New Automation & the Pharmacy Buyer

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New Automation & the
Pharmacy Buyer
Laurie Price RPhT, CPhT
Mercy San Juan Medical Center
Background
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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
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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?
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A computerized and automated inventory management system
consisting of machinery, a network of computers, printers,
scanners and hand-held devices
Why?
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Inventory
Management
Quick Annual and
Semi-Annual Physical
Inventory Count
Reports
Time
Medication Safety
Space Utilization
Advantages
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Provides comprehensive inventory management
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Contains 90% of Inventory
Tightens Inventory and decreases shrinkage
Reduces cart fill times (saves 2+ hrs/day)
Provides smart queues
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Decreases med errors through bar-coding
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-Has the potential to capture expiration dates and lot
numbers
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Provides reports on inventory adjustments for
ordering
Documents discrepancies
Controls access via usernames/passwords
Disadvantages
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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
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Tedious for Put-Backs
Expectations and Establishing a
Timeline
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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
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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
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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?
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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
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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
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Construction
Access to pharmacy
areas
Installation of
machinery prior to
Go-live
Set-up
Loading the Carousel
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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
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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
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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
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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
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Enforce
Communication
-Flyers
-Meetings
-Written Instruction aids
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Computer or People
Problem?
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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
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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
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Ordering Process
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Orders can be Automatic or
Manual
All items are set with
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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
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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
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Maintenance
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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
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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
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