DRAFT ::: Pharmacy_Script_HIMSS15_Pharmacy_v1.5.docx
HIMSS15 Pharmacy Script 4/2015
Contents
HIMSS15 Pharmacy Script 4/2015
Introduction
1-Main Pharmacy Part 1
1.1_ID badge authentication (HID.1)~
1.2_Alaris Infusion Viewer (Carefusion.1)
1.3_networking infrastructure (Extreme Networks.1)~
1.4_Central Controlled Substance Storage (AutoVault Mini & Autocool – Talyst.1)
1.5_ADC Replenishment (AutoCarousel Mini – Talyst.2)
1.6_Temp monitoring (Arista.1)~
2-Sterile Compounding Room
2.1_Compounding (Talyst.3)~
2.2_labeling (Zebra.1)~
2.3_Real Time Status View of IVs for Pharmacy (BBraun.1)~
2.4_TPN Compounding (BBraun.2)~
2.5_ Optimized IV Compounding (Carefusion.2)
3-Main Pharmacy Part 2
3.1_ Medication Tracking and Delivery (CareFusion)
3.2_Video Visit (Skylight.1)~
4-Outpatient Pharmacy
4.1_E-prescribing (HID.2)~~
4.2_M5000 Robot (Omnicell.1)
4.3_retail security (Cbord.1)
4.4_Medication Compliance (eMedonline.1)
Conclusion
Appendices
A-Setup procedures for Next Tour
B-Sample Labels to be Printed
C. Map of Room (not to scale)
D-Furniture & Fixtures To Obtain
E-Furniture & Props:
[any text in blue or red will not be SPOKEN in the script, red text is for actor performance, blue text is for organizing/structuring the script, green is directorial for the voice. This script requires a minimum of 5 actors:
- Central pharmacy
- tech (Actor 1)
- pharmacist (Actor 2)
Introduction[SJJ1]
[Prop List[i]]
Hello, welcome to the Intelligent Hospital Pharmacy. In this demonstration you’ll see a Pharmacystaffed with pharmacists and pharmacy techniciansperform important and complex tasks and see examples of technology improving efficiency and accuracyto help ensure the 5 Rights of medication safetyare made possiblebrief pause>the right medication, to the right patient, at the right time, via the right route, and at the right dose.
[Slide: ______]
1-Main Pharmacy Part 1
1.1_ID badge authentication (HID.1)~
{Suggest leveraging this quick use case to increase awareness of increased cyber security in every demo room where a tablet is being used}.
[Hardware: NFC Tablet, Mobile Phone, ID Badge]
[Actor #1: Picks up/ Holds out the Tablet]
We begin our tour in the pharmacy by demonstrating the importance of security in this ever increasing world of mobility. To address this issue, the intelligent pharmacy employs <emphasis>two factor authentication to log in to any systems and application.
[Slide 1: Screen shot of ActivID Tap Application]
[Actor #1: Enters there reduced complexity domain password and then Taps their ID Badge to the back of the Tablet for a second factor]
With a single tap of this smart identification card, the innovative technology inside the card both generates and transmits a One-Time-password without the inconvenience of re-keying[SJJ2]. Elevated security that’s efficient is a must-have in the environment of care and because this card is ‘bound[SJJ3]’ to the device, should a user lose their card, there’s never a risk of someone else being able use it to access any of the pharmacy applications.
[Slide 1: Screen shot of Authentication]
1.2_Alaris Infusion Viewer (Carefusion.1[SJJ4])
[Hardware: ______]
[Props: ______]
[Slides: ______]
Pharmacists can now view near real-time infusion status data for all large volume and syringe infusions administered throughout their hospital or health system. Using information provided by this infusion viewer, Pharmacists can make timely, informed decisions to improve medication safety, as well as infusion preparation and management.
[Pharmacist Actor comes back to computer workstation / power-point Screenshots of Infusion Viewer displayed on screen]
For example, shortly after an infusion begins anywhere in the hospital, the IV pump will communicate wirelessly to a central server that will update the “Infusion Viewer” you see here on the monitors.
From this web-based dashboard, the pharmacist now has visibility to patient-specific infusion data, due to the dashboard’s integration with the hospital’s Admission, Discharge, and Transfer system (or ADT). This helps the pharmacist by providing key patient demographic and location information, such as patient name and room number, to each infusion that is currently being administered. In addition, the dashboard clearly identifies all infusions that are violating a safety software “soft” limit and the violation that occurred, as well as identifies those infusions that are not being protected by dose error reduction software at all, which show up as “Unknown” in the Infusion drug name column.
[Pharmacist Actor points to yellow G badge in the Infusion Name column, as well as an infusion with the name ‘Unknown’ in the same column]
This gives the pharmacist the opportunity to review the current dose, rate, concentration, and duration of running infusions - as well as review overall safety software compliance – to help identify potential medication errors and ensure optimal care coordination between both Nursing and Pharmacy.
