Implementing Automation for Medication Distribution

November 2021 - Vol.18 No. 11 - Page #28
Category: Medication Tracking

In recent decades, technologies such as smartphones and smartwatches have become ubiquitous in daily life. The health care industry has followed this trend as well, working diligently to incorporate computers and automation into daily processes. In fact, according to the Pharmacy Purchasing & Products’ 2021 State of Pharmacy Automation survey, 91% of hospital pharmacies use automated dispensing cabinets (ADCs), and 61% use smart pumps.1

However, there are still many automation tools available for hospital pharmacists that appear to be underutilized (see the FIGURE). This is especially true for medication distribution technology, which can have a positive impact on both pharmacy and other departments throughout the health system. Historically, a key barrier to the adoption of this technology has been financial limitations. However, automating medication distribution has the potential to deliver a multitude of safety, workflow, and financial benefits that far exceed the historical metric of justifying automation investment with an offset of decreasing FTEs. As such, it is critical to consider the hospital-wide implications of adopting automation for medication distribution, and more importantly, to communicate these broad benefits as part of your request for financial support.

Cost Justification

As automation technology continues to advance and evolve, so do opportunities for reducing human error (see the SIDEBAR). Unit dose packaging machines, carousels, and high-density storage and dispensing units are examples of automation that can help streamline the distribution process and decrease the number of FTEs needed for stocking and distributing medication.

However, providing financial justification for the move to this technology can be difficult if the impact on FTEs is the sole focus. It is incumbent on the individual creating a business case to ensure that the technology is also aligned with the organization’s strategic goals, and to demonstrate how these products will help achieve these ends.

A more complete argument in favor of automation integration should include additional key advantages that benefit the entire health system, such as:

  • Pharmacy automation allows for redeployment of pharmacists so that their professional expertise can be used in a broader fashion throughout the hospital. This can help to reduce the long-term cost of providing health care by improving patient outcomes and reducing hospital stays.2-5
  • Pharmacy automation reduces the opportunity for drug diversion by improving inventory control.6,7
  • The use of automation allows for a more streamlined medication supply chain to both decrease inventory costs and ensure availability of items when needed.
  • By incorporating expiration date tracking, these systems help to reduce waste.
  • Pharmacy automation can increase charge capture.
  • The use of bulk medication in conjunction with the unit dosing capability of these systems can decrease the acquisition cost of medication and support shortage management strategies.

In addition, many vendors now offer financing options that do not require capital investment, such as contracted services or price per piece for products such as IV room automation, which can be a more palatable option when assessing return on investment for some health systems.

The initial cost of automation can be quickly offset by increased efficiencies in the hospital system, better use of professional staff time, more one-on-one time with patients, and improved management of drug procurement and dispensing.

Key Considerations

Once funding is secured, proper integration of the technology is a crucial step in the implementation process. It is important to conduct a needs assessment to establish what areas will benefit from distribution automation, identify financial ramifications, and detail how various departments and existing workflows will be affected.

Key to any needs assessment is identifying the immediate and future goals that the facility aims to achieve via the automation implementation. The needs assessment should also analyze financial considerations, information technology needs, human resource impacts, process flows, capacity and storage requirements, security considerations, as well as effects on medication errors, governance, and stakeholders (see the TABLE).

Careful consideration should be given to process flow for all departments impacted by the new automation. While workflows can be changed to support the technology implementation, unexamined changes can lead to downstream impacts on efficiency. The assessment should consider all steps in the medication process, from medication ordering and receiving to distribution and administration. The impact on nursing and other departments that will be affected by the technology needs to be assessed. Also, if the pharmacy does not provide 24-hour support, a plan for accessing medication after hours must be established. Location of the equipment can also impact workflow and will need to be reviewed to ensure that the equipment placement supports efficiency and safety. The future state for controlled drug management and documentation under the new automation will need to fully support best practice.

If time savings are an anticipated outcome of automation implementation, the expectation of how pharmacy staff will utilize that time for additional tasks should be clearly delineated.

Capacity and space design is also a significant part of planning for automated technology as an efficient design can significantly reduce storage space requirements. Nevertheless, some items may not be suitable for storage within the devices. Planning for appropriate storage and access to items such as large volume parenteral fluids and other bulk items not managed within the automation is an important step.

Consideration should also be given to the profile of medications commonly used at each site to optimize the design configurations. Some aspects to review include:

  • Quantifying the historical use of medications in each area where automation will be deployed, detailing both the types and volumes of medications used
  • Ascertain the number and volume of controlled drugs used and their storage requirements
  • Establish the amount of refrigerated storage required
  • Determine the process for storing patients’ own controlled drugs, if allowed by hospital policy
  • Ascertain the typical usage of large volume parenteral fluids
  • Estimate the storage requirements for cytotoxic preparations

Stakeholder Engagement

Stakeholder engagement is an important part of an assessment; engaging champions from other departments impacted by the automation adoption is necessary to help promote acceptance of the change. Identify individuals who can serve as change agents and trainers, and engage these individuals early in the process so that they can create excitement regarding the updates within their departments.

