Healthcare Information Systems 90853

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Healthcare Information Systems90-853

• Decentralized Automated Drug-Dispensing Systems
• Sudhir N. Reddy

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Presentation Outline

• Introduction
• Case Analysis
• Case I (No automation)
• Case II (Automation)
• Case Comparisons
• Implementing the System
• Potential Problems
• Preparing for Impending Implementation

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Project Outline

• Vendor Analysis
• Vendor Profiles
• Vendor Comparisons
• Recommendations
• Case Examples
• Conclusion

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Once Upon A Time...

• Individual Doses were prepared from floor stock
  or from medications dispensed in bulk from the
  pharmacy

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Our story continues...

• The Unit Dose System completely changed the way
  drugs and medications were dispensed and provided
  additional safety precautions by both the
  pharmacy and the nurses.

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Case I (Non-Automated System)University of Poppi
(1997)

• Major referral center with many specialties.
• 400-bed Teaching Hospital
• 120,000 Patient Days 15,000 Admissions
• Inpatient Drug Budget 14 million
• Medications Distributed in unit-dose cassettes.
• Employs 6 full-time equivalents (FTEs) 1
  part-time equivalent.

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Case ITime Line
Started billing for narcotics from the
controlled-drug records rather than medication
administration records.
Gave technicians more responsibilities, such as
checking medication cassettes newly ordered
medications being sent to nursing stations.
Removed As-Needed Medications from
cassettes while adding them to stock and in
sealable plastic bags.
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Case II (Automated System)University of Balboa
(1997)

• Identical to the Medical Center at Poppi
• However, implemented a specifically designed
  system on a 40-bed intensive care unit (System
  was called DFZ-I)
• DFZ-I replaced the cassette-exchange system in
  the nursing unit.

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DFZ-1

• Similar to an ATM machine
• Controlled through passwords
• Screen displayed the transaction options
  available to user.
• System stored most drugs routinely needed
• Narcotics, First-dose, As-Needed, and Scheduled
  Medications
• Interface with the Pharmacy Computer System

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DFZ Process
Medication profile presents the medication
orders that were entered in the computer system
Enters Password and selects patient from list of
patients on screen
Drawer containing the drug opens

• Data in the Central Console Keeps Track of the
  Refill Level for each medication
• The Nurse is confidant that the medication is
  correct because it has been bar code checked

Transaction ID is printed immediately and sent
electronically to the central DFZ-1 in the
pharmacy.
Patient and Billing Information is Updated
Immediately
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Case Comparisons

• Fewer types of medication errors reported at
  Balboa Hospital
• Workload Decreased
• Nurses
• Spent less time taking inventory of the
  controlled substances. (.29 hr/week at Balboa
  compared to 4.0 hr/week at Poppi.
• Pharmacists and Technicians
• Less time spent processing new orders

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Case Comparisons

• Billing and stock-replacement sheets eliminated
• Financially Sound System
• Reductions in personnel. Savings from FTE
  reduction was 2.08 million.
• Decreased use of narcotic forms and decreased
  drug pilferage
• Potential to save 500,000 to 1,000,000
• BOTTOM LINE- More efficient workers not doing
  needless paperwork.

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Implementing a Decentralized Automated Dispensing
System

• Potential Problems
• Hardware Problems
• Cables Break, Gears Become Misaligned, movement
  mechanisms become clogged, sensors become
  occluded, and bar scanners misread.
• Software Failure
• Typographical error in the program
• Failure by the programmer to anticipate and deal
  with a given situation
• Creation of multiple contradictory conditions
  that prevent the software from functioning
  properly.

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Implementing a Decentralized Automated Dispensing
System

• Potential Problems cont.
• Software Problems cont.
• However, most problems are the result of the
  program being used in a way that was not
  intended. (Discrepancies between anticipated and
  actual use often result in system failures.)
• Untrained Users

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Implementing a Decentralized Automated Dispensing
System

• Preparations for Installing a Decentralized
  Automated Dispensing System

Nurses
Pharmacists
Hospital Information Systems Vendor Company

• Objectives
• Timetable
• Training
• Responsibilities

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Nurses and Pharmacists

• Decide Access
• Types of Medications
• Time for Restocking and Amounts of Medications

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Implementing a Decentralized Automated Dispensing
System

• Preparations for Installing a Decentralized
  Automated Dispensing System

Nurses
Pharmacists
Hospital Information Systems Vendor Company

• Objectives
• Timetable
• Training
• Responsibilities

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Pharmacists and Information Systems Personnel

• Security Issues
• Companys Installation Specialists
• Most players will be trained by outside
  consultants, but all the players should be aware
  of the other persons duties.

