The Future of Pharmacy, presented by Omnicell

You can’t manage what you can’t see. When pharmacy leaders at St. Jude Children’s Research Hospital and their teams made their medication inventories visible through intelligent data solutions, they were able to make better decisions for their patients, workflow, compliance, and financial performance.

Guest Host:

Dennis Wright, Senior Director, Product Marketing

Guest Expert

Berkley Sykes, Pharmacy Operations Manager, Huntsville Hospital

Episode Highlights

Q: Can you give an overview of Huntsville Hospital and some of your early experiences with IV robotics and how you're using them at Huntsville?

Berkley Sykes: Huntsville Hospital is a 971-bed community hospital. It's located in Huntsville, Alabama. We are the flagship of twelve hospitals within the Huntsville Hospital Health System. As the hospital pharmacy operations manager, I provide operational leadership and strategic guidance for inpatient and outpatient sterile compounding, centralized services, inventory management, and pharmacy. Most ops managers get to wear many hats, but my favorite is sterile compounding and IV robotics. For the past 20 years, I've been able to provide direction for sterile and hazardous compounding regulations, IV workflow, technology implementation, and IV robotics. Both of those journeys began for us back in 2013, as well as clean room design construction throughout the hospital system. I've been fortunate enough that I've been highly involved in seven to eight cleanroom builds over the years, which I enjoy. And most recently, I led the design and construction of a standalone IV robotics center that was established to add our new Omnicell IVX Station compounding robots.

Q: So, Berkeley talking about your experience with IV robotics, I know it goes back a long way. Can you take us back to the early days of why Huntsville Hospital started to go down this path and decided to leverage IV robotic technology as part of your pharmacy operation?

Berkley Sykes: I've been asked why we chose IV automation. Our main objectives have stayed the same since the beginning. They are safety, and they are savings. And while I would love only to say safety, the savings help us pay for the safety. But fortunately, these two go hand in hand. IV Robotics allows us to prepare medications without human inconsistency safely, and that, in turn, reduces our dependency on outsourcing. So, this provides a two-pronged result of saving us a significant amount of money by not purchasing these expensive 503B drugs. It also reduces our exposure to the quality assurance issues that we all know are inherent with the 503 D products.

It's been such a long, exciting road from when we first got IV robotics to now, we have the IVX Station, and one of the main reasons we made this change was based on regulations. I’m glad we've created this shift to IVX. It's going to be beneficial for us.

Q: When you implemented the brand new IVX station that you referenced, can you talk a little bit about what that transition looked like, the overall implementation process itself, and then any early impacts that you've seen?

Berkley Sykes: As with any significant go-live, I'm sure you can close your eyes and picture this. All the people running around and planning and working and making this happen. It was hectic, but many Omnicell people were involved in the project for weeks. We had engineers, and there was project management, a product team, and all kinds of people in and out who were helping us. They were fixing things and educating and teaching us what to do. And a big part, too, is that they were listening to us. The leaders and the developers at Omnicell are always thinking about our best interests. We've already had some releases of some new updates based on our program's needs, and they have our best interests in mind for future roadmap updates. That part has been just incredible for us.

Q: Do you have any other advice you would give to some of your peers at different hospitals and health systems around best practices for gaining that support and adoption with other stakeholders within your organization?

Berkley Sykes: It's such a good question, and it's something that hospital and pharmacy leaders struggle with. Robotics can be very complicated. Think about your pharmacy, where you want to be, how it elevates your pharmacy, and the safety it brings. And so, to be able to sell that, one of the big pieces is safety. And all those things you mentioned are so proper about removing the humans and how much safer the robot is just inherently in its design. So, looking at errors may be that you've had with manual preparations or errors that you've had from 503Bs, mainly if you outsource. If the question comes up, how will you pay for this? If you are outsourcing, that's number one because you can bring all that stuff in-house. IV robotics also helps manage waste, meet regulations, and have ready-to-use products that you do not have to outsource.

Q: You mentioned going live with the new IVX s...

