Evolving Pharmacy Automation

State of Pharmacy Automation 2014 - Vol.11 No. 8 - Page #4

As the era of budget reductions recedes, optimization is quickly becoming the new standard. While new automation purchases are expected—particularly in areas that have not traditionally benefited from multiple technology options, such as the compounding complex, outpatient pharmacy, and the operating room—a strong focus is expected on optimizing existing technology, whether it be improvements to packaging operations to reduce the need for manual work or capacity expansion of existing ADCs. Pharmacy directors are now tasking their staff with ensuring the full value is extracted from investments in technology and automation. 

Survey Design
In the second quarter of 2014, Pharmacy Purchasing & Products polled a random, nationwide sample of health system pharmacy directors. We queried these pharmacy leaders on their current usage of automation in the pharmacy, the amount of budget allocated to support automation, the depth of their informatics staff, and their 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% +/-4.36) based on the population of pharmacy directors nationwide. The results of our survey are shared on the following pages. 

We intentionally survey a random sample of pharmacy directors, not just readers of Pharmacy Purchasing & Products, to ensure the data reflects trends across the entirety of US hospital pharmacy practice. Given this fact, we are quite pleased that more than eight out of 10 pharmacy directors rely on Pharmacy Purchasing & Products when researching automation purchases. 

Automation Expansion by Facility Size
As would be expected, facility size often has an impact on automation acquisition, budget allocation, and depth of IT support. To accurately reflect the similarities and differences that exist between small, mid-sized, and larger facilities, we ensure that our survey respondents are proportionately representative of facility sizes nationwide, based on AHA data. On the pages that follow, we have noted those areas where technology use is impacted by facility size.

Historically, larger facilities with correspondingly larger budgets and deeper IT staff have been the leading adopters of new technology and automation. That observation holds true this year for many areas of automation, particularly with solutions that are newer to the marketplace, like IV workflow solutions for compounding, and those that support large-volume activities, like automated compounding devices. However, much of this year’s growth in adoptions among the more established technologies, such as CPOE and BCMA, was driven by small facilities. Automated solutions have become the mainstay in many larger facilities—consider that BCMA, CPOE, and ADCs are enjoyed by 80-90% of hospitals with greater than 400 beds—yet this year saw strong efforts by hospitals with fewer than 200 beds to build highly automated pharmacy operations.

Increasing Budgets
Five years ago, as many as three out of 10 facilities were addressing budget cuts and flat budgets were the norm. While it would be the rare pharmacy director who is charged with managing an unlimited budget today, projections are far less dire than they were five years ago.  Eight out of 10 of facilities expect to maintain or expand their automation budgets next year, and projections are rosier over the longer term, as a majority of facilities expect their automation budgets will grow over the next three to five years. 

Top User Satisfaction Ratings
1. Automated Compounding Devices
2. Carousel/Robot Storage
3. Automated Dispensing Cabinets
4. Outsourced Repackaging
5. IV Compounding Robots

Click here to view a larger version of this Table

The top-rated automation solutions in terms of user satisfaction are notable this year for their diversity; they represent established technologies and cutting-edge automation, products that meet targeted needs and those that are used universally. Achieving fourth and fifth place this year are two newcomers to the list of top-rated automation solutions. Both outsourced repackaging and compounding robots provide solutions to a persistent problem in pharmacy: Ensuring the availability of bar coded, unit of use products for patients when they are not available as such from the manufacturer. 

Also notable are those areas where pharmacy directors are consistently dissatisfied. Perhaps owing to the complexity of implementation and the fact that the system vendor is often mandated by administration, CPOE systems consistently receive low satisfaction marks, as do manual systems for medication reconciliation. The area where pharmacists express their highest dissatisfaction is with data collection from smart pumps. Frustration runs high when it is difficult to leverage the data collected by the system, making it challenging to optimize practice changes and impact patient safety.

When prioritizing automation purchases, a review of the satisfaction those systems have delivered to your peers is a wise measurement to undertake. Perhaps the most important return on investment we have noted in our survey does not involve a technology, but rather the addition of an informaticist to the pharmacy staff. 

