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Technology in the IV room - it's time has come

Submitted by JFahrni on Thu, 12/01/2011 - 23:52

The cleanroom environment, a.k.a. the IV room, is one of my favorite areas inside an acute care pharmacy. It is often alive with activity, and can often be the busiest area of the pharmacy. It is also a unique place since the use of intravenous (IV) medications is vital to the successful outcomes of patients, but at the same time can result in some of the most egregious errors in healthcare. While the IV compounding process is under tight control as demanded by USP guidelines, the method of preparation and distribution is decidedly more conventional, i.e. IV rooms often rely heavily on humans. It’s an interesting dichotomy found nowhere else in the pharmacy. It is for these reasons that I find it interesting that pharmacy IV rooms have lagged behind other areas of pharmacy operations in automation and technology.

However, that’s beginning to change. Pharmacy IV rooms are no longer overlooked when implementing innovative technologies. As pharmacy operations continue to evolve it is becoming clear that IV rooms are starting to receive their due respect.

A certain percentage of healthcare systems already utilize some form of technology in the IV room, however the numbers are small. A 2007 ASHP national survey on informatics found that, depending on number of beds, between 9% and 27% of facilities were utilizing some form of device in sterile product preparation1 (small-volume and large-volume parenterals). It is unknown what technologies these facilities were utilizing at the time of the survey.

Rise of the Machines Allows Pharmacists to Reach for the Sky

Submitted by pillguy on Mon, 10/03/2011 - 21:57

My complements to Mr. Manjoo for writing an editorial on the impact of robotics in pharmacy.  The message is clear:  pharmacists could be replaced by robots.  Like many other pharmacy informatics professionals, I share some of the article’s viewpoints on the overall state of our practice.  Automation has a lasting impact on repetitive, assembly-driven tasks in many industries around the world.  Add to this a retail pharmacy practice being molded into an insurance driven, turnaround-time model of product delivery and it is not difficult  to conclude the slow demise pharmacy practice. 

As a second generation pharmacist, I have seen the industry transform over the past few decades.  As an active member of the Section of Pharmacy Informatics and Technology, I am also aware of how automation has changed our profession.    It is sad but expected to see the public’s view of our profession.  They are bound by their observations and interactions with the pharmacist in a retail setting.  Many of us know the boundaries of our practice stretch far beyond the walls of the typical drug store, and our future is with patients. 

The weakest link in building a safer medication use model

Submitted by JFahrni on Mon, 06/20/2011 - 09:00

I’ve just spent four days at the ASHP Summer Meeting in Denver, CO. The meeting offered a nice variety of topics, but seemed to focus on medication safety and informatics more this year than in the past. In fact, this is the first year that ASHP has offered a medication safety tract at one of their meetings.

I avoided the more traditional sessions on therapeutics, choosing instead to focus on the informatics and medication safety sessions. Based on the information presented it was obvious to me that these two disciplines are intimately linked. After all, the idea behind much of the technology we use in healthcare today is to improve patient safety.

In 1999, the Institute of Medicine (IOM) published the now infamous To Err Is Human: Building a Safer Health System. The information presented in that report sent shockwaves through the healthcare industry. More than a decade later we haven’t seen much improvement in the number of mistakes made in hospitals, but To Err Is Human effectively changed the foundation of healthcare forever. While healthcare remains squarely focused on caring for patients, the approach to how we provide that care has changed dramatically. The interest on patient safety has generated an immense body of literature aimed at using automation and technology to improve patient care.

Technology and pharmacist impact on medication adherence

Submitted by JFahrni on Thu, 06/02/2011 - 15:50

mobihealthnews: “According to a recent study by Express Scripts, Americans might be wasting as much as $258 billion annually by not taking their prescribed medications. Missed doses can lead to emergency room visits and doctors’ visits, which could be prevented if medication adherence was improved. The Express Scripts study found that more than half of people who believe they take their medications properly are not, according to a report in USA Today.

A similar study conducted by NEHI found that poor medication adherence results in illnesses and ensuing treatments that cost some $290 billion in unnecessary spending each year, $100 billion of that in avoidable hospitalizations alone.

Two members of Congress recently introduced bills to allow Medicare reimbursement for more patients to sit down with therapists one-on-one and equip patients with pill boxes or text message services that help patients become more adherent, the USA Today report said.

