New Automation & the

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5 Νοε 2013 (πριν από 3 χρόνια και 5 μήνες)

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New Automation & the
Pharmacy Buyer

Laurie Price RPhT, CPhT

Mercy San Juan Medical Center


Background


260 Bed Hospital with new construction adding 110 new
beds


New Electronic Health Record system installed prior to
completed construction


8 new Automated Dispensing Machines in addition to 41
existing ADMs


2 new Carousels

Pharmacy Automation


There have been numerous automation devices introduced into
pharmacy with in the last twenty years all designed to provide an
efficient and safer way of dispensing medication to patients. They
include, but are not limited to:


Pre
-
packaging machines


Unit based cabinets


Robotics


Carousels


Over the years more Companies and Vendors have entered the
marketplace providing more comparisons and choices to meet the
needs of the Pharmacy, governing standards, and patient safety
goals.





Objectives


Description: Pharmacy Inventory Management
Automation


Advantages/Disadvantages


Expectations and establishing a timeline


Preparations: Testing and building the Database


Loading the Carousel, training and establishing the
Workflow


Implementation and Adjustments


Ordering


Maintenance


Final Thoughts

What is a Carousel?

What is the Carousel?


A computerized and automated inventory management system
consisting of machinery, a network of computers, printers,
scanners and hand
-
held devices

Why?


Inventory
Management


Quick Annual and
Semi
-
Annual Physical
Inventory Count
Reports


Time


Medication Safety


Space Utilization

Advantages


Provides comprehensive inventory management


Contains 90% of Inventory


Tightens Inventory and decreases shrinkage


Reduces cart fill times (saves 2+ hrs/day)


Provides smart queues


Decreases med errors through bar
-
coding



-
Has the potential to capture expiration dates and lot
numbers


Provides reports on inventory adjustments for
ordering


Documents discrepancies


Controls access via usernames/passwords


Disadvantages


Only one person at a time controlling
each carousel


Missing Bar
-
codes


Items not accurately counted and
adjusted especially remote items


Increased potential in technical
problems


-
Reliance on remote servers


-
Potential server shut downs


Tedious for Put
-
Backs

Expectations and Establishing a
Timeline


Initial plans


-
more than a year in advance


Meetings with project managers


-
builders: Specs


-
vendors: Requirements


Estimation of completed construction
and “Go
-
live” date set


Database Entry and IT testing


-
starting 6 months prior to Go
-
live


Teambuilding and Extensive Setup

Preparations: IT Testing and
Building the Database


Simultaneous IT testing and Database Build


Core Team Development


-
Pharmacy Technician/Buyers


-
Pharmacists


-
Facility IT Specialist


-
Automation Vendor Interface Analyst


-
Automation Vendor Implementation Specialist


-
Automation Vendor Training Specialist


-
IT Implementation Team/Facility Electronic Health Records System
Liaison


Weekly Progress Meetings


Building the Database in the Vendor’s
Automation Catalog and gathering
information


Vendor Specifications


Excel Format


Time consuming
manipulation of data


Weekly transfers of
database information
to Vendor Training
Specialist



Why the Buyer?

Where to get information?


Wholesaler reports (3 years of purchase history
recommended)


Hospital Formulary Databases


GPO Reports


Wholesaler item look
-
up


Buyer’s knowledge


Combination of reports and programs

Special Circumstances and
Considerations


Wholesaler change with less than 3 years
purchase history


Bid Role
-
Out


Using correct NDC numbers


Meeting established timeline goals


Mandatory data


Communication with Pharmacy Informatics
Specialist


1000 hours of data entry






Gaining access to the Carousel


Construction


Access to pharmacy
areas


Installation of
machinery prior to
Go
-
live


Set
-
up


Loading the Carousel



Assigning locations, levels, totes and bins


Determining space needed


Fast
-
movers


-
levels 1 and 2


Separating “look
-
alike/sound
-
alike”


Using “tall” shelves


Using scanners


Printing labels for bins


-
Bar
-
coded item number for locations


Minimal amounts of product and empty
packaging used for initial loading


Using PBC (Product Bar Code)


-
Case Bar Code


-
Package Bar code


-
Individual Item Barcode


Training


Buyer’s were trained on the Ordering Process


Minimal amounts of product was ordered via carousel
workflow computer and used for initial stocking of
carousels


Pharmacy Buyer experience to help facilitate training


A team of Pharmacists and Technicians were assembled
to help with the initial load of the carousels


Repetitive actions used to familiarize Pharmacists and
Technicians with carousel


The team members were utilized to train other staff


The team presented their ideas on workflow


Sign off sheets and training overviews were used.

Implementation and Adjustments


Capture and identify potential problems and
workflow changes before Go
-
Live


-
Inventory split by use, not alphabetical


Setup model as Technician
-
centric

Timing is Everything


Set to move all medication from old pharmacy
into the new pharmacy overnight


Go
-
Live day limited to filling all orders from the
new pharmacy and Carousels

Workflow Adjustment


Enforce
Communication


-
Flyers


-
Meetings


-
Written Instruction aids


Computer or People
Problem?


Verify Interfaces


-
Staff and Missing labels


Reports

Post Implementation Surprises

“Whenever we computerize a medical process to reduce
errors, there is always the risk that new errors will be
introduced”
-

Larry Ozeran, MD


Wrong item loaded into bins


Missing Barcodes


Wrong Item associated with Barcode


Items not loaded into Carousels


Post Implementation Fixes



Establish Remote Access to Carousels


Adding Hand
-
Held Devices


Adding the Carousel computer program
and Scanners to more computers


Rescheduling cart fills and batch picks



Ordering Process


Orders can be Automatic or
Manual


All items are set with


Min/Max levels


Distributor item numbers


Pricing


Packaging information


Quantity levels



Orders can be manipulated in
the order manager program


Orders can be interfaced with
the distributor’s ordering
program



Receiving Process


Order Invoice can be received Electronically or
Directly


Product Bar Codes are used for receiving
directly


Received items are stocked to a queue in the
Carousel for efficient restocking


Order status on items are displayed while
carousel is being used


Has capabilities to return items to Distributor

Ordering Process Limitations


Once a purchase order is sent it must be
received and restocked before another
order is placed to avoid double ordering


Large order restocking can disrupt
workflow


Remote area items may be missed due to
incorrect inventory adjustments


Maintenance


Buyers designated for
formulary maintenance of
database


-
New item entry and
associations


-
Maintain price schedules


-
Interfacing


Inventory


-
Set par levels


-
Efficient stock qty
management


Export inventory needs to
specific distributors


Reporting functions

Getting it right


Organization


Communication


Teamwork


Not only building a good relationship with
vendor, IT, and construction, but the
individual people representing those
entities

Final Thoughts

“We are continually doing formulary maintenance
to make sure that we are compliant with
formulary standards. However, the benefits of
the carousel for inventory management and
workflow have outweighed this extra task.
Before we used to over order too many items,
but now we have a much leaner inventory and a
faster safer workflow.”


-
Kelly Huang, CPht

Questions