samantha nothling - unitingcare health - incorporating profiled automated dispensing cabinets (adcs)...
TRANSCRIPT
Samantha Nothling
Clinical Informatics Pharmacist
UnitingCare Health
UnitingCare HealthSt Stephen’s Hospital, Hervey Bay
Incorporating Profiled Automated Dispensing Cabinets
into CLEMM
Medication Interfaces
ADC
EMR
Pumps
Phcy Mgmt Software
Billing
Wholesaler
Enhancing patient
safety and nursing
workflows
Tighter control over
inventory management &
associated financial benefits
CLEMM
Closed Loop Electronic
Medication Management
Guided electronic
transcription at point of
patient transition
Clinical Decision Support
BCMA
Unit Dose Packaging and
electronic dispensing
Product selection at computer terminals
AnywhereRN
Improve nursing
workflow
Reduces
bottleneck during
busy med rounds
Clinical Workflow Challenges
Override functionality Recent data shows 4-5% of Issue transactions are via override
Breaks the loop and increases risk of selection error
Reason required
Causes include interruption to interface, med order overlooked, bad
habit
Overrides create system-generated once orders in
patient EMR No administration task created
Orders tab “looks messy”
Med order reporting can be skewed
Clinical Workflow Challenges
Bottleneck during
medication rounds
EMR auto product
assignment may not align
with stock in clinical area
Med order displays on
ADC as unavailable
Ability to set equivalent
doses in Omnicell – not yet
in use
Inventory Management
Eliminates requirement for
manual imprest ordering
All items require barcode
scan confirmation prior to
restock
Electronic expiry tracking
reduces wastage
Reporting enables regular
PAR vs usage reviews
Controlled Drug Management
Access granted at ADC after witness
scans fingerprint
Blind count
Discrepancies in stock count
Electronic notification sent to CNM
CNM involvement required for resolution
Reason for incorrect count MUST be
documented
Controlled Drugs are tracked from
Pharmacy to ADC
Pharmacy Dispensing & PBS Claiming
Med removal creates Merlin dispense record
ADC
Phcy Mgmt Software
Dispense quantity accumulates with each transaction until
Max PBS qty reached
Patient discharges
Pharmacist reviews for paperless PBS claiming eligibility
Inventory Databases
Paracetamol 500mg tabs
PARA300
x2 tabs ordered
Paracetamol 500mg tabs
PARA300
x2 tabs removed
Paracetamol 500mg tabs
PARA300
x2 tabs charged
Inventory Challenges
Full integration means every
action has a system-generated
reaction
Inventory Challenges
Product changes due to supplier shortages or new tender
contract
Build modifications are required across ALL 3 systems (Cerner,
Omnicell, Merlin)
Needs to be done at the exact moment product changeover
occurs
Conversion factorsConversion factor
required
Paracetamol suspension
x20mL removed
Paracetamol suspensionParacetamol suspension
x20mL ordered x20 BOTTLES removed !!!x0.1 bottles removed
Testing & Implementation Challenges
Integration testing
Reliance on non-production interfaces in a constantly changing environment
Increases testing time affects test script throughput
Requires extensive knowledge of the systems the ADCs will interface with and the
expected outcomes of each transaction
Interface Architect involvement is essential
Training difficulties
No “spare” ADC for training ($$)
Training on Production cabinets requires:
• all transactions to be reversed and stock
checked in Merlin
• all controlled drug discrepancies to be
resolved with appropriate documentation
Testing & Implementation Challenges
ADC set up
Stock location mapping – considering
product security requirements
• Controlled Drugs
• Drugs of Diversion
• High Alert Medications
Stocking
• reshuffling due to product size & quantity
• Validating correct stock movements in Merlin
Final pharmacist validation
>300 lines per ADC = days of preparation
Maintenance
Twice yearly software upgrades
Regular cleaning
Hardware maintenance and repairs
Sometimes time consuming
Always requires Pharmacy staff
involvement
Need to ensure medication access is
uninterrupted
Pharmacy staff learning new skills
Thank you