1. New Automation & the Pharmacy Buyer Laurie Price RPhT, CPhT Mercy San Juan Medical Center

2. 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

3. 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.

4. 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

5. What is a Carousel?

6. What is the Carousel? A computerized and automated inventory management system consisting of machinery, a network of computers, printers, scanners and hand-held devices

7. Why? Inventory Management Quick Annual and Semi-Annual Physical Inventory Count Reports Time Medication Safety Space Utilization

8. 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

9. 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

11. 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

13. 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

15. 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

16. 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

17. 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

18. Gaining access to the Carousel Construction Access to pharmacy areas Installation of machinery prior to Go-live Set-up

19. 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

21. 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.

22. 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

23. 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

24. Workflow Adjustment Enforce Communication -Flyers -Meetings -Written Instruction aids Computer or People Problem?  Verify Interfaces -Staff and Missing labels  Reports

25. 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

26. 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

27. 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

28. 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

31. 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

32. 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

33. Getting it right Organization Communication Teamwork Not only building a good relationship with vendor, IT, and construction, but the individual people representing those entities

34. 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

35. Questions