Policies and Procedures for Managing Carousel Downtime


September 2016 - Vol. 13 No. 9 - Page #10

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.

Planned Downtime

A policy for planned downtime (ie, maintenance and upgrades) should include information detailing the following preferences:

  • Preferred day of the week and specific time for activity to occur
  • Point person responsible for managing the event
  • Communication strategy among affected parties
  • Timelines for each activity
  • Process for handling workload during the downtime
  • Steps necessary for bringing the system back online upon issue resolution

A timely post-event review to identify potential opportunities for improvement during the next planned downtime also is recommended.

Unplanned Downtime

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:

  • Identify a Champion. The first step is specifying who will champion the project, take ownership, and make decisions when downtime occurs. It is important to involve the technicians who work with the carousel on a daily basis. Their expertise using the technology is invaluable in developing effective P&Ps.
  • Define the Scope of the Problem. Correctly identifying the cause of the downtime is the first step toward implementing the solution. For example, is one drawer malfunctioning, or is the problem systemic? Performing a minor correction that will take 30 minutes requires a different approach than a scenario where a new part must be shipped in. Typically, there is a tiered approach to troubleshooting: the discovering user or other immediate staff should have the training and skills to correct minor issues. If that fails, an institutional pharmacy systems team or IT resources may be called in, with further escalation directed to the vendor. Be mindful that if the problem requires significant time to correct, it may be necessary to call in additional staff to assist with manual drug distribution. It may be beneficial to identify an alternate medication storage location to utilize while the carousel is being serviced.
  • Develop a Communication Plan. Once the problem has been catego­rized, notifications must be sent to the necessary parties regarding the nature of the problem, its projected impact on workflow, how it will be mitigated, and expected time for resuming normal operations. The P&P must include specific instructions detailing who should be notified, the method of communication (eg, phone, pager, in person, etc), and under what circumstances to activate this plan. For example, depending on the scope of the outage, pharmacy leadership, nursing management, prescribers, and/or ancillary staff may need to be informed.
  • Create a Documentation Plan. Documentation is a challenge during un­anticipated downtime. Therefore, it is important to specify in the P&P how documentation should occur. For example, controlled substances have spe­cific storage and recordkeeping requirements regardless of the automation status. The organization’s internal auditing team may be helpful in identifying a method of preserving chain of custody. The plan should encompass a worst-case scenario, such as a return to paper documentation, in which case using pre-printed forms is advisable.
  • Additional Considerations. The P&P also should include a plan for charging, wasting, and receipt of new shipments in the case of an extended event. Be sure to store the P&P where it will be accessible during downtime resulting from a network outage, and maintain a paper map of the medication arrangement within the carousel so that staff can locate a given medication manually should the technology be inoperable. Given carousels’ ability to store hundreds of medications, it would be impossible to locate medications quickly without knowing their position within the equipment. Attach a hard copy of the medication arrangement to the carousel so it is easily accessible. Remember to review the P&P periodically to ensure it is up to date.

Conclusion

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.

References

  1. Carousel and Robot Storage. State of Pharmacy Automation Survey. Pharm Purch Prod. 2015;12(8):20-21.

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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