Better Workflow Through Informatics; A MAJOR Automation Implementation Can Work Miracles
Duane E. Machaj, R.Ph., Thani Misra, Pharm.D., Sherry Mason, C.Ph.T., Isabel Sanvanson, Pharm.D.,
Jesse Brown VA Medical Center, Chicago Illinois
BACKGROUND:
Back in the “old” days for inpatient medications, our utilization of
automation equipment, data interfaces, co-ordination of VistA
software packages, and workflow processes were “comfortable”
(routine). We always did it that way, but why not find a way that
utilizes resources more effectively, more efficiently, enhances
patient information accessibility, and improves patient safety? It’s a
major challenge to a get a large multidisciplinary team of
pharmacists, technicians, nurses, physicians, etc. to modify their
routines in search of the “better way to do it”.
Methods: The Informatics Inc. Interface software
was purchased. This required approval at the VISN level as this is
commercial Class III software. This interface was customized to
the specifications of our site. In addition to the patient
demographics provided by the previous interface, we now
received patient specific medication orders in real time on each
designated workstation. Under this interface, we were able to
add profiling for outpatient areas (such as the Emergency
Department) which were not available previously.
The starting point of this transition can be described as follows:
•Centralized cart fills every 24 hours.
•Pharmacy technicians performing cart exchanges with multi-dose
items transferred manually at time of exchange.
•New orders and change orders delivered by pharmacy every 2
hours.
•Minimal ward stock. Mostly controlled substances maintained in
the Pyxis medstation of the 3000 system.
•The only interface was patient demographics so the nurse or
provider could just pick a patient from the list.
•Medication orders were not displayed so user could remove any
controlled substance.
•This version of automation did not authenticate correct drug by bar
codes when stocking.
OBJECTIVES: Our goal was to transition to a “point of care”
system which would expedite the availability of medication from
ordering through administration. We wanted to also enhance
the safety of medication handling by providing bar code checks
when stocking the cabinets and patient specific medication
profiling to ensure the correct medication was removed for the
correct patient. Since automation and informatics have
advanced significantly over the years, we intended to maximize
their role in the new process to better utilize our “human”
resources for hands on patient care.
This serves as the initial build of the new Pyxis drug file along with drug classes and dosage forms directly from Vista drug file
We ran the Pyxis 3000 system until the day of conversion. The
new drug database was built to coincide with similar data fields in
the VistA drug file. This included generic name, dosage form, and
therapeutic class obtained using fileman templates from the Vista
drug file. The drug identification number in Pyxis 4000 would
now be the IEN number from the VistA drug file. Tallman
lettering was also applied to appropriate medications to
eliminate any potential “look alike – sound alike” errors.
A second spreadsheet was prepared to identify each synonym
(NDC number) that corresponded to that EIN number in the VistA
drug file. This allowed Pyxis to auto-populate their drug file with
all the necessary synonyms and make all our drugs immediately
bar code readable in the new system.
The second overlay of the Pyxis drug file added potential for barcodes
The new process was built as a “parallel” system to the current
workflow. A commercial profiling interface software was
purchased, customized, and tested with the new dispensing
cabinets. The drug database for the new system was built from
scratch utilizing drug classes, EIN number, synonyms (for bar
codes), etc. extracted from our VistA system. All unit dose, ward
stock, and controlled substance software were modified to
maximize their role in the new process. Wards were
simultaneously brought down in the old system when they were
initiated in the new system.
Standard Configuration of New Medstation
RESULTS:
•Medications available to nurses within minutes of pharmacist
finishing order.
•Dispensing cabinet software identifies stock needs quicker at a
central location
•Medications are removed from cabinets specifically by patient
profile ensuring patient has order for that medication.
•The profiling system provides better handling of IMO orders in
clinics and emergency department and prescription dispensing
from CBOC’s.
•Significant reduction in missing or late doses.
•Greater security and accountability of multi-dose medications.
•Improved team morale with the overall workflow process.
Conclusion: Many times a long establish process may
never get reviewed or questioned unless there are specific
negative issues or concerns which prompt such a review.
With advances in technology leading to better
computerization and automation, we must continue to
incorporate these effectively into our daily workflow.
Ultimately the organization, staff and patients all reap the
benefits which include cost avoidance, improved efficiency,
and enhanced patient care.
Pyxis 4000 Implementation Plan