1.3_networking infrastructure (Extreme Networks.1)~
[______]
[Slide 1]
< insert copy about networking infrastructure[SJJ5]
1.4_Central Controlled Substance Storage (AutoVault Mini Autocool – Talyst.1)
[Pharmacist 1: Selects an item from the pick queue using the mouse to select. A label prints from the barcode printer. The appropriate AutoVAULT door opens (this could be an AutoVAULT door or a door on the refrigerated AutoCool +H (Helmer). Validates the picking location. Picks the appropriate number of items from the bin. Scans the barcode of the item. Attaches the label to the product. May or may not perform blind cycle count]
[Slide 1]
As just demonstrated with medications picked from pharmacy shelving for remote ADC replenishment, the same concept applies to the replenishment of refrigerated or non-refrigerated medications that require computer controlled storage. Orders for remote pharmacies, satellite pharmacies, outpatient clinics and specialty clinics can be automatically queued up from the pharmacy system. A controlled access vault or locking refrigerator like this uses barcode scanning to ensure control and recording of every transaction into and out of these controlled access devices.
[Slide 2]
For this demonstration, the technician selects an item for picking. The appropriate door is unlocked, the technician scans the item to confirm the right medication is picked and the door is then re-locked. All transactions, including user access are recorded, the inventory is updated, labels are printed, and the picking can continue.
[Slide 3]
With the integration to a perpetual inventory system and remotely located ADC's, workflows can be automated to help manage the restocking of controlled medications and ensure closed loop replenishment while documenting chain-of-custody at each step of the way.
[Slide 4]
And in the case of dealing with a controlled substance like morphine or vicodin, if a discrepancy were to occur signifying potential diversion, the investigation into the reason can easily occur to ensure an appropriate and accurate resolution.
1.5_ADC Replenishment (AutoCarousel Mini– Talyst.2)
[PHARMACIST 2: Technician signs into AutoPharm.]
[Slide 1]
Automated dispensing cabinets, or ADC’s for short, located throughout the hospital need frequent refilling. Just like the refill process being done at the Central Pharmacy for the fast movers, this pharmacy also refills the ADC’s and the focus here is on refiling the slow-movers and specialty medications that the Central pharmacy didn’t carry.
[Slide 2]
For the sake of this demonstration….
[PHARMACIST 2 starts the picking process – replenishment for Pyxis order. The AutoCarousel spins to the proper location and the tic-bar lights up to identify the location of the bin to pick the item. Barcode prints. Technician picks and scans the item to insure the proper medication. The technician packs and labels medication.]
[Slide 3]
…we are utilizing anautomated mini carousel that is more typical in small environments. Larger carousels can be seen on the main floor of the show.
[Slide 4]
Additionally, medications and components to support pharmacy workflowssuch as IV compounding and kitting can also be handled here for storage and picking.
[Video: show 15 second video without sound]
[actor: interacting with carousel, showing light to pick, barcode scanning]
High-density storage systems like these can be configured with multiple widths, depths, and heights, depending on the physical constraints of your pharmacy and the work activities that you perform. Integrated with an enterprise wide perpetual inventory system, all orders can be queued for an efficient workflow. Once the technician selects the order, the AutoCarousel will spin to the designated location, the light will light up on the correct bin from which the technician will pick the medication from. The technician uses the medical grade barcode scanner to scan the product and the label to confirm the proper item is picked. The carousel is then ready to rotate to the next pick, and the sequence starts again.
With an automated carousel like this, pharmacy stock can be stored in the carousel for better inventory management & tracking with the intent of keeping just-in-time inventory on hand, thereby preventing stock outs while avoiding overstocking. This carousel can be used to send patient specific first-doses and receives refill data from an ADC if ever there’s a stock out needing immediate attention. The system will also send order recommendations to the pharmacy buyer which will then be sent to the wholesale distributor, ensuring this machine has the desired “just in time” inventory at all times.
1.6_Temp monitoring (Arista.1)~
[Hardware: put module on Talyst autocool]
[Props: ______]
[Slides: actor can receive an alert that temperature or humidity has deviated within the room or within an asset and go to the screenshot for dashboard notifications]
Real Time monitoring of room/refrigerator/freezer/deep freezer environmental conditions with real time display of data via dashboards and other user interfaces. The temperature tags utilize existing Wi-Fi infrastructure to transmit the data for storing and processing. Alerting of abnormal conditions is achieved via email, SMS or other API[SJJ6].
###transition1 from main room to IV Compounding room
We will now shift your attention to the compounding area to your right. This area represents a clean-room area designed to adhere to USP797 standards for anticipatory batch compoundingof sterile preparations for the entire health-system.
2-Sterile Compounding Room
2.1_Compounding (Talyst.3)~
[Props: ______]
[Slides: ______]
The[SJJ7] next solution you see is aimed at streamlining sterile and non-sterile compounding within your pharmacy. This solution provides a process for medication preparation, verification and inventory management, all bar coded to manage complex multicomponent orders for the IV Room compounding needs. This module offers a preparation, verification, and check software component to your compounding areas while also tying into the inventory management and reporting capabilities of. It can be used in your inpatient pharmacy or satellite compounding locations and can be integrated to existing compounding solutions.
###transition2 from main IV Compounding room to Patient Care Area
We will now shift your attention from the compounding area to the monitors.