The Toronto University College of Pharmacy conducted a study that found medication therapy saved about $93.78 per patient annually in a study of 23,798 people, USA Today reports.”

Cleanrooms – the forgotten realm of acute care pharmacy

Submitted by JFahrni on Tue, 04/12/2011 - 16:34

Cleanroom environments, a.k.a. IV rooms, inside acute care pharmacies compound some of the most complex and dangerous medications used inside a hospital. Unfortunately this area is often overlooked when implementing safety features such as bar-code verification, identification of high-alert medications, advanced training and competency and so on. I was reminded of the dangers of intravenous products by a recent story coming out of Alabama where the death of 9 patients was linked to TPN (total parenteral nutrition) contaminated with Serratia marcenscens.

While IV rooms remain a high risk area they tend to fall off the radar of many hospital administrators when it comes to implementing technology capable of reducing risk. USP <797> tends to get all the glory even though much of the guidelines proposed in this USP chapter have yet to be shown any more effective than diligent hand washing and impeccable technique.

The ever expanding role of pharmacists

Submitted by JFahrni on Tue, 04/05/2011 - 10:52

Lately I’ve found myself thinking about how pharmacists are involved in healthcare. Despite popular belief pharmacists do more than simply work in the pharmacy.

Throughout my career I’ve become accustomed to people viewing pharmacists as the stereotypically person behind the counter at the drug store “counting pills”. While that’s not all pharmacists do, I’ve learned to live with the general publics simplistic view. I don’t think most people realize that pharmacists are involved in every aspect of a patient’s care. If you’ve ever been in a hospital, received a prescription medication, had a loved one in a long term care facility, received intravenous medications at home like total parenteral nutrition (TPN) or antibiotics, received an albumin or intravenous immunoglobulin (IVIG) infusion in an outpatient infusion center or met with a pharmacist in a clinic setting for a medication therapy management (MTM) session, then you’ve been touched by a pharmacist.

So, what are some of the roles filled by pharmacists? That’s a good question, and one that I take a look at in more depth below.

Cool Technology for Pharmacy – Sharp SX Bagger

Submitted by JFahrni on Thu, 01/27/2011 - 19:51

Some items in a pharmacy are simply difficult to bar-code. Perhaps they’re too small, have an awkward shape or their surface won’t accommodate ink or an adhesive. The problem creates some interesting workarounds, and not always for the better.

One solution is to individually package each item and place the drug information and a bar-code on the outside of the packaging material; overwrapping, if you will. I’ve never been a big fan of overwrapping items because it can be time consuming and cumbersome. Today I ran across a machine that I think offers a genuine option for medications that are difficult to bar-code.

At first glance the Sharp SX doesn’t look like much, but after giving it a closer inspection you start to understand how it might be used. Although not listed on the website as a potential use, the Sharp SX could be used to package pediatric syringes, suppositories, unit dose liquid cups, etc.

From the company website:

ALL ELECTRIC

  • All electric design–simply put, just plug in and use the SX™ absolutely anywhere you want it.
  • Cross flow fan channels high volume, low pressure ducted air for precise bag opening. No compressed air required.
  • Optional adjustable load shelf for easy loading of bulky or heavy parts.
  • Fewer moving parts-Less maintenance. Bagger uses off-the-shelf parts widely available so no more worries about proprietary parts.

PLC CONTROLLED

Cool Technology for Pharmacy – Pentapack HP500

Submitted by JFahrni on Fri, 12/17/2010 - 10:56

There really aren’t too many machines out there designed to unit dose liquids on a scale small enough for the needs of an acute care pharmacy in a hospital. So when I came across the Pentapack HP500 in the ASHP Midyear exhibit hall I took notice. As demonstrated at ASHP Midyear, the machine is capable of unit dosing both oral solids and oral liquid medications. That’s rather unique functionality that deserves some attention.

Unfortunately the Pentapack website is void of useful information, which is really a shame because the HP500 is a neat little device.

Cool Technology for Pharmacy – PharmaTrust MedCentre

Submitted by JFahrni on Thu, 07/22/2010 - 22:58

The PharmaTrust MedCentre is a fully automated remote dispensing machine similar to the InstyMeds Prescription Medication Dispenser I mentioned back in October of 2009. We were evaluating the InstyMeds machine when it died a slow agonizing death during budget talks.

