KDHCD Pharmacy Automation

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  • Indications: Acute Coronary Syndrome w/ or w/o PCI, recent MI, stroke, or established PAD
  • Discuss difficulty with insulin flag labels and work around for lot and expiration date, i.e. altering label template Insulin for BCMA …. What a hassle
  • http://picasaweb.google.com/jerry.fahrni/CarouselInstall#
  • shouldn’t store chemotherapy in it Large bulky underestimate storage space - virtually no “extra” room for future storage. What about refrigerated items?
  • Large items, such as our premixed DOPamine and DOBUTamine bags, metronidazole piggybacks “ static carousel” - fitted with adjustable shelving to accommodate the large blue bins that we use for storage. designated as RS1, for Remote Stock 1. shelves numbered in order from bottom to top and the bins are numbered left to right just as they would appear in the carousel - example premixed DOPamine bag (400mg/250mL) would appear as RS1-002-03-01 (Remote Stock 1, Shelf 2, Bin 3, Slot 1). Disadvantages shelves are more than 10 feet from the nearest carousel - don’t get the immediate visual feedback for an incorrect scan too easy for someone to pull an item without going through the scanning process. bypasses the safety features and creates a discrepancy -
  • AutoPharm’s remote ordering function. “ IVRoom”
  • small bins from Herman Miller (A-size subcontainer and are 2-3/16″ High x 13-13/16″ Deep x 2-1/4″ Wide) fit perfectly in the gaps. small items like opthalmic drops, otic preps, etc.
  • PARx in combination with our AutoPharm/AutoCarousel system . Replenishment Manual pull Decrease in fill errors
  • KDHCD Pharmacy Automation

    1. 1. Kaweah Delta Health Care District Drug Distribution Automation <ul><li>Jerry Fahrni, PharmD </li></ul>
    2. 2. Kaweah Delta Health Care District <ul><li>Centrally located in the San Joaquin Valley, California </li></ul><ul><li>581 beds </li></ul><ul><li>Offers a variety of services </li></ul><ul><ul><ul><ul><li>Inpatient </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Outpatient </li></ul></ul></ul></ul><ul><li>New tower opened April 2009 </li></ul>
    3. 3. Five Licensed Pharmacies <ul><li>Outpatient </li></ul><ul><ul><ul><ul><li>Employee Pharmacy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Home Infusion Pharmacy </li></ul></ul></ul></ul><ul><li>Inpatient </li></ul><ul><ul><ul><ul><li>Main Campus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>South Campus (Sub-acute, SNF) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>West Campus (Rehab, Mental Health) </li></ul></ul></ul></ul>
    4. 4. Pharmacy Remodel <ul><li>Phase I complete February 2008 </li></ul><ul><ul><ul><li>Designed around automation </li></ul></ul></ul><ul><li>Phase II complete December 2008 </li></ul><ul><ul><ul><li>Designed around clean room and dispensing </li></ul></ul></ul><ul><li>Phase III complete June 2009 </li></ul><ul><ul><ul><li>Designed around creating more work space </li></ul></ul></ul>“ Design the pharmacy around the technology”
    5. 5.
    6. 6.
    7. 7.
    8. 8.
    9. 9.
    10. 10. Pharmacy Remodel – Phase I <ul><li>Part of Kaweah Delta’s Medication Error Reduction Plan (MERP) </li></ul><ul><ul><ul><li>All Medications will have a readable bar code prior to dispensing </li></ul></ul></ul><ul><ul><ul><li>Patient Safety </li></ul></ul></ul><ul><li>Create an error free Pyxis fill </li></ul><ul><li>Increase Pyxis fill efficiency </li></ul><ul><li>Automate wholesaler ordering </li></ul><ul><li>Control Inventory - $$$ </li></ul>
    11. 11. Phase I-Automation/Technology <ul><li>AutoPack </li></ul><ul><ul><ul><li>Implemented February 2008 </li></ul></ul></ul><ul><li>AutoLabel </li></ul><ul><ul><ul><li>Implemented February 2008 </li></ul></ul></ul><ul><li>AutoCarousel / AutoPharm </li></ul><ul><ul><ul><li>Implemented March 2008 </li></ul></ul></ul>
    12. 12.
    13. 13. Pharmacy Remodel - Phase I AutoPack February 2008
    14. 14. <ul><li>500 canister model </li></ul><ul><li>Currently using just over 120 canisters </li></ul><ul><li>“ Back-fill” vs. “Primary-fill” model </li></ul><ul><li>Minimize “A” locations </li></ul>AutoPack
    15. 15.
    16. 16. Pharmacy Remodel - Phase I AutoLabel February 2008
    17. 17. <ul><li>Circle labels </li></ul><ul><ul><ul><li>Mostly for liquids unit-dosed to smaller size </li></ul></ul></ul>AutoLabel <ul><li>Flag labels </li></ul><ul><ul><ul><li>Mostly vials and ampules </li></ul></ul></ul><ul><ul><ul><li>Insulin for BCMA </li></ul></ul></ul>
    18. 18. Pharmacy Remodel - Phase I AutoCarousel March 2008
    19. 21.
    20. 23. AutoCarousel <ul><li>Items in carousel MUST be barcoded </li></ul><ul><li>Full integration with Pyxis </li></ul><ul><ul><ul><li>Replenishment </li></ul></ul></ul><ul><ul><ul><li>OMNL </li></ul></ul></ul><ul><ul><ul><li>PARx </li></ul></ul></ul>
    21. 24. Extending AutoPharm’s Reach <ul><li>Storage outside the carousel </li></ul><ul><ul><li>Chemotherapy </li></ul></ul><ul><ul><li>Large, bulky items with high turnover </li></ul></ul><ul><li>Increasing storage within the carousel </li></ul><ul><li>Refrigerated storage </li></ul><ul><li>“Other” locations </li></ul><ul><ul><ul><li>Remote ordering </li></ul></ul></ul>
    22. 25. Storage Outside the Carousel <ul><li>Consistency </li></ul><ul><li>Large items with high turnover </li></ul><ul><li>Take advantage of: </li></ul><ul><ul><ul><li>Barcoding </li></ul></ul></ul><ul><ul><ul><li>Inventory tracking </li></ul></ul></ul>
    23. 28. Remote Ordering
    24. 30. Tweaks and such … <ul><li>Package insert holders </li></ul><ul><li>Smaller storage bins </li></ul><ul><li>Pyxis PARx technology </li></ul><ul><li>Barcode scanners – newer is better </li></ul><ul><li>Label changes </li></ul>
    25. 31. Package insert holder
    26. 32. Maximizing Storage Space Herman Miller (A-size subcontainer) fit perfectly in the gaps
    27. 33. Pyxis CUBIE / PARx Technology Implemented with Pyxis 3500 in April 2008
    28. 34. Barcode scanners <ul><li>Code Corp CR3 vs. 3500 – no contest … really </li></ul><ul><li>The 3500 is </li></ul><ul><ul><ul><ul><ul><li>Faster </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Easier to use </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>More forgiving </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Slightly tougher </li></ul></ul></ul></ul></ul>
    29. 35.
    30. 36.
    31. 37. <ul><li>Better control of inventory on the wall and counter area </li></ul><ul><li>Barcode solution for off campus locations </li></ul><ul><li>Decreased fill time for main campus </li></ul><ul><li>Not so happy at satellite location </li></ul><ul><ul><ul><li>“ Interrupts” workflow </li></ul></ul></ul><ul><ul><ul><li>Takes too long </li></ul></ul></ul>AutoPharm Pilot
    32. 38. Questions? jfahrni@kdhcd.org

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