A manual approach to inventory management requires a significant commitment of time and resources, and can be challenging in the complex hospital environment where multiple vendors, suppliers, and data stocking points are utilized. Automating inventory management—including the purchasing, receiving, and invoicing processes—helps maintain accurate inventory and enables data-driven purchasing decisions.
The University Hospital, the flagship hospital of the University of Mississippi Medical Center, provides a complete range of primary and specialty care services and houses the state’s only Level 1 trauma center. Located on the campus of the University of Mississippi Medical Center, the hospital serves as the teaching hospital for the Medical Center’s education programs; also located on campus is a 70-bed critical care hospital, the state’s only bone marrow transplant unit, a women’s and children’s hospital, and a pediatric facility.
It became clear that our manual method of inventory control—walking the shelves to identify items that require replenishment—was no longer effective for our growing facility. Consequently, we began the process of reviewing literature and networking with similar hospitals to identify a workable automated solution. This journey led us to implement medication carousels. After reviewing a number of carousel vendors, we selected AmerisourceBergen’s solution, SupplyWorks; recently the carousel division was sold to ARxIUM. The software, originally called Dimension 21, is now named RxWorks Pro. Because our organization was already using MedSelect ADCs, integration between the ADCs and carousels was straightforward.
Implementing the New Technology
We purchased two standard and one refrigerated carousel, to ensure proper storage of high-cost refrigerated inventory. When configuring the system, it was critical that the carousel software be integrated with our EHR. When a medication order is verified in the EHR, it is interfaced to RxWorks Pro based on the dispensing code and dispense logic in the EHR. The software manages first doses, re-dispenses, and cart fill.
Once entered, the order is evaluated for availability in the carousels. If the product is not in the carousels, the packager stock is checked next. This allows for the utilization of any nursing returns before sending additional products to the packager. The EHR is used to print a label for these pulls and also to alert the technician of any items stored outside the carousels. The software keeps a perpetual inventory of all items in the ADCs, the carousel, and the packager, and creates a purchase order for medications when they fall below minimum par levels.
The carousel software runs a daily ADC replenishment report to identify which medications must be restocked on the nursing units. Three years ago, we began a project with our wholesaler to pull and deliver some of our ADC replenishment medications by low unit of measure, which has helped maximize carousel utilization, as we do not need to stock these medications in the carousels and then immediately pull the medications back out for ADC restocking. Accessing this data allows us to review medication usage and identify top movers used in the ADCs that qualified for low-unit-of-measure purchases. The carousel software facilitates this process by marking those medications that are replenished by low unit of measure and identifying the medications that are to be replenished during the usual 24-hour fill.
A daily electronic order of inventory requests for each of the ADCs is sent to our wholesaler; these items are pulled from inventory, verified for accuracy, labeled for each cabinet, and delivered in bags labeled for each nursing unit. Medications sourced from the carousels and packager are delivered at the same time.
The carousel inventory management software addresses a number of challenges in the pharmacy:
- Robust Integration Between ADCs and Carousels. ADC inventory is accessible in the carousel software, permitting buyers and pharmacy staff to access inventory in both the carousels and ADCs throughout the hospital. This integration facilitates management of the many shortages that have become ubiquitous of late. If a stock out is identified in one area, we can easily identify other areas where the medication is available.
- Improved Inventory Control. Keeping a perpetual inventory based on minimum and maximum par levels has reduced both over-ordering and outages. Our technical staff verifies that the medication count is correct when pulling medications from the carousel, improving inventory control.
- Ease of Conducting Annual Inventory. The time required to complete the yearly inventory required by our internal auditors is significantly reduced; the new process consists of simply printing a report from the carousel software and counting items that are not stored in the carousels (eg, chemotherapy and oversized items).
- Ease of Ordering. The software’s intranet ordering feature allows other departments and our satellite pharmacies to access the ordering system to create a purchase requisition. Pharmacy buyers can send them the order to the carousels or create a purchase order for the wholesalers.
The most significant benefit realized from the software is the satisfaction of knowing that our drug supply is properly managed; medication access is ensured while overages and outages are minimized.
Jim Westmoreland, PharmD, is a pharmacy supervisor at the University of Mississippi Medical Center. He graduated from the University of Mississippi School of Pharmacy and then received a BS in Computer Science from the University of Southern Mississippi and a Doctor of Pharmacy from the University of Mississippi.
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