Investing in a pharmacy informaticist pays strong dividends, from high rates of automation acquisition to exceptional depth of automation use. Not only are ADCs and smart pumps ubiquitous in facilities with pharmacy informaticists, but those facilities also are much more likely to verify stock before placing it in the ADC to reduce risk of adverse incidents and to interface their smart pumps with their BCMA system. Ultimately, facilities with a pharmacy informaticist on staff are more satisfied with the value they receive from their automation. The challenge often lies in identifying and recruiting experienced IT pharmacists, as they are in such high demand. Particularly in small facilities, it may be wise to consider creating a half-time informaticist position and investing the necessary resources to train an existing staff member to take on that role. 

Evolving Pharmacy
Pharmacy continues to create efficiencies in medication use to promote safety and ensure responsible management of limited resources. Oftentimes that means leveraging technologies and systems to achieve novel ends. For example, ADCs and CPOE are now pivotal tools in the effort to manage access to drugs on shortage. Outpatient pharmacy, which has historically been employed to control staff prescription costs, may now serve as a partner in the process to ensure smooth transitions in care. With bedside delivery of medications for patients to take home, outpatient pharmacy has evolved into a service that can build strong patient satisfaction. Overall, hospital pharmacies of all sizes are becoming highly automated operations, and pharmacy directors are continually working to leverage that automation into increased efficiency, productivity, and ultimately, improved patient safety. Some of the interesting developments this year include:

  • The use of finance integrity systems is widespread; almost 9 out of 10 hospital pharmacies utilize these systems in response to the increasing pressure to account for thorough and accurate billing.
  • Physician order imaging systems remain a valuable tool for pharmacy, either as a back-up when the CPOE system is down, or to provide automated order management for those departments that have yet to adopt CPOE. 
  • Pharmacy directors continually endeavor to increase the number of orders sent through CPOE to ensure a broad application of the safety this system can provide. 
  • Given the popularity of ADCs, it is not surprising that an increasing number of pharmacy directors have implemented bar code verification upon ADC restocking, and a growing number plan to expand the capacity of their cabinets.
  • Committing to an effective packaging operation provides dividends: Pharmacy directors taking advantage of 2D bar codes, automated packaging equipment, and dispensing 100% of doses in unit of use are also the happiest with their packaging operations.
  • Applying the same bar code safety benefits to IV compounds that oral doses currently enjoy is quickly becoming a key imperative for pharmacy directors, as many aspire to implement automated IV workflow management systems.
  • The increased attention brought to managing drugs in the OR has resulted in the addition of significant controls in this area, from improved pharmacist reviews to increased adoptions of OR-specific automated medication cabinets. 
  • Satisfaction with pharmacy systems increases in direct proportion to pharmacy’s level of involvement in choosing the system, making it key that selection teams for automation systems—whether for BCMA, CPOE, or temperature monitoring systems—include pharmacy representation.
  • Expanding services will be the hallmark of outpatient pharmacy as many pharmacy directors look to capitalize on the value derived from outpatient operations.
  • Much of the growth in automation use is supported by connectivity; the continued expansion of wireless networks across facilities of all sizes will bolster pharmacy’s efforts to move beyond manual systems. 

In Conclusion
With growing budgets, the next few years should provide ample opportunities within the pharmacy to improve patient safety through new technology adoptions and the exploitation of existing automation to deliver increased efficiencies. We also expect to see pharmacy directors leveraging analytics to improve patient care—from utilizing CPOE to support prescribing excellence or smart pump data to fine tune limitations on order sets, to utilizing big data to optimize specialty pharmacy contracting.  

As we do every year, we invite you to take advantage of our Automation Slide Kit. Pharmacy Purchasing & Products is happy to provide much of the data you find on the following pages as PowerPoint slides. You are welcome to use this data in your own presentations; we hope it serves as a valuable support as you make the case for additional investments in automation at your facility. And you are certainly welcome to incorporate the data into presentations you may make externally to educate your colleagues on automation opportunities they may be considering. Simply access the slides on our website (www.pppmag.com/slides).







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


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