Kelli Donovan, CPhT Adventist Medical Center Portland, OR

 Why automation?  Time-line for set-up  Using reports from a Buyer’s standpoint  Diversion  Lost Charges  Choosing machines  Choosing medications  Load machines  Going live  Reordering supplies  Decreasing stock levels

 30% of a prescription drug abusers work in the medical field, and of those 70% ARE NURSES.  Types of diversion: falsification substitution omission breakage/wastage theft

 Falsification: nurse cannot remove medication without medication order in Omnicell  Substitution: nurse has no access to any narcotic except one asked for  Omission: medication is automatically charged for with electronic record  Breakage/wastage: nurses must have witness sign at time of breakage/wastage

 Theft: There is an electronic record in addition to a charge in billing system of each transaction

 Dispenser Drawer: Only accessed by Pharmacy personnel. Drops only the narcotic and quantity asked for into a separate drawer. Used for CIIs and most commonly abused narcotics (Hydrocodone combinations)  Medium Security Locking Drawer: Holds multiple doses of CIII-CV drugs. Every drawer is locked any only medication asked for opens.

 Sensing drawers: Used for non-controlled medications. Any drawer can be opened, but the machine records an illegal drawer was opened.

 ED Department had over $90,000 in lost charges in  Most of the charges came from cardiac drugs (Integrelin, Reopro, etc.)  With Omnicell, each transaction has to have a name attached to access the drugs.  Reports can be generated to track down “temporary patient” entries.

 Not limited to high expense items: Tylenol, Lidocaine, Sterile Water, Normal Saline are most common low cost items most often lost charges

Step 1 Decide on machines for different areas 2-3 hours with nursing/pharmacy staff Step 2 Assign medication to machines 2-3 hours per machine Step 3 Load medication in machines 4-6 hours per machine

Step 4 Go-live 1-2 hours per machine Step 5 Training 2 hours minimum per employee 9 to 12 hours for each machine

Stock level report: Shows up-to-minute quantity in each machine -Order exactly how much to fill each machine -Can choose to move medication from one machine to another, instead of ordering more stock

 Loaded meds without active orders: Can remove medication from one machine that is not being used and move it to one that has orders for it. -Prevents overstock and possibly outdating -Helps with stock rotation -Decreases stock in main pharmacy