Steadfast growth was the hallmark of the marketplace this year with bursts of excitement surrounding the automation of ordering processes. Many of the budget limitations that have defined pharmacy automation over the past few years were lifted this year and technologies such as CPOE, e-prescribing, smart pumps, and BCMA benefitted with expanded implementation numbers. Clearly, the value these automated systems bring to enhanced patient safety must be embraced facility-wide.
In the second quarter of 2011, Pharmacy Purchasing & Products polled a random, nationwide sampling of health system pharmacy directors. We asked about staffing, budgets, current automation use, and plans for future technology adoptions. Responses were solicited via email and a total of 500 pharmacy directors replied, yielding a confidence interval of 4.19 (95% +/4.19) based on the total population of pharmacy directors nationwide.
We intentionally surveyed a random sampling of pharmacy directors, not simply readers of PP&P, ensuring the data reflects trends across the entirety of hospital pharmacy practice. Given this, we are quite pleased to learn that 85% of pharmacy directors use PP&P as a tool to research automation purchases.
News on the budget front continues to move into positive territory. The number of facilities experiencing budget cuts this year remained on a downward trend and while budget predictions for next year are mixed between growth and stasis, the majority of hospitals are planning for increased automation budget investments over the next few years. Additional evidence of abating financial pressure is that lack of budget is no longer cited as the prime roadblock for those facilities that are not planning to adopt common automation solutions such as unit dose packaging technology and BCMA.
Despite the upbeat budget data, automation staffing levels remained flat this year. Looking forward, 47% of facilities are looking to increase their FTEs allocated to pharmacy informatics and automation over the next year, raising demand for these specialized pharmacists.
Medication Ordering Trends
Wireless networks have become commonplace and as a core support structure for many pharmacy automation adoptions, their increasing prevalence has created opportunities for many other implementations including e-prescribing, which enjoyed a big uptick in use this year.
Reflecting both the strong opportunities for automated order entry to enhance medication safety and the maturation of the products on the market, CPOE adoptions exploded this year, even surpassing BCMA adoptions for the first time. While few facilities are sending all of their orders through CPOE, many are committed to raising the percentage of orders that are transmitted electronically. Nonetheless, very few CPOE adopters give their system an excellent rating, indicating the need for additional system developments to meet the practice needs of increasingly experienced users.
Given that wireless networks are the backbone supporting much of pharmacy’s automation adoptions, it is concerning that the few facilities without this key technology made little progress this year in moving toward adoption. Those facilities without a wireless network in place are at a significant disadvantage, as they are hobbled from modernizing safety practices—be it from evaluating usage patterns from smart pumps, developing automated order sets for CPOE, or simply automating the temperature monitoring of all medication refrigerators.
Challenges in Medication Preparation Processes
Given the myriad activities required in the pharmacy to prepare doses and the difficulty of automating every process, pharmacy directors face many challenges in perfecting preparation workflows. Despite a desire to conduct less unit dose packaging, few pharmacy directors have been successful at eliminating this activity altogether; in fact, overall unit dose repackaging volume is expected to expand. While those who outsource some of their repackaging needs rate such services highly and plan to expand the number of products they outsource, this remains a small percentage of repackaging as the bulk is conducted in-house.
Manual repackaging has yet to disappear completely—while few enjoy taking this approach, many ancillary products, such as non-formulary medications, are still packaged in this manner. To date, just 15% of hospitals have successfully eliminated all manual packaging activities.
Adoption of 2D bar codes has yet to become widespread; while slightly more than one third of facilities are dabbling with these codes, few using them are doing so on the majority of their medication inventory. The adoption rates for 2D bar codes will be an interesting trend to watch—should usage become more widespread, will vendors accommodate this higher level of data capture with upgrades to automation tools such as ADCs and smart pumps?
The challenges inherent in syringe production and labeling remain without a universal solution. Robotic IV device implementations are still in their infancy and have found a limited audience thus far. IV workflow management tools are growing in popularity but to date, the benefits of theses system are enjoyed primarily by larger facilities, thus, we will be watching to see if adoptions of these safety tools become more prevalent over time.
Automated dispensing cabinets are perennial favorites with pharmacy directors. While 88% of hospitals are using this technology, the story does not end with widespread adoption. Rather, pharmacy directors bestow high satisfaction marks on this technology and are expanding their use of these units. Most facilities now use their ADCs as the primary drug dispensing method and plan to enlarge the capacity of their existing units. Despite the growing sophistication of ADC use, 65% of users are not consistently verifying medication bar codes during the refill process. Deployment of this key safety measure remains surprisingly low, leaving a significant weakness in the distribution process for many facilities.
The popularity of the point-of-care approach to medication distribution remains high, with half of all hospitals expected to implement this model within the next five years. In addition, point-of-care facilities have been quick to adopt new technologies including BCMA and CPOE.
BCMA adoption, now just under the 50% mark for all hospitals nationwide (but more broadly implemented in larger facilities), is expected to be nearly universal within the next few years for facilities with at least 100 beds. Historically, most hospitals implemented BCMA before undertaking CPOE. As that trend began to change this year, we will keep eye on how pharmacies are allocating their capital budgets in the coming years.
Smart pump adoption has outpaced both BCMA and CPOE with no signs of slowing down. Many hospitals are now focusing on expanding the efficiency of this technology through improved data transfer capabilities, links to BCMA systems, and programming with patient-specific data. While smart pumps are generally well rated, we will be watching for improvements to these ratings as smart pump use becomes more sophisticated.
Medication safety technology implementations alone do not decrease errors; rather it is leadership that drives safety improvements. As such, it is imperative that pharmacy directors lead the way to creating and maintaining effective medication safety initiatives. With the easing of budget restrictions, pharmacy directors have an excellent opportunity to implement automation to further their institution’s safety goals. At PP&P, we aim to provide you with guidance for getting the most value for your automation dollars.
Select graphs from the State of Pharmacy Automation are available for your use as PowerPoint slides. Click here to download