Pharmacy's Commitment to Safety

State of Pharmacy Automation 2012 - Vol.9 No. 8 - Page #4

In a best-case scenario, a pharmacy without up-to-date automation is going to suffer from inefficiency and ensuing staff morale issues. In a worst-case scenario, that pharmacy may be incapable of identifying common miscalculations that lead to IV overdoses, or may unknowingly experience transcription errors in medication orders—risks that directly threaten patient safety. Examples of how automation can deliver safety improvements abound and include order profiling, IV pump limits, and electronic ordering. Nonetheless, technology implementations alone do not guarantee patient safety or improved operations. Therefore, a key element in achieving these improvements is having dedicated, qualified staff capable of not only implementing new technology, but also managing it over the long term to ensure these tools serve your evolving operation.

Survey Design
In the second quarter of 2012, Pharmacy Purchasing & Products polled a random, nationwide sample of health system pharmacy directors. We asked about automation budgets, informatics staffing, current automation use, and future plans for technology adoptions. Responses were solicited via email and a total of 513 pharmacy directors replied, yielding a confidence interval of 4.13 (95% +/-4.13) based on the population of pharmacy directors nationwide. The results of our survey are shared on the following pages.

We intentionally surveyed a random sample of pharmacy directors, not simply readers of PP&P, to ensure the data reflects trends across the entirety of US hospital pharmacy practice. Given this, we are quite pleased that almost nine out of 10 pharmacy directors rely on PP&P when researching automation purchases. 

Automation Expansion
2012 was defined by significant expansions in automation implementations across facilities of all sizes. Likewise, significant efforts are under way to increase the sophistication of pharmacy technology, be it in terms of adoptions of new tools and upgrades, or the expansion of data integration and reporting capabilities for existing technologies. 

In support of BCMA, the delivery of all medications to the units in bar coded unit dose format has become an almost universal practice, despite the continuing challenge of sourcing cost-efficient unit dose products directly from manufacturers. While automated packaging operations are widespread, the need for some manual repackaging has yet to be eliminated. In the effort to communicate more data at the bedside, the use of 2D bar codes is expanding, although it is still used by a minority of facilities and generally only for some bar code needs. Pharmacy directors will need to work with their vendors to ensure 2D bar code options expand, be that through packaging more drugs with these data rich codes, developing more tools that include 2D reading capabilities, or developing more sophisticated reporting tools that utilize this expanded data capacity.

Phenomenal gains have been realized over the past year in the implementation rates for CPOE, and BCMA also has seen brisk growth. For the first time, both CPOE and BCMA are now used by a majority of health systems in the US. While larger facilities are more likely to have these tools in place, this year also saw rapid growth in the number of smaller facilities that are moving to electronic order entry. Similarly, many smaller facilities are also in the process of converting their IV delivery to smart pumps, thereby ensuring the patient safety benefits from these technologies will not just be the domain of the largest facilities with the deepest resources. 

Outpatient pharmacy operations also benefitted from a renewed interest this year. More facilities offered outpatient services and the level of automation used to fill outpatient prescriptions also increased.

This automation expansion is largely driven by budget confidence—not only are very few facilities currently facing budget cuts (most pharmacy budgets are likely to increase or stay the same next year), but the longer-term forecasts are increasingly positive, as most facilities project automation budget increases over the next three to five years.

New Technology Options
More pharmacies are exploring newly available technologies, such as automation to ease the hassle of waste sorting and manage controlled substance disposal, and software to automate compounding room workflow and identify error points in CSP processes. While these technologies did not enjoy the phenomenal growth seen with CPOE, their implementation numbers increased this year. As with any automation that delivers increased efficiencies and higher assurances of patient safety, accompanied by high satisfaction rates from early adopters, we will continue to monitor the progress of these newer automation tools.

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Automation Driving High-level Results
Evolving technology is the key to delivering progressive growth. Thus, efforts invested in improving technology outputs result in clearly measurable increases in system satisfaction. For example, those facilities that have worked to interface smart pumps with their BCMA system or program their pumps with patient-specific data give very high satisfaction rates to their smart pumps. Likewise, CPOE satisfaction rates are higher for those facilities using integrated databases. As hospitals move beyond the stage of initial adoption for many of these technologies, it will be imperative that pharmacy management work directly with their vendors to ensure the technology can evolve to provide more sophisticated outcomes. We will be watching for satisfaction ratings to improve over the next few years as more facilities are able to increase the maturity of their automation by improving smart pump data management, profiling more cabinets, applying electronic order entry facility-wide, etc. 

Dedicated Automation Staff
The key to pharmacy increasing the number of automated processes and functioning at a higher level (ie, programming smart pumps with patient-specific data via 2D bar codes) is employing strong automation resources—in other words, dedicated pharmacy informaticists. The one commonality among the most automated pharmacy operations is having dedicated automation specialists on staff. These operations also are the most satisfied with the results of their technology implementations. Again, to significantly impact patient safety, simply purchasing the latest automation tool will not provide automatic results; rather, it is the long-term management of your systems and the resulting improvements you make to your databases that will ensure the building of a living, growing infrastructure that supports the development of safe processes and meets the ever-evolving needs of your department and your patients.

An institutional commitment to dedicated automation staff delivers compelling dividends, as most facilities taking this approach not only benefit from a stronger IT infrastructure, but also from higher automation budgets than their peers who are not supporting informaticist positions.

In Conclusion
Developing an understanding of how the various automation, software, and technological products and services currently being used in hospital pharmacy practice can work together to augment operations is vital. Staying abreast of new advancements, seeking to constantly improve workflow, and hiring and nurturing apt and ambitious staff are the keys to developing this understanding.

 


Deanne Halvorsen is the editorial director at Pharmacy Purchasing & Products and can be reached at dhalvorsen@ridgewoodmedia.com


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