David Grant, RPh, MBA
Vice President of Pharmacy and
Clinical Process Improvement
Technology in use: Omnicell WorkflowRx
Print the carousel “level” on each medication label to aid in managing returns. On each printed label, we include the carousel level that corresponds to the product location. Therefore, when multiple items need to be returned, we can group them by level and simply scan them back into the inventory. When returning products, the technician works on one level at a time, thereby eliminating the need to continuously rotate the carousel during the restocking process. This has created a much more efficient process for managing carousel returns.
Use dynamic routing to the fullest. Whether you use patient-specific cart-fill or simply refill automated dispensing cabinets on a schedule, dynamic routing, if available in the carousel’s software package, enables direct picking from either the carousel or the packager (or any other inventory location) depending on their respective inventory levels. For example, if you have adequate stock in your carousel, the software will direct the picking from this location. If the carousel stock is not adequate to fulfill a pick, the system will route to the packager automatically. When we implemented this feature, we were able to decrease our inventory value by nearly 10%. This enabled us to use inventory that would have been stagnant in the carousel. It also eliminated the need to manually direct picking to this location.
Place high-volume items within the same general levels. When completing your initial set-up, be sure to place all high-volume items in close proximity. For example, we placed our high-volume items on levels one through four. Thus, the carousel does not have to rotate far to complete the majority of the picking. Also, you can sort your pick list by location and work from left to right across the levels. This has significantly increased our efficiency with high-volume items. Using Omnicell’s carousel and packager, one pharmacist and one technician can complete a cart-fill for 180+ patients in 60 to 90 minutes. Prior to implementation, this process took the same two people eight to 10 hours.
Michael Hodgkins, CPhT
Inpatient Pharmacy Information Systems Technician
Eastern Maine Medical Center
Technology in use: Talyst AutoCarousel, AutoPharm3.0
Devise a load strategy before installing your carousel. After the carousel is installed, it is difficult to remove the shelf units (pans), so it is important to have a good estimate of the number of double-height shelves needed to accommodate your inventory before the installers begin to build the unit. By removing the pan on a shelf, oversized medications can sit upright. We use these taller shelves for Diprivan, nitroglycerin premix bottles, Go-LYTELY, etc. These items tend to be heavier as well, so it can be helpful to offset the load burden by placing them opposite each other within the layout of the carousel (i.e, shelf 1 and shelf 12 in a 24-shelf unit). This will allow for even weight distribution and decreases noise as the carousel rotates.
Once these locations are set, inventory loading can start. We put the 250 most-used medications on our formulary within two pans of the double-height shelves (shelves 3-22 and 10-14). This reduces the number of rotations needed to retrieve commonly used items and helps minimize order turn-around time.
Bob Ragan, RPh
Wesley Medical Center
Technology in use: McKesson MedCarousel
Implement inventory optimization software to help reduce medication inventory costs. The software package we use automatically calculates par and max values from user-defined parameters and usage statistics. Users have the opportunity to define the time intervals from which the moving averages are derived, as well as the number of days of inventory that par and max represent. This feature is configurable for each medication.
After building a 90-day data history, we started using the inventory optimization feature, which allows the max and par to “free float.” The algorithm watches and changes these numbers based on usage. This allows for the optimal days of stock to be kept on hand, lowering inventory days. Overall, we are no longer seeing any large spikes and variations in par and max, and the par and max levels are a lot closer together.
The inventory optimization process works well with relatively high-volume items; very low-volume items are not good candidates. An inventory alert report shows items that have unusual usage based on the established parameters. This reduces stock-outs by allowing us to better plan ahead.
Richard C. Capps, PharmD
Greenville Hospital System University Medical Center
Technology in use: AmerisourceBergen SupplyWorks Carousel
Assign inventory locations to avoid picking errors. With traditional shelving, drugs are generally organized alphabetically and divided by route of administration, allowing for the quick retrieval of products when filling an order. Unfortunately, this also means that different strengths of the same product are side-by-side on the shelf and many look-alike/sound-alike drugs are in close proximity to each other, which can lead to picking errors.
Carousels provide a big safety advantage over traditional storage, with the option to assign inventory locations. Products with a high risk of confusion should be separated in the carousel to reduce the risk of medication picking errors. A facility’s look-alike/sound-alike list is a good starting point when determining inventory locations within a carousel.
Restocking high-risk/high-alert items to the carousel also is safer when the inventory is dispersed throughout the carousel. The system guides the technician to the correct inventory locations. This benefit is greatly enhanced when product bar codes are used to identify the product.
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