Less Time to Fill
Written by Christopher Prawdzik
MMT 2009 Volume: 13 Issue: 7 (October)
Improve Accuracy And Leave Pharmacists
With More Time For Patient Care.
Bar codes, dispensing cabinets, counting software and tighter inventory control are just a few features of the growing technology in military pharmacies. Automation at military pharmacies has streamlined and improved delivery methods in recent years to bring them into the 21st century, helping save pharmacists from counting individual pills, save pharmacies from suffering product loss because of inexact inventory procedures that lead to drug expiration, and sometimes even save the lives of patients, who might in the past have received the wrong prescription as a result of human error.
For military and Veterans Affairs pharmacies, as is the case in the civilian world, costs savings may be the bottom line of any technology’s success. But for all patients, the most important benefit of pharmacy automation is safety. While this technology may reduce human error, observers should not assume that the technology is taking the pharmacist away from the patients. Far from it.
Even as far back as five years ago, when many systems were not as advanced as today, industry professionals and educators were focused on maintaining a strong relationship between pharmacists and patients, and pharmacy technology was instrumental in maintaining and growing that relationship.
At a National Association of Chain Drug Stores Pharmacy and Technology Conference in 2004, for example, Pharmacy Times assembled a panel that included 10 individuals from academia and industry to discuss automation. Maintaining that patient/pharmacist relationship was tantamount, they noted.
The consensus of the roundtable was that because of cost pressures, the technology should enhance the role of the pharmacist. By allowing technicians to handle the bulk of the work, pharmacists could spend more time with patients.
In addition, technology was deemed a catalyst to enhance safety and efficiency while pharmacists proceed to the next level as a “clinical expert.” Ultimately, individuals at the roundtable viewed the technology not as a human replacement, but an enhancement. And as military pharmacies and technology providers increase technology utilization, they’re now seeing these results first-hand, as noted by a number of industry observers today.
“It started out with robotics systems … and that has expanded into adding on workflow systems that coordinate the [roles in a] pharmacy,” said Mike Coughlin, a member of the 2004 roundtable and president and CEO of Mission, Kan.-based ScriptPro, which operates in hundreds of Defense Department and Veterans Affairs pharmacies, including Navy and Army facilities. “[It] prioritizes and organizes the workflow to make pharmacies operate more efficiently and accurately.”
For example, the Navy’s Pensacola, Fla., command has about 11 remote sites in addition to the Pensacola Naval Hospital. Using ScriptPro’s Telepharmacy system, any pharmacist on duty at any of these sites can accept a call at a station and verify that prescriptions are accurate. This includes verifying pictures of individual drugs with the actual filled prescription.
One big bonus of such systems is that instead of spending exorbitant amounts of time on what are essentially administrative or inventory matters, the technology allows pharmacists to do what they were trained to do. That includes understanding the medication needs of patients and ensuring that drug combinations, if multiple drugs are involved, do not lead to adverse interactions.
“These systems take care of those tasks for them, and also like the robots … allow them to delegate those kinds of duties to technicians … but do it in such a way that the system will guide the technician through the process so that accuracy is still preserved, even though you don’t have the trained eye of the pharmacist watching every step,” Coughlin said. “Pharmacists are very important, first of all, to be sure that the right drug is being prescribed, and many times that is not the case. Many times pharmacists have to go in and interact with the doctors to make a right choice.”
In addition to understanding drug prescriptions and the effects of multiple prescriptions taken simultaneously, pharmacists also have the ability and the opportunity to educate and instruct patients about the drugs they take.
“If you have all this technology, and the design of drug, but the patient really doesn’t understand how to use them or maybe doesn’t have a full explanation that will motivate him or her to use the drug properly, [then] instead of having a very successful medication therapy program you can have one that backfires and causes problems,” Coughlin said.
PRESCRIPTION PROCESSING
As for other military services’ pharmacy automation systems, the U.S. Air Force uses more than 100 systems from Johnson City, N.Y.-based Innovation, beginning with workflow software for the pharmacy to process prescriptions.
All bar code-based, the various work stations are set up for order entry and auto and manual filling and verification, and work in conjunction with Innovation’s Robotx system, which includes anywhere from 70 to 140 dispensers. This modular system allows pharmacies to add different cabinet dispensers in increments. So, depending on a pharmacy’s volumes, they can utilize the proper number of counting cabinets.
“Basically you match it up with what your volumes are, and that’s really the driver,” said Jamie Reno, a spokesperson for Innovation. “Certainly efficiency comes into play, because you can save the government some money, but at the end of the day it boils down to that they wanted to invest in automation to increase the quality and patient safety.”
One of the overall trends in the retail world that is also emerging within the military, including the Air Force, is the model of “central fill”: Instead of having high-end automation at every single base, regional refill centers fill large volumes and then truck the scripts out to the appropriate bases.
In the Air Force, Innovation has five such sites and hopes to add more. It’s not necessarily new prescriptions that increase the workload, Reno said, but rather the “maintenance scripts” and refills that make up the bulk of a pharmacy’s workload in many cases. That’s where pharmacy automation helps boost efficiency.
“By having that patient information already in the system, they can just crank those out whenever they need to,” Reno said.
IN THE HOSPITALS
For its pharmaceutical needs, Walter Reed Army Medical Center in recent years began implementing dispensing solutions from Mountain View, Calif.-based Omnicell to handle tens of thousands of prescriptions dispensed each week through nursing units. In 2008, the hospital implemented Omnicell’s Central Pharmacy solution, which Robert Mullenger, group product marketing manager for Omnicell, said serves as a distribution point for dispensing cabinets throughout the facility.
In the interest of safety, bar coding and other technologies are part of a three-stage process that starts in the pharmacy. First, medical professionals ensure the proper medication is dispensed. Second, on the way to the patient, the medication must be located in the proper dispensing cabinet. Finally, the process ensures that the patient gets the right medication.
Removing as much of the manual labor involved in physically tracking items, putting them on shelves and doing inventory helps improve safety and cut costs.
“Overstocking [is] a cost implication if you’re carrying too much inventory of one item and it expires,” Mullenger said. “These medications have shelf lives. Another [concern] is the inefficiency of figuring out where your items are.”
Again, the removal of as much of the inventory-taking and other “manual” work that the pharmacy automation technology enables lets health care providers spend more time talking with patients and ensuring they get the right medications in the right amounts and the right combinations.
“With an automated process, these folks are actually spending less time managing all these medications and more time on patient care,” Mullenger said. “We’re trying to take all of that logistical stuff, do it very efficiently, very safely, so that they can focus on more of the clinical work, which is really the most important place for them to be.”
At Walter Reed, these innovations have not only streamlined the pharmacists’ workloads; they have affected efficiencies throughout the hospital—particularly with limited space. With tight government budgets and an ever-increasing workload at most military medical facilities, Omnicell’s technology utilizes a vertical carousel that fits in Walter Reed’s limited space, allowing them to pack more medications into a smaller vertical space. It also removes the problem of pharmacists having to hunt for various prescriptions on basic and inefficient shelves and allows pharmacists the time to do the things they were trained to do.
“The clinical training—it’s about the diagnosis, and the prescriptions and what interactions the medications are going to have—and here they come out of medical school, out of pharmacy school, and they go into a pharmacy and they spend all of their time doing manual work, running around trying to find out where the pills are,” Mullenger said. “It’s not the right work for them to spend their time on.” ♦