The idea is simple really. Load the MedCentre machine with a few hundred of the most commonly prescribed medications in ready to dispense, pre-packaged bottles, have a patient insert a prescription, or "voucher" depending on what country or state you're in, and sit back and wait for the prescription to pop out. Just like a vending machine. Of course the patient has the option to consult a pharmacist by simply picking up a telephone attached to the machine, but I don't assume that happens too often. Most people want their medications as quickly as possible.

Quick Hit - Time to change the way healthcare information is disseminated

Submitted by JFahrni on Sun, 04/25/2010 - 15:50

I spend a fair amount of time reading various medical, pharmacy and technology journals. Why? That’s a very good question. I was taught in pharmacy school that you need to read a host of journals every week to stay up to date on current trends for the betterment of your knowledge base and the patients you care for. So like any self-respecting pharmacist that’s what I’ve been doing for the past 13 years.

With that said, my view of the medical literature is starting to change. The information in journals today is out of date by the time it's published. This is especially true when it comes to any journal articles related to technology. A recent conversation with a friend and colleague verified this when he mentioned that much of his research findings could take as long as a year to grace the pages of a journal. That’s just plain crazy. If advancing technology has taught us one thing it’s that no one should have to wait a year to become better informed.

This may not apply to all information; facts need to be checked, calculations verified and references scrutinized, but if the material is informational only then it should be throw out there immediately for the rest of the world to digest. I want to know what technology you’re using to make your pharmacy safer and more efficient, and I want to know now. It does me no good to read about your problems implementing BCMA six months after I’ve already done it. However, that information would have saved me a lot of headaches if it would have appeared in journal form three months before I did it.

Cool Technology for Pharmacy - BoxPicker

Submitted by JFahrni on Fri, 04/23/2010 - 19:50

The Swisslog BoxPicker is an automated alternative to carousel technology for drug storage and retrieval. Unlike the open shelf architecture of automated carousel storage the BoxPicker offers access to medications via a single-opening/loading drawer process.

Once you get past the name, the technology is impressive. The most interesting thing about the Swisslog BoxPicker however, is that it is available in dual-temperature and refrigerated models. The “dual-temperature ™ option for BoxPicker allows automated storage and picking of temperature-sensitive drugs requiring refrigeration and room temperature storage within one automated compact unit.” And the “BoxPicker refrigerated option eliminates the need for pharmacy refrigerators and increases security with automated storage and dispensing of refrigerated medications.”

In addition, the BoxPicker is clean room compatible with positive pressure. The pass-through capability is a very nice feature for an automated storage unit featuring refrigeration. It prevents staff from moving in and out of the clean room environment to retrieve equipment or medications necessary for compounding.

According to Swisslog:

Cool Technology for Pharmacy - PASS Rx

Submitted by JFahrni on Thu, 03/18/2010 - 21:48

The Pharmaceutical Authentication Sensor System, PASS Rx, by Centice is a medication verification system designed to help pharmacists avoid dispensing errors. The system uses a combination of two sensors to create a unique identification profile for oral solid medications. The first sensor utilizes Ramon Spectroscopy to calculate chemical composition while the second sensor, a “machine vision” sensor, takes images of the medication to determine size, color and shape. The information gathered from both sensors is combined to create a unique identification for the drug that can be compared against the Centice database for verification.

Based on the video of PASS Rx in action, the entire process looks quick and easy. Information on the medication, including the NDC number, is scanned into the system via bar code. The medication is then loaded into the device, the user presses the start button and the results are returned in just a few seconds. Positive identification results in a green ribbon at the top of the PASS Rx screen that reads “Verified”. Failure to verify the medication results in a flashing red screen and audible alert; pretty simple.

Cool Technology for Pharmacy - OmniLinkRx

Submitted by JFahrni on Thu, 03/11/2010 - 21:24

Ask any pharmacist that’s been around for a while and they'll tell you about the headaches associated with faxed medication orders. I can’t tell you how inefficient a fax machine can be for order retrieval, storage and sorting. In fact, fax machines really can’t do any of that. Well, you no longer have to deal with fax machines in the pharmacy if you chose not to.

Pharmacy, or physician, order management systems like OmniLinkRx offer a software only solution designed to reduce the influx of faxed orders to the pharmacy. Not only do systems like this reduce confusion, they also reduce paper waste. I suppose that makes OmniLinkRx “green”. Consider OmniLinkRx a digital fax machine that sends the order to your computer monitor instead of a fax machine.

