Barcoding Solution In Pharmacy June2009


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  • Turns out that most of the facilities I talked to didn’t really think about what they were going to do AFTER implementation. They tried to plug the new technology into their existing workflow. While I think that may work in some circumstances, overall I don’t think it’s necessarily a good approach. Instead of trying to force the technology into our existing workflow, I decided to step back and figure out a way to build the workflow around the technology. After we had invested a lot of time, energy and money into this equipment and we wanted to maximize it’s benefits. With the help of several technicians and lots of trial and error, we developed our current system. It’s clearly a work in progress and we’ve made several changes along the way. We’ve found that there’s almost always a better way to do things, we just have to figure our what that way is. This slide shows a couple of photos of one of our carousels…the photo on the left is during installation and the one on the right is how the carousel looks today. I have photos of the entire installation posted on Google’s Picasa website if anyone is interested in taking a look at them.
  • Because we underestimated the amount of storage space we needed, we’ve had to take advantage of every little nook and cranny. Each shelf in the carousel has these little supports that are pretty much wasted space. To take advantage of them, we ordered some small bins from Herman Miller (A-size subcontainer and are 2-3/16″ High x 13-13/16″ Deep x 2-1/4″ Wide) that fit perfectly in the gaps. We use them to hold small items like opthalmic drops, otic preps, etc. It’s opened up a few slots in the carousel.
  • stick with it. So far it’s worked our for the best.
  • Barcoding Solution In Pharmacy June2009

    1. 1. Implementing a Barcode System in Pharmacy Jerry Fahrni, Pharm.D. IT Pharmacist Kaweah Delta Medical Center Visalia, California
    2. 2. Kaweah Delta Medical Center <ul><li>Located in the San Joaquin Valley of California </li></ul><ul><li>460 bed acute care facility </li></ul><ul><li>Offers a variety of services </li></ul><ul><ul><li>Inpatient </li></ul></ul><ul><ul><li>Outpatient </li></ul></ul><ul><li>New tower opened April 2009 </li></ul>
    3. 3. Kaweah Delta Medical Center Visalia, California
    4. 4. Medication Error Reduction Plan <ul><li>Task force created in July 2005 </li></ul><ul><li>8 nurses and 2 pharmacists as part of the facilities MERP </li></ul><ul><li>Purpose = develop a model to reduce risk of errors </li></ul><ul><li>Implement technology at different steps in the medication use process </li></ul><ul><ul><li>Heavy use of barcode technology </li></ul></ul>
    5. 5. Bar Coding Plan <ul><li>All medications will have a readable bar code prior to dispensing </li></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>Automate inventory </li></ul>
    6. 6. Barcode Equipment Implementation <ul><li>Pharmacy Remodel </li></ul><ul><ul><li>Phase I completed in February 2008 </li></ul></ul><ul><ul><ul><li>Designed around automation </li></ul></ul></ul><ul><ul><li>Phase II completed in December 2009 </li></ul></ul><ul><ul><ul><li>Designed around clean room and dispensing </li></ul></ul></ul><ul><ul><li>Phase III completed in June 2009 </li></ul></ul><ul><ul><ul><li>Designed around work space </li></ul></ul></ul>
    7. 7. Pharmacy Remodel - Phase I <ul><li>AutoPack </li></ul><ul><ul><li>Implemented February 2008 </li></ul></ul>
    8. 8. Pharmacy Remodel - Phase I <ul><li>“Design the pharmacy around the technology” </li></ul><ul><li>AutoCarousel </li></ul><ul><ul><li>Implemented March 2008 </li></ul></ul>
    9. 9. AutoPack <ul><li>Unit-dosing solution for bulk tablets </li></ul><ul><li>500 canister model </li></ul><ul><li>Interfaced with AutoPharm </li></ul><ul><li>Interfaced with carousel </li></ul><ul><li>Currently have 122 medication canisters. </li></ul><ul><li>“ Back-fill” model vs. “Primary-fill” model </li></ul>
    10. 10. AutoCarousel <ul><li>Inventory management and storage solution for barcoded medications </li></ul><ul><li>Medications placed in the carousel MUST be barcoded </li></ul><ul><li>Integrated into our pharmacy system (Siemens) </li></ul><ul><li>Integrated into Pyxis </li></ul><ul><ul><li>Replenishment </li></ul></ul><ul><ul><li>PARx </li></ul></ul><ul><ul><li>OMNL </li></ul></ul><ul><li>Integrated to AutoPack </li></ul>
    11. 11. Pyxis PARx Technology <ul><li>Implemented April 2008 (Pyxis 3500) </li></ul><ul><li>OMNL </li></ul><ul><li>Replenishment </li></ul><ul><li>Manual pull </li></ul><ul><li>Significant decrease in error rates </li></ul>
    12. 12. 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><li>Remote ordering </li></ul></ul>
    13. 13. Storage Outside the Carousel <ul><li>For large items with high turnover </li></ul><ul><li>Take advantage of barcode </li></ul><ul><li>Take advantage of inventory tracking </li></ul><ul><li>Mimic carousel shelving </li></ul>
    14. 14. Increasing Storage Space
    15. 16. Remote Ordering
    16. 17. Lessons Learned <ul><li>Devoting a pharmacist to the project KEY </li></ul><ul><li>Identify at least one pharmacy technician to be part of the transition </li></ul><ul><li>Identify at least one pharmacy technician to take ownership </li></ul><ul><li>Conduct training sessions close to “Go-live” </li></ul><ul><li>Do as much integrated testing as possible </li></ul><ul><li>Build a clean formulary and standardize whenever possible </li></ul>
    17. 18. Was it worth the effort? <ul><li>Benefits </li></ul><ul><ul><li>Error Reduction </li></ul></ul><ul><li>Improved patient safety </li></ul><ul><ul><li>First dose dispensing (scan on first dose) </li></ul></ul><ul><ul><li>Scan on Pyxis pull / Pyxis stock / restocking / </li></ul></ul><ul><li>Improved inventory management </li></ul><ul><li>Improved Efficiency </li></ul>
    18. 19. Thank you - Questions?