Assessment of vendor support models is also necessary so that processes for maintenance, troubleshooting, and repair can be identified. Review this aspect with other health systems that employ the same technology.

The potential impact on medication errors should also be considered. Review the current types of medication errors occurring in your facility. By identifying their root causes, you can ascertain whether the addition of automation can address those errors. There is a risk with any new technology introduction that unforeseen errors may result; thus, a mechanism to monitor for this possibility needs to be established.8 Training must be part of the implementation investment and should include a focus on decreasing workarounds, such as responses to medication bar codes that do not scan. Because ISMP recommends the use of ADCs in profile mode, this requires the development of specific guidelines for override processes.7

Multidisciplinary Committee

Due to the far-reaching effects on a hospital system, automated pharmacy systems implementation requires a well-established governance process to ensure an efficient implementation as well as safe and optimal use of the technology. Creating a multidisciplinary steering group is recommended to provide governance when automated technology is implemented. This group should identify, assess, and manage implementation risks, establish policies for alerts, review protocols and policies, standardize drug catalogues across the health system, and make decisions on workflow recommendations in addition to other system specific issues.

Conclusion

Implementing medication distribution automation delivers positive results for healthcare facilities far exceeding the simple replacement of FTEs. Taking the time to consult with other health systems, reviewing existing processes to determine how they will be affected, and utilizing vendor resources and expertise can be helpful in making a final decision as to which automation tools to incorporate, and aid in a seamless transition across all departments.

References

  1. Halvorsen, D. Maximize the Utility of Pharmacy Automation. Pharmacy Purchasing & Products. 2021;18(8):4.
  2. Schumock GT, Butler MG, Meek PD, Vermeulen LC, Arondekar BV, Bauman JL. Evidence of the Economic Benefit of Clinical Pharmacy Services: 1996–2000. Pharmacotherapy. 2003;23(1):113-132.
  3. Perez A, Doloresco F, Hoffman JM, et al. Economic evaluations of clinical pharmacy services: 2001–2005. Pharmacotherapy. 2009;29(1):128-128.
  4. Touchette DR, Doloresco F, Suda KJ, Perez A, Turner S, Jalundhwala Y, Tangonan MC, Hoffman JM. Economic evaluations of clinical pharmacy services: 2006–2010. Pharmacotherapy. 2014;34(8):771-793.
  5. Talon B, Perez A, Yan C, et al. Economic evaluations of clinical pharmacy services in the United States: 2011-2017. JACCP. 2020;3(4):793-806.
  6. Shah N, Sinha A, Thompson A, et al. An automated software application reduces controlled substance discrepancies in perioperative areas. Anesthesiology. 2019;131:1264–1275 .
  7. American Society of Health-System Pharmacists. ASHP guidelines on preventing diversion of controlled substances. Am J Health-Syst Pharm. 2017;74:325-48.
  8. Koppel R, Metlay JP, Cohen A, et al. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA. 2005;293(10):1197–1203.

David Jaspan, RPh, MBA, is a hospital pharmacy consultant with over 30 years of pharmacy practice experience. He has served as a member or chair of multiple regional and national group purchasing organizations’ Pharmacy and Materials Management advisory committees. David is an experienced health system leader with an extensive background in clinical practice, operations, strategic planning, information technology, pharmacy automation, supply chain, and financial management.

 
 In pharmacy, automation for medication distribution has its origins in the late 1960s with John and Frank Kirby’s efforts in England. Their first portable digital pill counter created a new option of packaging and dispensing pills after counting them. This was followed by the development of the first ADC in 1990, which offered new opportunities for increasing charge capture, lowering inventory costs, reducing stock-outs, and improving overall accountability of the products in the ADC. As these systems showed value in studies,1-4 more hospitals implemented the technology.

As of the 2021 State of Pharmacy Automation survey, just 9% of hospitals operate without cabinet technology. Instrumental in the adoption of ADCs were the implementation of bar code medication administration systems and integration of electronic health records to improve the level of safety associated with medication administration.

A key development in the adoption of automated drug storage and retrieval systems was the ability to interface those systems with the purchasing, distribution, and tracking of medications. With the growing financial pressure driven by medication shortages, high-cost medications, and medication waste, finding ways to better manage the supply chain became a significant challenge for pharmacy leaders. This brought to the forefront technology that automates drug ordering, drug storage, retrieval, distribution, and tracking of administration.

Recently, we have seen the addition of robotic medication distribution technology that focuses on limiting human touch opportunities to reduce errors in the health system environment. Examples include carousel and robot technology, automated unit-dose packaging, storage and dispensing from the same unit, and high-density medication storage units that automate medication stocking, storage, and retrieval. With appropriate interfaces between hardware and software solutions, this automation can overlay bar code technology, technology guidance, and photographic images to the processes for product ordering, stocking, unit-dosing, and dispensing.

These technologies provide the ability to package unit dose medications with limited human touch and then stock medications into the system with bar code software verifying medications for distribution and for restocking returns. These systems can support cart fill as well as ADC restocking with their expanded capability. However, it is important to remember that this technology does not replace the need for caution and careful attention to workflow. As such, it is important that pharmacies continue to carefully monitor each process.

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