 Automated dispensing devices (ADD) ◦ ADD requirements ◦ Examples of ADDs  Bar code enabled medication administration  Becoming a pharmacy informaticist  Role of the pharmacy informaticist

 ADDs are drug storage devices or cabinets that electronically dispense medications in a controlled fashion and track medication use  ADDs are located in hospital patient care units, surgical suites, emergency rooms, long-term-care facilities, physicians’ offices, and other settings

 These automated dispensing systems can be stocked by centralized or decentralized pharmacies  Centralized pharmacies prepare and distribute medications from a central location within the hospital  Decentralized pharmacies reside on nursing units or wards, with a single decentralized pharmacy often serving several units or wards  These decentralized pharmacies usually receive their medication stock and supplies from the hospital’ s central pharmacy

 Medications are contained in, and administered from, single-unit or unit-dose packages  Medications are dispensed in ready-to-administer form to the extent possible  Medications are available for administration to the patient only at the time at which they are to be administered, according to the institution’s policy ASHP. Am J Health-Syst Pharm.2010; 67:483-90

 An electronic patient medication profile is concurrently maintained in the pharmacy for each patient and made easily accessible to the pharmacist  Medications are accessible to different categories of health care professionals with the ability to limit access based on policy or law ASHP. Am J Health-Syst Pharm.2010; 67:483-90

 Small systems: ◦ Pyxis medstation ◦ Baxter ATC ◦ Script-pro 200  Large systems: ◦ Baker cells ◦ Baxter international

 Are automated dispensing devices kept on the nursing unit  These machines are often compared to automatic teller machines (ATMs)

 The Medstation interfaces with the pharmacy computer  Physicians’ orders are entered into the pharmacy computer and then transferred to the Medstation where patient profiles are displayed to the nurse who accesses the medications for verified orders  Each nurse is provided with a password that must be used to access the Medstation

 Many Pyxis MedStations are configured with a medication profile for each patient  When selecting a patient, only active medication orders that have been reviewed by the pharmacy can be accessed at the MedStation

 Certain MedStations do not have patient profiles available: ◦ Medications are removed by selecting the necessary medication ◦ Non-profile units include the Emergency Department, Radiology, and Surgery

 Pharmacists or technicians keep these units loaded with medication. Charges are made automatically for drugs dispensed by the unit  Earlier models had sufficient memory to contain data for about one week, and newer models can store data for longer periods

1. Nursing staff are guided to the correct drawer and pocket to access required medicine. Medicines which sound similar or have multiple strengths are loaded indifferent drawers of the machine 2. Access is restricted to only one drawer/door at a time 3. Ward stock levels are monitored by the pharmacy computer and stocks topped up before drugs run out, reducing delay to patients and staff frustration 4. Management of controlled medication

5. Possible to add additional safety features for individual high risk drugs. For example, ◦ must be authorized by two staff members ◦ soft lock outs to prevent duplicate administrations (reduces risk of multiple administrations when staff forget to sign for medications) 6. Advice given or required information recorded at time of dose removal

7. Use of profile mode enables constant monitoring by pharmacist of drug dosages/interactions. It also reduces the amount of interpretation required by nursing staff at time of dose removal 8. Real time data collection for drug usage which can be advantageous for audit and other quality improvement processes

1. May be frustrating to get drugs in an emergency 2. Requires additional staff training and technical help 3. Downtime, system failure and inflexibility 4. Cost and space issues

 Uses a microcomputer to pack unit- dose tablets and capsules for oral administration  It is usually installed at the pharmacy

 Medications are stored in calibrated canisters that are designed specifically for each medication  Canisters are assigned a numbered location, which is thought to reduce mix-up errors upon dispensing. When an order is sent to the microcomputer, a tablet is dispensed from a particular canister  The drug is ejected into a strip-packing device where it is labeled and sealed

 Installed in the pharmacy  Contains 200 universal dispensing cells and three vial dispensers  Fills vials directly from dispensing cells  Prints prescription and auxiliary labels

 Installed in the pharmacy  Counts a 30-count vial in 3-5 seconds  When a prescription is dispensed, information is sent to the Baker Cell. The Baker Cell counts the correct number of units of the medication

 Are inventory control systems that uses barcodes to prevent human errors in the distribution of prescription medications at hospitals  The goal of BCMA is to make sure that patients are receiving the correct medications at the correct time by electronically validating and documenting medications

 It ensures adherence to the “5 Rights” of medication administration ◦ Right Patient, ◦ Right Route, ◦ Right Dose, ◦ Right Time, ◦ Right Medication  It visually alerts staff when the proper parameters are not met

 Stocking of inventory both in pharmacy & in other locations from which medications may be dispensed (e.g. automated dispensing device)  Manual packaging of oral solid and liquid medications  Compounding, repackaging, and labeling processes (e.g., scanning of source ingredients)

 Retrieving medications from automated dispensing devices  Dispensing from the pharmacy to any location

A. Patient name B. Medication name and strengths C. Time of administration D. Bar code for bedside scanning

 Bar codes mismatch with drug, dose and patient at times  Bar code sometimes function erroneously  Unable to scan bar codes properly at times  Unreadable bar codes  Time consuming

 The typical pharmacy informaticist is a pharmacist who has knowledge of: ◦ computer systems ◦ medication-use processes ◦ safety issues ◦ clinical management of medications ◦ drug distribution, and administration AND  Has developed extensive expertise in using technology to support these activities. ASHP. Am J Health-Syst Pharm. 2007;64:200–3.

 Three options are available: ◦ Take specific courses or obtain a degree in computer science, information systems or business information technology ◦ Complete an advanced residency ◦ Volunteer to assume an informatics role at one’s current place of employment by:  Volunteering to take responsibility in aspects of informatics  Obtaining as much on-the-job experience as possible  Attending courses, conferences & learning form colleagues

 Work closely with information systems and pharmacy staff to develop system programming requirements  Develop and oversee databases related to medication management systems  Identify, suggest solutions to, and resolve system or application problems

 Assess medication-use systems for vulnerabilities to medication errors and implement medication-error prevention strategies  Assist in mining, aggregating, analyzing, and interpreting data from clinical information systems to improve patient outcomes  Collaborate with other health care technology and clinical leaders to ensure that medication-related systems support safe and effective medication use

 Training pharmacy staff in the use of medication- related computer systems  Performing research to expand informatics knowledge and its use in supporting patient care