August 15, 2008

Automation drives Central Pharmacy’s efficiency

Featured Image

Central Pharmacy’s Linda Phaneuf and Ken Sinclair examine an order filled by one of Vanderbilt University Hospital’s automated medication retrieval units. (photo by Neil Brake)

Automation drives Central Pharmacy’s efficiency

The Vanderbilt Department of Pharmaceutical Services has made some sizeable changes over the past year.

Key is the installation last year of three automated medication retrieval units in the Vanderbilt University Hospital Central Pharmacy.

Sheree Foster, D.Ph., and Michael O'Neal, R.Ph., directed the installation, and, after one full year of operation, the state-of-the-art units are performing beyond expectation.

Each rectangular MedCarousel unit is 5-feet deep, 11-feet wide, and 9-feet tall. The three are arranged in a U-shape, with retrieval stations facing each other. In order to accommodate the large machines, the pharmacy had to undergo approximately $1 million in renovations.

The MedCarousel units completely automate the medication retrieval process. Each unit is a rotating system of storage bins designated for specific drugs.

“The best analogy I've heard is, imagine going to the grocery store, and you go up to this machine. It already knows what's in your cabinet, what's missing from your cabinet and what you are going to be eating the next day. It spins and out comes a bin with everything you need,” explained Mark Sullivan, Pharm.D., M.B.A., director of Central Pharmacy operations.

Prior to 2007, the pharmacy operated on a manual system of storing and retrieving medications. Medications were stored in multiple locations, and because they were arranged by generic product name, there existed the potential for error with drugs that look and sound alike.

Now, before drugs are placed in a container they are identified using a computer system, both visually — drugs contain unique markers from the distributor as well as distinct sizes, shapes and colors — and by name.

Further, specific drug containers have unique barcodes. Before a drug container can be placed in its appropriate bin on the MedCarousel, its barcode must be scanned and verified.

“It's adding another layer of safety in the pharmacy,” said Sullivan.

Later, after the drug is retrieved and brought to the bedside for inpatient delivery, its barcode is scanned using the Horizon AdminRx verification system, which checks the scanned code against the electronic medication order for each patient.

It also checks that the medication is being given in the right dosage at the correct time.

Apart from the safety that the new MedCarousel units guarantee, the pharmacy has also become more cost effective, having realized $600,000 in inventory reduction savings over the last six months.

In 2006, Harry Jacobson, M.D, vice chancellor for Health Affairs, launched initiatives to improve medication safety at Vanderbilt Medical Center.

Along with the MedCarousel and Horizon AdminRx barcode verification systems, there have been a host of other medication safety initiatives and projects.

Some of these include creating monitoring strategies for warfarin, heparin and other high-risk anticoagulation drugs, as well as creating an algorithm for insulin dosage.

The Vanderbilt-Ingram Cancer Center is undergoing a $20 million renovation that will include doubling its infusion area. They will also add a MedCarousel and barcode system to their pharmacy for chemotherapy drugs.

Many of these initiatives, at their foundations, require novel informatics technology.

Vast improvements have been made to program the myriad distinctions between various drugs — children's and adult dosages, dosages based on weight, age and current medication usage — into the computer interface.

To track the medication safety initiatives at VMC, the Department of Pharmaceutical Services has added a medication safety pharmacist. Amy Potts, Pharm.D., will direct the growing medication safety initiatives.

“The key piece is communication, at all levels, across the organization,” Potts said.

“It's exciting to see these initiatives fly from the launch pad. We will continue to benchmark medication safety at Vanderbilt; it is one of our highest priorities, something central to what we do here,” said Jacobson.