At Union Hospital—a 122-bed, acute care hospital located in Cecil County, Maryland—the pharmacy department interacts with the rest of the facility via BCMA, CPOE, decentralized medication distribution via ADCs, and smart pump technology in order to help provide a safe patient experience. Essential to the viability of all of these safety and efficiency tools is an orderly system of inventory storage and access.
Prior to implementing an automated carousel in the spring of 2013, we used a manual process for ordering, receiving, storing, and dispensing medications, a process fraught with the potential for human error. Among these manual processes was noting medications for reorder on a paper log; this approach resulted in medication scarcities when staff members were too busy or forgot to document what medications were needed. Furthermore, outdated or incorrect medications were occasionally found in the manually sorted drug bins, causing additional work in order to avoid dispensing the wrong drug strength or dosage form to the nursing units. We were concerned that these manual processes introduced an unacceptable level of risk to our medication management and administration systems.
To improve inventory management, we decided to implement a carousel to automate the medication storage, ordering, and distribution processes. After reviewing various carousels, we chose the InnoStore VC from Pharmovative as it provided the most competitive pricing for our operation and they were able to incorporate our software optimization suggestions at no additional cost. For example, we believed it necessary to include a step requiring a pharmacist-check of all medications pulled from the carousel by technicians, and this forced function was promptly incorporated into the software.
In the acquisition proposal to hospital administration, several projected benefits to medication safety and streamlining of workflow were emphasized. We outlined how this technology would help improve the management of our inventory in the face of increasing national medication shortages. Furthermore, we noted the elimination of costs related to annual inventory counts (the carousel software provides perpetual inventory counts), as well as the carousel software’s ability to assist in cycle counting to improve inventory tracking. Finally, we included the expectation that the carousel would allow more time for pharmacy technicians to engage in the medication reconciliation process.
Housing the carousel within the central pharmacy required physical and operational adjustments. Fortunately, expansion space was available from an adjoining department. If operating space is limited, as is often the case for hospital pharmacies, be sure to consult with facility engineering personnel prior to selecting a vendor to make sure you have appropriate space and weight-bearing capabilities for the device.
Pharmovative was helpful in providing tools to assist with the implementation, including project plans with defined timelines for achieving major goals, suggestions for managing the transfer of medications into the carousel, and developing a process to deliver and set up the carousel in a timely and efficient manner. They worked with our ADC and IT system vendors to ensure all interfaces were in place to integrate the systems seamlessly. Pharmovative representatives also provided training on the carousel’s use concurrent to the initial setup of the system.
The InnoStore VC receives data from our hospital IT system and from individual ADCs, identifying the drugs needed to restock the cabinets at specific times throughout the day. Those lists are posted on the carousel monitor as they are received and technicians initiate the drug pull as the carousel rotates to the correct shelf and bin. A scrolling digital ticker lists the name and quantity of the medication needed and indicates the proper medication bin to pick from. The medication is removed by the technician and scanned for accuracy, and then the carousel automatically spins to the next item on the list. Bulk items and drugs that are not stored in the ADCs are sent over to the carousel via our hospital IT system, which initiates a separate pull. Likewise, stat medication requests will interrupt routine medication pulls.
The buyer downloads a daily list of medications that are below par, which is then sent directly to our drug wholesaler via their ordering software. Thisallows the buyer to conduct a final manipulation of the order if the usual amounts need to be amended, or if alternative medications must be obtained due to availability issues. Furthermore, when purchased medications are received, an electronic invoice is uploaded to the carousel for ease of restocking.
The InnoStore VC has proven to be an easy to use, efficient, and useful addition to our workflow, as it fits well into our purchasing, storage, and dispensing process. Although we initially used the system only to manage medications stored in the carousel, we now include larger bulk items, IV solutions, and refrigerated medications in the carousel’s inventory. By listing these items as remote stock, we have improved the efficiency of ordering and tracking of these medications. Overall, we have experienced a decrease of incorrect medications delivered to the ADCs, improved inventory purchasing, and fewer stock outs.
David Jaspan, RPh, MBA, is the director of pharmacy and materials management at Union Hospital of Cecil County, Maryland.