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Yuma Regional Uses Integrated Automation to Improve Pharmacy Safety and EfficiencyBy Tom Van Hassel, RPh, MPA Director of Pharmacy Yuma Regional Medical Center Yuma, Ariz.  Tying it Together At Yuma Regional Medical Center (YRMC), we've been using automation to improve our pharmacy performance for more than two decades. Initially, separate systems and disparate data slowed us down and consumed resources. But with system integration, we found a faster, more accurate way to make technology work for us. Our 333-bed, general acute-care hospital now has a fully automated pharmacy with multiple integrated technology solutions in place. We use McKesson's automation decision support, robotic dispensing, bar-code medication packaging, cabinets and distribution technologies to enhance medication ordering, dispensing, administration, and inventory management processes. Tying these systems together has improved operational efficiencies in the pharmacy and patient safety across the organization. Interface Reliability Integrated automation helps guarantee dispensing accuracy, which is paramount for us. For example, a patient given amoxicillin can be assured the medication has been tracked from receiving to inventory to dispensing and administration to ensure its integrity. This is unique in the industry. If you asked 100 hospitals if they could assure this level of accuracy, few could answer yes. Consolidating data from multiple sources helps reduce the potential for mistakes — by man or machine. We seamlessly integrate data from sources such as universal allergy files, dosing files and drug identification files, enabling us to reduce redundant work. Redundancy not only slows things down, it increases the risk of error because of the potential for staff to find ways to "work around the system" and skip crucial steps. Pharmacists at the Heart of Care Our biggest safety and efficiency improvement by far is our hybrid pharmacy model, with robotic patient-specific fill in the pharmacy and automated dispensing cabinets on each floor. Instead of standing behind a counter in a basement somewhere, our pharmacists are on the nursing units, working with physicians and nurses to provide direct patient care. One dedicated pharmacist rounds with the discharge team in the intensive care unit (ICU). The others provide clinical expertise for whatever a particular floor needs to enhance proper medication use and reduce adverse drug events. With pharmacists on the patient floors, they can clarify orders, conduct drug utilization reviews, offer drug dosing assistance and provide patient education. Meanwhile, our 12 pharmacy technicians facilitate the dispensing functions in our two hospital pharmacies. Automation has dramatically reduced the learning curve so we can train our new techs much more quickly. The processes are so user-friendly that we've gained in both function and efficiency. We did not eliminate positions when our technology was adopted. Instead we chose to re-task our workforce so that we've expanded and enhanced our clinical and distribution services, improving customer satisfaction and patient care. Inventory Control YRMC is more than 180 miles away from the nearest drug wholesaler or a hospital where we might borrow a critical drug item, so maintaining the correct inventory is vital. It doesn't matter how good a clinical pharmacy job we're doing if medications are not available when and where we need them. Our automation system maintains a perpetual inventory. This ability to manage our inventory in real-time ensures medications are always available, and we can place medication orders at the best price. At any given time, we know what we have in our dispensing robot or our medication carousel and cabinets. Automated inventory control provides optimum efficiency — we don't run out of medications and we don't have to overstock. Tighter inventory control is especially critical in fall and spring, when the arrival and departure of Arizona's "snowbirds" cause census swings. With the ability to monitor inventory on a seasonal as well as a daily basis, we make better-informed decisions throughout the year. A Picture Worth a Thousand Words Pharmacy performance scorecards have enabled us to gain greater control of the data used in the decision-making process. They truly give meaning to the phrase "a picture is worth a thousand words." Scorecards provide a quick assessment of how we're doing, consolidate critical data from multiple sources into a single view, and identify performance trends for improved long-range planning. The data updates automatically, so it doesn't slow us down and is always close to real time. At YRMC, we use scorecards to regularly review five key indicators:  Robot efficiency averages Medication return percentages Expenses Pharmacy inventory cost Pharmacy inventory quality If an indicator falls below the benchmark, we can drill down to learn the reason. For example, if our monthly expenses are out of line, we can review each week or drill down further to examine a single day or even a specific hour. Once we determine the cause, we can take the appropriate steps to remedy the situation. In addition, scorecards give me credibility with the C-suite. Hospital administrators see trends for themselves in an easy-to-understand format. This helps me do a better job as pharmacy director and secure the resources, people and equipment that I need. Something for Nothing Holistically integrated technology effectively gives you "something for nothing." By automating the process, the work of a few individuals can serve the needs of many others. Nurses, patients and the pharmacists all reap the benefit of integrated technology. It provides additional value that enables us to improve our performance and enhance patient care. Tom Van Hassel is director of Pharmacy at Yuma Regional Medical Center (YRMC) and past president of the Arizona State Board of Pharmacy. He has been with YRMC for more than 23 years and served as president of the Arizona Hospital Pharmacy Association in 1998. Arizona awarded him the Elias Schlossberg Award for continuous service to the profession in 2003.   |
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