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Implementing a Decentralized Automated Dispensing
System

• Final Thoughts
• Preparations for the change
• Par Levels for the system will have to be
  constantly modified
• However, all changes in the departments should be
  made through the director. (Actions must be made
  according to a chain of command)
• Continue training for at least another year after
  the system is implemented

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Implementing a Decentralized Automated Dispensing
System

• Final Thoughts (cont.)
• Patience
• Use the selling companys training to the fullest
  and insist on hands-on training
• Ask the company how other similar institution
  have handled problems

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Vendor Selection

• Automated Drug Dispensing System
• (ADDS)
• Develops and Manufactures computer controlled
  drug-dispensing systems
• Automated Prescription for physician offices,
  clinics, and emergency rooms

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ADDS

• Typical On-Site Hardware
• Remote Controlled Dispenser Series 2.0 or 3.0

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ADDS

• ADDS Workstation Accessories with ADDS Software
  Installed
• Bar Code Reader
• Laser Printer
• Video Teleconferencing Equipment

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ADDS System Process
ADDS operator faxes script to Central Pharmacy
ADDS Operator receives script from provider
Central Pharmacy makes remote connection
to ADDS workstation and enters
patient information
ADDS Software performs Full DUR/DUE Online
Adjudication
Central Pharmacy makes Televideo connection to
ADDS workstation
OR
1. Patient Monograph and Label are printed 2.
Label is barcode checked to insure correct label
for drug 3. Label is applied to medication
Central Pharmacy Counsels Patient on Medication
Medication is dispensed from RCD
Medication and Monograph are delivered to patient
Drug is barcode checked
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ADDS

• Typical On-Site Software
• Hardware and Software are connected on site to
  form a ADDS Dispensing Site via a Pentium based
  PC
• Central Pharmacy software that can control the
  dispenser is on a PC with a modem or LAN
  connection.

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• On-Site Software
• Software has the functionality to control
• Access
• Maintain a Patient Data Base
• Perform OBRS/DUR compliance checking
• Process Billing
• Insure Inventory Control
• Generate Reports
• Provide Remote Control Capabilities

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• On-Site Software
• Telecommunication Technologies
• More Direct Service to Healthcare Providers and
  Patients
• Additional Series of Software
• Incorporates Interfacing to legacy software in
  various clinical centers.

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Vendor Selection

• Pyxis Corporation
• Pioneered the Idea of Decentralized Automated
  Medication Dispensing
• Allows Hospitals and other healthcare providers
  the means to streamline the medication and
  distribution process.

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Pyxis

• Typical On-Site Hardware
• MedStation Rx

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Pyxis

• Remote Manager

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Pyxis

• PARx

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Pyxis

• PyxisConnect

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PyxisSystem Process
Medications taken from pharmacy to
MedStation unit in clinical area.
Medication verified to right place in
MedStation by PARx Device (Barcode Checked)
Nurse enters Password and Patient ID into the
MedStation
Correct amount of Medication Dispensed. Patient
Record Updated
MedStation
Pharmacist receives order. Updates Patient Record
over the Computer System
Provider sends Pharmacy the order over
PyxisConnect
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Pyxis

• Custom Developed software make it possible to
  control the dispensing of medications and
  supplies to archive usage for dissemination
  throughout the hospital.

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Vendor Comparison

• Comparison Matrix

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Recommendations

• It all really depends...
• Pyxis
• Johns Hopkins University Medical Center
• Best suited for major hospital and clinical
  institutions
• Geared toward increasing efficiency at places
  which handle lots of information and vast amounts
  of medications
• Greater engineering and research department which
  has the capability to work with institutions
• Constantly investing in new research technology
  which will benefit major institutions with the
  monetary resources to buy the technology

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Recommendations

• ADDS
• VA Outreach Center in North Billerica, MA
• Used in smaller or more rural areas
• Telecommunication technology allows for patients
  in very isolated areas to gain access medications
  from distant pharmacies
• Rural areas have less need to store many
  non-medicine items.
• Rural also have less of a need to keep buying new
  products which need to be connected with their
  automated dispensing system

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Concluding Thoughts

• What I learned...
• Role of the Pharmacist
• Speed of Technological Change

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Questions