Flagstaff Medical Center is a 267-bed tertiary care medical center. As the only level one trauma center north of Phoenix, Arizona, it is an active facility, with multiple ERs, extensive cardiovascular and surgical services, behavior health units, inpatient dialysis, a cancer center, and a retail pharmacy. The entire hospital utilizes CPOE and BCMA. The medication distribution system is a hybrid model, using profiled automated dispensing cabinets (ADCs) and unit-based clinical pharmacists, with the central pharmacy supplementing first doses as needed and supporting the outpatient infusion unit, ERs, and sterile compounding.
Previously, our storage and distribution process relied on a workhorse carousel, which was introduced to the pharmacy without the benefit of a renovation. In 2010, the equipment was approaching the end of its life; it would require an extensive rebuilding of its critical components to maintain its productivity.
Pharmacy leadership took this opportunity to review the carousel offerings on the market, as well as alternative technologies that provided similar capabilities. The new system needed to improve efficiencies in distribution and inventory control processes, and simultaneously promote a high level of patient safety.
When deciding which equipment would best support the pharmacy’s drug storage, dispensing, and inventory control processes, leadership considered the level of involvement required of the pharmacy technicians in order to reduce the opportunities for error. As such, a core group of technicians served on the evaluation team and went on site visits. Including the primary end users was invaluable to the decision making process.
The goal was to implement a system that would minimize the chance of picking and dispensing errors, while improving efficiency and productivity. As such, the team looked for a technology that would deliver the requested medication directly to the technician and require a bar code scan to verify the transaction.
Furthermore, pharmacy wanted a technology that would enable multiple staff members to simultaneously use the equipment for distinct operations, such as loading, dispensing, and crediting, in order to improve workflow within the pharmacy. As a result, after consulting with colleagues and conducting site visits, pharmacy chose the Swisslog BoxPicker. To justify the expense to administration, the team highlighted the fact that the lease for the current system was expiring, as was its functionality.
Benefits of Automation
The system that was ultimately installed is a five-module, two-access point Swisslog BoxPicker. It serves as the primary means of medication storage, dispensing, and inventory control in the pharmacy. The software manages the inventory that resides both within and outside of the unit and interfaces with all hospital systems. The BoxPicker can pick and dispense patient-specific first doses, as well as ADC and cart fills, while also providing perpetual inventory control and automatically drafting wholesaler orders.
With the dual access points, one technician can stock medications within the system while a second technician simultaneously picks patient-specific drugs, completes refills for ADCs, or credits and restocks returns. The system can manage multiple medication formats, including tablets, injectables, inhalers, bulk items, and remote stock. The safety checks, which include product bar code validation, reduce the chance of a picking or dispensing error. The system also optimizes dispensing speed by queuing the requested medications based on the most efficient delivery order for that specific list of drugs.
In comparison to the previous system, the Swisslog BoxPicker reduced daily ADC pick time by 26 to 32 minutes and reduced the time to pick patient-specific first doses 4- to 5-fold. The efficiencies gained thus far have allowed pharmacy to reduce drug to patient turn-around time, curtail ADC stock outs, allocate additional resources to sterile compounding, and spend more time on medication reconciliation and transition of care activities. In addition, medication returns will soon be simplified; a single scan of the bar code will allow technicians to credit the patient’s account and return the medication to inventory.
The vendor’s team of experts was instrumental in overseeing project management, collaborating with the hospital facility design team, building and testing interfaces, and training staff. In particular, their workflow design expert consulted with our pharmacy team on all workflow changes, oversaw the set-up of the technology, performed all super-user training, and conducted pre- and post-installation analyses. This guidance contributed to our successful implementation. Recently, the workflow expert returned to evaluate our ongoing use, perform some retraining, and made recommendations to fine-tune our use of the technology.
Installing the system did require some renovations, including changes to lighting and power, and the addition of a compressed gas line. Although the system went live more than 6 months ago, we continue to look for opportunities for workflow improvement that complement our mission to provide safe and efficient pharmacy services to all patients and staff. While implementing the system required a significant outlay of time, money, and energy, the efficiencies and safety mechanisms it provides make it well worth the investment.
Richard Mendribil, BS, PharmD, is the health system director of Northern Arizona Health. Previously, he was director of pharmacy and support services for Seton Medical Center and Seton Coastside Hospital in the San Francisco Bay Area for 20 years. Richard also led the Daughters of Charity Health System Pharmacy Directors Council.
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