According to the OmniLinkRx datasheet (PDF):

“OmniLinkRx runs on a standard server with user access via workstations using Microsoft Windows Internet Explorer. Orders may be sent via analog fax and/or digital sending devices. Nurses simply place the physician order into the sending device and indicate STAT or routine. The scanned document image is sent to the OmniLinkRx server where it is immediately viewable by pharmacy for order entry. The orders can be viewed remotely.

Nurses may view the orders sent to pharmacy at any internet enabled PC and/or at Omnicell Color Touch cabinets. Nurses are able to view the status of the order to allow them to know when to expect new medications. “

Cool Technology for Pharmacy - DoseEdge

Submitted by JFahrni on Thu, 02/11/2010 - 20:18

The DoseEdge Pharmacy Workflow Manager, formerly IntelliFlowRx Workload Management Software by Baxa, is a system designed to track and manage intravenous (IV) medication dosages prepared by pharmacy personnel in a clean room environment. The system is touted as “The world’s first and only fully integrated workflow manager for the IV room.”

The system is designed to flow something like this:

- IV medication orders entered by the pharmacist, or other healthcare professional, are sent to the DoseEdge system where they appear on the DoseEdge touchscreen.
- When the technician, or pharmacist in some cases, accesses the order via the touchscreen instructions for preparation of the product are displayed.
- The product label is generated.
- The barcode on each injectable ingredient used for the preparation of the IV product is scanned to ensure the correct medications have been selected. Items identified as incorrect result in an audible message of “product not allowed for this dose.”
- The barcode on the IV product label generated by the pharmacy is scanned to ensure that ingredients are appropriately matched.
- Each ingredient is drawn into a syringe.
- An image of the syringe with appropriately drawn medication is taken for review by the pharmacist, or technician, whichever the case may be. This is a nice feature as it allows one to see the actual amount of drug drawn into the syringe prior to shooting it into the fluid bag.
- Ingredients are injected into the fluid bag and an image of the final product is taken.
- A final scan of the product barcode is done to complete the fill.

Cool Technology for Pharmacy - OnDemand 400

Submitted by JFahrni on Thu, 01/28/2010 - 19:17

This week's Cool Technology for Pharmacy is the OnDemand 400 for RxMap from MTS, a company that specializes in adherence packaging systems.

According to the MTS website:

OnDemand ® 400 for RxMap ® is the first pharmacy automation equipment system designed specifically for multi-med adherence packaging.

This efficient system uses OnDemand technology to dispense multiple medications for a single patient quickly and accurately and in a fraction of the time it would take to do it manually. This pharmacy automation equipment system utilizes a custom interface to work with your existing information systems, enabling automated workflow management in the pharmacy. This single data input process reduces input time and the possibility of data entry errors. OnDemand ® 400 for RxMap ® uses bar-code technology to accurately dispense multiple medications into one compartment - as many or as few as needed. RxMap ® Adherence Packs vary in size and shape to meet the needs of the customers you serve. The finished product is a patient - specific adherence package filled “just-in-time” for your customer.

Workforce training and allocation for modernization of HIT

Submitted by JFahrni on Thu, 01/28/2010 - 14:31

The most recent issue of Hospital Pharmacy (Vol 45, No 1, 2010) has an article by Fox and Felkey that discusses the demand that the ARRA will place on the current and future HIT workforce. According to the article “the workforce to shepherd implementation, training, and support [for the modernization of heath care delivery] simply does not exist today; consequently, we could face a situation where health systems and clinics are financially ready to adopt HIT but do not have the personnel to carry it out.” I believe this is absolutely true and have alluded to it in the past (here and here).

More importantly, the shortage of HIT personnel will be further exacerbated by the need for clinicians to enter the technology field. The article supports this thinking by saying that “some experts have suggested that clinically-trained individuals are more suited to the design, selection, implementation, and management of HIT because they have a fundamental understanding of the processes of health care delivery. Alternatively, individuals trained in IT are more technically inclined, but lack firsthand experience with health care delivery systems” Another truism and a problem that is certainly not unique to the HIT field. Companies like Microsoft, Google, GE, Siemens, etc hire pharmacists and other clinician for their unique experience in the health care industry.

Has interest in technology come and gone for pharmacists?

