaces must exist for all steps in
the medication use-process starting at prescribing, to order
entry & dispensing, & through administration
Which Automated Technology
Should be Selected?
•
There is no right or wrong answer
•
It depends on how they are carefully integrated into the
system
•
Characteristics for an ideal system you need: patient care &
safety benefits, responsiveness to costumer or patients needs,
& cost effectiveness
Which Automated Technology
Should be Selected?
•
Before implementing a technology in your hospital check the
advantages & disadvantages, check safety issues regarding
the automation you are about to implement
•
Must always remember the importance of pharmacist role in
overseeing & coordinating the use of such system
Cost Issues in Automation
•
Adding New Fixtures/Shelving - $5,000 to $100,000
•
Automated Workflow - $5,000 to $200,000
•
Automated Dispensing - $6,000 to $70,000
•
Robotics - $100,000 to 225,000
•
Self Checkout - $80,000
•
IVR - $5,000 to $20,000
Cost Issues in Automation
•
Must know the area in your pharmacy which requires
automation
•
Funding issues
•
There is no doubt that automation is costly but when it comes
to patient care & safety the quality of services comes first
Impact of Automation on Manpower
•
Pharmacists fear that automation will decrease the number of
pharmacist positions & consequently the demand for
pharmacists
•
It MAY decrease the number of positions for pharmacists &
technicians in which their only job was preparing &
dispensing
•
They will probably cause less jobs for pharmacy technicians
Impact of Automation on Manpower
•
It actually depends in the pharmacists & pharmacy directors
to show the value of having pharmacists
•
If they were able to demonstrate & market the quality &
economic value of pharmacist patient care services to
physicians & administrators, there will be rather an increase
of job opportunities for pharmacists
Impact of Automation on Manpower
•
We should look how automation opened a new role for
pharmacists rather than deleting their role
•
They provided the pharmacists with opportunity to work
more closely with patients & physicians to assure appropriate
drug therapy & outcomes
•
There will always be need for pharmacist to identify, solve &
prevent drug related problems
In Summary
•
We are entering a new era in pharmacy technology
•
There is no perfect technology & all systems must be well
managed to provide best outcomes
•
To be successful in the future pharmacists must view
automation-induced productivity & efficiency as desired
goals not threats to their work
•
Every change must be implemented with an understating that
even good changes can create unexpected hazards
Thank you