2.2_labeling (Zebra.1)~
[Technician 1 holds a zebra scanner and interacts with a printer or print label; presses scanner button and outputs a label from a zebra printer, applies to a medication, and then scans the medication to note when the meds were prepared. ]
[slide ##]
The use of barcode scanning is very important throughout the intelligent hospital. Many different processes rely on barcode scanning to help ensure accuracy and simplify documentation. To achieve accuracy and efficiency, scanners need barcodes printed clearly with a high degree resolution. And when working inside a clean room like this, it is especially important that barcode scanners and printers are produced with medical grade plastics to ensure a clean and sterile pharmacy environment and use power supplies built specifically for hospital environments.
2.3_Real Time Status View of IVs for Pharmacy (BBraun.1[SJJ8])~
[Hardware: ______]
[Props: ______]
The pharmacist working here in this IV Room has a special system that provides us with real-time infusion information on when IVs are due for our patients.
[Slide 1; TECH 2 point to last column with colors]
As you can see the color coding provides a quick visual as to what needs to be worked on first, allowing staff to anticipate what’s needed before the patient runs out. And because it ignores things like Piggybacks or Boluses, this systemdoesn’t direct staff to produce something that isn’t actually needed.
[Slide 2: Actor points to Time Thresholds on monitor]
This screen allows staff set preferred time thresholds to better achieve “just in time” production which will decrease waste. Warnings set for 30 minutes and lesswill appear in red. Reminders for 60 minutes and less, will appear in yellow. This approach allows you to proactively prepare IVs before they’re due the patient.
[Slide 3; actor point to last column with red colors]
As you can tell by the red indications on this screen, there are a lot of IVs now due. In a busy hospital it can be frustrating receiving phones calls from nursing asking for their IVs that about to run out. That will not happen with this system. Pharmacy technicians also appreciate not having to perform IV rounds anymore, allowing them to focus on more important duties.
2.4_TPN Compounding (BBraun.2)~
[Hardware: Jessica Pitt will again work with GermFree for a hood]
[Props: ______]
[Slides: ______]
[Technician #: garbed and gowned inside the compounding lab area, holds up label]
We will now show you another system that helps manage the production of “total parenteral nutrition”, also known as TPN. The set-up of the hood and compounder is a critical process. The hood cleaning has been documented, and this compounding pump has been accurately calibrated. The ingredients have also been hung inside the hood[ii] and connected to the compounder using this bar-code scanner. Because an accidental swap of the tubing is an easy mistake to make, this scanning step verifies the correct ingredients are hanging on the correct tubing line and helps ensure a proper line tracing is done for each connection. And with barcode scanning, the system will also capture the lot number and expiration date directly from the barcode to eliminate the need for manual transcription or data entry and will even alert the user if something is expired[iii].
[Technician 1: hangs ingredients, scanning the bar codes on the lines of the transfer set and the corresponding source containers. Then holds up empty 2-liter bag with barcode label, scans the bar code, then presses the “Start” button on the compounder]
The pharmacist has just received electronic orders for a pediatric TPN. A patient specific bar-coded label has been printed and placed on the empty bag. With one simple scan of this patient specific label, the pump is queued with the exact formula that was ordered by the pediatrician, eliminating any opportunity for error with manual data-entry. All that’s left to do now is press START on the compounder and wait for the pumping to finish.
brief pause
Upon completion of pumping, the technician takes the completed bag off of the compounder and readies it for delivery to the pediatric wing across town. Later, we will see how an order like this is actually generated at the bedside using a tablet computer.
2.5_ Optimized IV Compounding(Carefusion.2)
IV compounding isn’t complete once the IV has been compounded. Currently, most Pharmacies lack the visibility…
[Slide: CareFusion_Pharmacy2.5_visibility.png]
…into where the IV is going, was it used, what to do if it returns and can it be re-used?
[Screen shot: (1) questions asked bubble[SJJ9]]
Through technology,…
[Slide: CareFusion_Pharmacy2.5_technology.jpg]
…patient specific medication can be tracked from the pharmacy to any patient care area.
[Screen shot: (2) Track/delivery screen[SJJ10]]
When a patient specific IV is not administered because the IV orders have changed, been discontinued or the patient has been discharged, the medication can be returned to pharmacy. This results in thousands, if not millions for some health systems, of dollars going down the drain. This technology helps manage…
[Slide: CareFusion_Pharmacy2.5_manage.png]
[Actor points to monitor showing screen shot]
…unused IV medications returned to the pharmacy by storing them as inventory. If an identical IV medication is requested before its expiration date, the software will notify the technician of the already-existing IV medication and allow re-issue. If the medication is not usable, it can be appropriately documented and discarded as waste.
[Screen shot: (3) Pyxis Prep waste/return screen[SJJ11]]
With changing state board of pharmacy requirements and increased need for documentation, consider technology that provides a log…
[Slide: CareFusion_Pharmacy2.5_log.png]
[Actor points to monitor showing screen shot]
…with detailed information on all IV preparations compounded for administration to patients. Information captured includes complete IV preparation process: pick, prep, check and final check information. In addition, reports include the NDC, Lot # and expiration information. The latter is critical in managing recalled medications.