Automated drug storage and retrieval systems are used in about 35% of US hospital pharmacies and are becoming increasingly popular each year.1 While larger organizations are more likely to employ these technologies, a greater number of smaller hospitals are automating their medication storage by adopting carousels and robots. High staff satisfaction rates and improved storage capacity are driving their increasing prominence, as almost four out of five pharmacists rate their carousel or robot technology as good or excellent.1
As medication distribution becomes increasingly automated, pharmacists and technicians rely on carousels and robots to facilitate the safety and efficiency of this process. However, there are times when these technologies require downtime. Creating a contingency plan to guide practice during downtime is critical to preserving workflow and continuity of care.
The Medical University of South Carolina (MUSC) is a 750-bed academic medical center served by multiple pharmacy locations, including inpatient, outpatient, hazardous, compounding, retail, specialty pharmacy, and mail order services. MUSC Pharmacy Services utilizes two medication carousels and two robots to facilitate medication distribution throughout the health system. As the carousels are integral to the drug distribution model, comprehensive policies and procedures (P&Ps) are critical to guide pharmacy practice should the equipment become inoperable.
Developing a Policy and Procedure
The P&Ps for carousel downtime should be developed prior to carousel implementation and go-live. MUSC has operated carousels for over 5 years and developed downtime procedures prior to go-live to ensure a strategy would be in place for continuity should a problem arise. Effective P&Ps cover instructions for operation during both anticipated and unanticipated downtimes.
A policy for planned downtime (ie, maintenance and upgrades) should include information detailing the following preferences:
A timely post-event review to identify potential opportunities for improvement during the next planned downtime also is recommended.
Although rare, unplanned carousel downtimes do occur, making the creation of a P&P for these scenarios mandatory. In these situations, staff requires clear, concise direction indicating the steps to take to ensure patient care is unaffected. Consider staff competency when developing the P&P; instructions should be easy to follow so that even the least experienced employees execute accordingly.
The P&P should be broad enough to be practical, while also offering specific guidance for managing contingencies that may arise. Request that the vendor put you in contact with seasoned customers who can advise you on real world challenges that accompany carousel and robot technologies. Reach out to other institutions to identify gaps you may not anticipate on your own. It is vital to clearly define your expectations of downtime support with the vendor, preferably in writing, as part of the contracting process. Finally, be sure to include a strategy for review and enhancement of the P&Ps on a continual basis.
Steps in developing an effective unplanned downtime P&P include:
Automated drug storage and retrieval systems increase the efficiency of medication distribution. However, all technologies are subject to interruption, so it is important to develop a contingency plan to ensure medication distribution continues safely and smoothly should the technology become inoperable. The availability of effective P&Ps ensures staff has the tools they need to manage medication storage and distribution during these times.
Jeff Brittain, PharmD, BCPS, is the manager of medication use, policy, and informatics at the Medical University of South Carolina in Charleston. He has presented on topics surrounding pharmacy automation at the local, state, and national levels.
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