Pharmacy supervisor offers advice on evaluating carousel technology
Talk to peers to find out pros and cons
Before hospital pharmacy directors and health systems invest in new and expensive technology such as carousel/packager equipment, they need to research its use to ensure this will work within their system's culture and infrastructure.
Here are some tips on how to best implement this new technology:
1. Assemble a team.
"First you need to assemble a team of people who are decision-makers who will evaluate what your needs are," says Ronald E. Lay, MS, RPh, pharmacy supervisor at the Penn State Milton S. Hershey Medical Center in Hershey, PA. Lay was a scheduled speaker on the topic of carousel technology implementation at the American Society of Health-System Pharmacists' (ASHP's) 44th Mid-Year Clinical Meeting and Exhibition, held Dec. 6-10, 2009, in Las Vegas, NV.
"Ask yourself: 'Is this something that will work for us?'" Lay says. "Bring in people from pharmacy, but also management-level people and end-users, including technicians."
Information technology (IT) experts and facilities staff will help assess the hospital's needs in terms of electrical requirements, data support requirements, etc., he adds.
2. Identify your organization's goals.
"Then you need to determine what goals you want to accomplish by bringing in this technology," Lay says. "Don't do it because somebody down the street has it."
Pharmacy directors need to define their goals, whether these are for inventory control, increasing safety, increasing efficiency, or all three, he adds.
"You need to identify the needs your organization has when it comes to incorporating this technology," Lay says.
For instance, ask these questions:
- What kind of information system are you using?
- What kind of technology do you already have?
- What third-party vendors will you have to work with?
- How are people going to work with you and the carousel?
- How much inventory do you have?
- Are there any regulatory requirements, such as a need for a construction project approval by a state board?
- How much space in the carousel do you have and does your inventory match the space?
"If you have 400 cubic feet of inventory and you're thinking of buying a 200 cubic-foot carousel, then you really have a mismatch," Lay says. "Maybe you can't afford to buy two carousels, so you'll have to decide if it's better to buy one and put in only half the inventory or to do without and go manual."
Also, some existing software systems will integrate with the new technology, and others will not. And this can be an important consideration.
3. Talk to people who have used the technology.
Once the goals are defined and a particular carousel/packager is identified as a way to meet these goals, then it's time to talk to people who have used it.
"It's important to talk with people from other organizations," he says.
"You don't know what you don't know," Lay says. "Someone who has used the technology might say, 'If we had to do it all over again, we would do this…'"
Other users will be honest about their experiences, both good and bad. And they'll have tips and advice on who to call and which products work best, Lay says.
4. Engage in discussions with all partners.
"I suggest a real detailed discussion with whatever partners you have, and those could be your wholesaler for the hospital information system or vendors for dispensing cabinets and point-of-care barcoding," Lay says.
Also, ask the carousel technology vendors if they work with other companies and whether there are any incompatibilities you would need to know about, he adds.
"Make sure you understand your needs and requirements because you don't want to spend $200,000 on a piece of equipment and then find out it doesn't interface with some other equipment you have," Lay explains. "Most vendors can tell you what works and what doesn't."
5. Evaluate work processes in the pharmacy.
The initial team should start evaluating work processes, perhaps by making flowcharts, Lay says.
"We've found it very helpful to do a flowchart of what you do today and what you want your work to look like in the future once you put in the carousels," Lay says. "Think about where you're going and what the outcome will be."
Pharmacists, technicians, IT staff, and everyone who will be a user of the new technology should be involved in the evaluation process.
Some questions the evaluation should answer are these:
- If we put a carousel in what will it impact?
- How will we receive the order from the wholesaler?
- How will we put away the equipment?
- How will we refill dispensing cabinets?
- How do you handle stock for the nursing unit?
- How will you restock clinics?
- What time of day will the restocking be done?
"You have to think about how to avoid conflicts of jobs because you can't be putting the order from the wholesaler away at the time you're dispensing medications from the dispensing cabinets," Lay says. "So you have to think about how this will change what you're already doing."
For example, a pharmacy might have to change the time scheduled for refilling dispensing cabinets, he adds.
"You need to think about that upfront so you have this plan, and as you go forward you know what you're doing and who is doing what," Lay says.
One way to make certain the restocking schedule will work is to create a calendar with daily hours in a column. Each task would be written beside the hours in which it can be performed.
"So we put that between 7:30 and 10:30 a.m., we receive and put away the wholesaler order," Lay says. "Then from 1-4 p.m., we do the dispensing cabinets."
6. Determine expected return on investment.
New technology like carousels and packagers, often have a potential return on investment in the form of better inventory control, as well as inventory reduction, Lay says.
"You can increase your inventory returns, which is real dollars to offset against the expense," Lay says. "With a packager you can look at buying medications in bulk instead of unit dose, so your drug costs will go down."
A hospital pharmacy might find that personnel needs decrease because of the technology results in a more efficient operation.
"You might not need as many technicians," Lay says. "You might say [to hospital leadership], 'If I don't get a carousel, I will have to hire another person.'"
It's hard to place a return on investment dollar amount to increased patient safety, but this also could be a benefit, he adds.
"If you could say this will prevent one dispensing error per day, it is soft money, but it can help justify these things," Lay explains. "And theoretically it should improve patient safety because it does rely on barcoding, and it should make the dispensing process more accurate and safer."
7. Obtain approval for capital expense.
Even if a pharmacy director chooses to seek this approval before following the other steps, the key is to at least think through the steps and what is required.
"You should make sure the carousel is going to meet your needs," Lay says.
For instance, the director should know whether the site will need one or two carousels and whether there also will need to be funds for renovations, Lay says.
"Do we need to hire additional people? Do we have to pay for interfaces?" he says. "I want to have a sense of what it will cost before I say, 'Here's what we need and here's our expected return on investment.'"
Before hospital pharmacy directors and health systems invest in new and expensive technology such as carousel/packager equipment, they need to research its use to ensure this will work within their system's culture and infrastructure.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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