Submitted by JFahrni on Tue, 01/26/2010 - 22:31

I spent some time yesterday talking with some good people over at Pharmacy OneSource about pharmacy technology, clinical decision support, data mining, and a whole bunch of other interesting items. During one point of a conversations the history of Pharmacy OneSource came up. Part of that history includes the merger of Pharmacy OneSource with HealthProLink (HPL) sometime in late 2005.

The mention of HealthProLink (HPL) brought back fond memories of a time when pharmacy informatics was really starting to take off and I was infatuated with the Palm Pilot <insert flashback sequence here>. HPL was a set of software tools for collecting and quantifying pharmacist intervention data as well as ADR/ADE information. In addition, the application offered access to several clinical calculators and a fairly robust reporting system. I was part of the implementation team for HPL when I worked at Community Medical Centers – Fresno and used it daily for a couple of years.

This was also a time when Palm Pilots were all the rage and every pharmacist I knew carried one in their lab coat pocket. The Palm OS was a stroke of genius because of its minimalistic approach to the user interface. Anyone could pick up a device using the Palm OS and figure out how to use it in a matter of minutes. They were a model of simplicity and functionality. In addition, several development environments were available for application development as well as several “readers” and database applications. This led to the development of hundreds of medical references, medical calculators, free and commercial peripheral brains and countless ways to track patients, labs, and medications available for devices running the Palm OS. It is the only time in my career as a pharmacist that the entire profession embraced a new technology and used it to their advantage. The literature was full of “studies” using handheld devices for documenting clinical interventions1-4, carrying individually created documents and “peripheral brains”5,6 performing pharmacokinetic calculations, accessing drug information and performing drug interaction checking.7-12 The entire handheld movement was quite impressive to watch.

Pharmacy technology - Automated dispensing

Submitted by JFahrni on Tue, 01/19/2010 - 16:41

PROmanager-Rx is an automated system from McKesson designed for dispensing unit-dosed oral solids. PROmanager-Rx has a 12,000-dose capacity and uses a conveyor system and bar-code scanner to fill orders generated through the pharmacy information system.

The system automates storage, dispensing, restocking, and various inventory management functions via the McKesson Connect-Rx software platform. And of course the system interfaces with McKesson’s pharmaceutical distribution system.

According to the McKesson product brochure:

The PROmanager-Rx™ system helps hospital pharmacies get the most out of manufacturer packaged oral solid medications. And relieves the burden of medication packaging.

It’s the only fully automated system that directly stores and dispenses pre-packaged oral solids. PROmanager-Rx is ideal for patient-centric filling. Bar-code-driven robotics scan every dose for the greatest possible safety and accuracy.

Pharmacists are freed from packaging and dispensing activities so they can play more integral roles on the clinical care team. Bar-code scanning also simplifies tasks such as managing returns, expired meds, and overall inventory.

Technology to prevent medication errors (article)

Submitted by JFahrni on Tue, 12/22/2009 - 13:32

Forni A, Chu HT. Technology Utilization to Prevent Medication Errors. Curr Drug Saf. 2009 Oct 7 [ePub]

This is a nice review article explores current technologies available to healthcare and what role they play in the reduction of medication errors. The article provides a short review of literature to support each technology reviewed. Technologies covered include: Computerized Physician Order Entry (CPOE), Clinical Decision Support Systems (CDSS), Patient Monitoring: Electronic Surveillance, Reminders, and Alerts, Telemedicine, Bar Code Medication Verification (BMV), a.k.a. Bar Code Medication Administration (BCMA), Smart Infusion Pumps, and electronic medication administration record (eMAR).

Biometric identification and facial recognition

Submitted by JFahrni on Mon, 12/21/2009 - 17:47

CrunchGear reports on a new product called Lockface USB flash drive from Futen, a Japanese company. The flash drive uses facial recognition to identify its users. According to CrunchGear: “The first thing to do is to register a number of pictures of your face. After that, the Lockface verifies your face every time you need to access data on it (the verification process takes about a second). The USB drive doesn’t require extra software to be downloaded or installed. Alternatively, you can also use a password, completely ignoring the face recognition function of the device. It uses 256-bit AES to encrypt the data. Futen says the device has an error rate of about 2% (it verifies the “wrong” person in 1.91% of cases and won’t verify the right person in 1.98% of cases).”

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