Jennifer Yahnian, BSN, RN
Pharmacy Information Manager
VA Central California Health Care System

Melissa Chase, PharmD
Chief, Pharmacy Service
VA Central California Health Care System
Technology in use: OptiFill II, Generation 4

Perform a workflow analysis to help streamline pharmacy operations. When we made the decision to upgrade our automated dispensing system, we evaluated our pharmacy layout, staffing, staff movements, workflow, ergonomics, and specific needs to determine the best design/configuration for our automation unit, conveyor, and workstations. We wanted to eliminate excessive bending, reaching, and walking to multiple areas for products. In addition, we incorporated shelves within the technician workstations for fast moving, manual-pick products such as insulin syringes, alcohol pads, test strips, lancets, inhalers, triple antibiotic ointment, and diabetic cough syrup. These shelves are within easy reach and allow for faster filling time.

Consider your highest-volume medications when building and placing canisters to help increase dispensing potential. It is critical to identify the pharmacy's high-volume oral tablets and capsules and the most frequently filled window pickup medications when deciding where to place the canisters in the automated dispensing machine; this will significantly affect dispensing capacity. Large-capacity canisters, which do not need to be refilled as often,
should be used for large-sized and/or fast-moving medications such as ibuprofen, multivitamins, and simvastatin. Fast-moving medications that are placed in regular canisters should be kept in the top sections of the cabinets to reduce frequent bending during restocking.

In order to prevent selection errors for manual-pick products, document and maintain the exact shelf location of these products in the software system. This way, when a patient's medication tote is scanned, the exact location of the product will display to the technician for quick retrieval. This saves the technician the time of searching shelves for the ordered product and reduces the possibility of a selection error. The final barcode scan of the product verifies that the product is correct. For this to be effective, each shelving unit in the pharmacy should be carefully labeled prior to drug location mapping. This process will require updating as more products are added and/or changed.

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Leslie S. Bucey, RPh
Supervisor, Pharmacy Services,
Outpatient Department
Brigham and Women's Hospital
Technology in use: ScriptPro SP Central Workflow System

Take account of how the security settings are configured in your system, and work with your vendor to ensure the configurations meet your needs. When our system was first initiated, we realized that any user had the authority to interchange a product if a prescription needed to be filled with a manufacturer other than the one requested. Allowing this functionality opened up the opportunity for a prescription to be filled with an incorrect product. If an error occurred at this time, it would need to be detected by a pharmacist during the final verification process in order to prevent a dispensing error. We felt that having this functionality compromised patient safety, so we worked with our vendor to modify the security settings to disallow interchanging of products. Now, a prescription can only be filled with the exact product selected via barcode scanning at the time of the request.

Monitor drug quantities in the cells of the robot in order to stay apprised of drug-usage trends. Cells that are not being used efficiently translate into money wasted. We run quarterly usage reports, so we can compare previous usage with current usage. This way, if we notice that use of a particular drug is falling off, we know to scale back our par levels. Stay informed of impending new generic releases as well, as this will impact your use of the brand version.

Link the prescription notification board to the pharmacist final verification process. We needed to find a way to let the patient know that their prescription was ready since the patient waiting area is not part of our pharmacy, and we needed to execute this in a way that was HIPAA compliant, yet practical. We decided on using the last five digits of the patient's hospital medical record number as this information is already stored in the system database. We set up the system so that this information is transferred to the notification board in the waiting area during the final verification process. This is an automatic process that does not require any keystroke entry, therefore eliminating any risk for manual data entry error.

Do not skimp on daily cleaning and regular maintenance; this will ensure optimal performance of your costly equipment. Every day, the early morning technician cleans the floor of the machine, the spouts of each cell, and the sensing locations of the "gripper." In addition to cleaning, make sure to schedule routine maintenance by the manufacturer in a timely manner.