Persistent labor shortages are forcing health system pharmacy leaders to rethink their operational and clinical choices. Learn how innovative leaders at Owensboro Health are sidestepping labor issues, up-leveling clinical programs, and optimizing medication management processes with advanced robotics and software operated by a dedicated resident expert.

Host: Ken Perez, Vice President, Healthcare Policy and Government Affairs, Omnicell

Guest Expert: Arpit Mehta, PharmD, MPH, MHA, Director of Pharmacy, Allegheny General Hospital

The Future of Pharmacy Podcast

Episode 2

Advocates for Safe IV Preparation Practices Share Their Inspiration

Introduction

Technology-aided processes are proven to be safer and more accurate when compounding sterile products. Yet, studies show that just 1 in 4 hospitals use workflow management systems when compounding sterile products. During this episode, discover how a tragic medication error helped to inspire the formation of THRIV—a safety coalition comprised of healthcare providers, consumers and technology developers. You’ll also learn about THRIV’s technology checklist for best practices, encompassing Workflow Management Software, Barcode Scanning, Volume Verification, Auto Labeling, and Auto Documentation.

Participants

Host: Ken Perez, Vice President of Healthcare Policy for Omnicell

Guest experts:

•Mark Neuenschwander, Founding Director, THRIV

•Derek Gillespie, BPharm, MBA, Pharmacy Operations Manager, Renown Regional Medical Center

Highlights

How were you personally impacted by an IV medication error?

Derek Gillespie: I happened to be the Director of Pharmacy at a hospital where a fatal medication error occurred. I’d like to tell the story just so that everybody understands what occurred and the impact that it had on the family as well as on people working at the hospital....It hits me every year at this time. Loretta did not get to enjoy that Christmas with her two sons and her grandchildren. And she and they did not get to enjoy any further Christmases as a family. Loretta was a vibrant 65-year-old lady, a vibrant member of our community. We lost that person as a result of a preventable medication error. The technician that prepared the admixture and the pharmacist that performed the check did not work another day in healthcare. They chose not to continue their professions going forward. There are similar stories with the nurses involved with administering the drug, and with some of the caregivers that participated in the code for the patient to the ICU. The physician that took care of her after the event as well as the physician that ordered the medications were deeply affected. I spent a lot of time talking to our pharmacists and technicians. As you can imagine, there was a feeling that we had failed the patient and had failed the community. Nobody came to work that day with an intent to harm anyone. In fact, they came with the opposite intent. But we are human beings and we all make errors. Until we have systemsin place everywhere that help us to safely manage sterile compounding preparation, these errors will continue to occur.

What does THRIV do?

Mark Neuenschwander: Imagine if Delta lost one of every ten bags checked. Or if one in ten Amazon orders that arrived on your porch contained the wrong ingredients. Seminal research from 1997 on IV compounding practices has haunted me for years. A five-hospital study found that 9 percent of compounded preparations contained wrong ingredients and incorrect volumes. I realize 1997 may sound to some like a beyond-use dated study. However, the vast majority of today’s IVs are being prepared essentially the same manual way they were two decades ago, giving us little reason to believe that error rates are lower now than they were then. In our technological world, I find this unconscionable. Bags checked with Delta fail to show up just 0.2 percent of the time and most of these are eventually found. An Amazon executive told me error rates in their fulfillment centers run below 0.1 percent—and both companies continue chasing zero—even though it’s hard to believe that losing a suitcase or shipping a wrong book title or wrong sized T-shirt has harmed a customer. So, two years ago, we formed THRIV—a safety coalition comprised of healthcare providers, consumers and technology developers. With the objective of protecting patients from being harmed and caregivers from unwittingly doing harm—harm which too often stems from compounding errors made in pharmacies when IVs are manually prepared. To get down to or below Delta’s and Amazon’s error rates.

What is THRIV’s technology checklist?

Mark Neuenschwander: If you have not read Atul Gawande’s book, “The Checklist Manifesto,” you must add it to and check it off your reading list. Gawande brilliantly outlines the science and value of simple manual checklists. In aviation, construction, culinary arts, and ultimately in operating rooms. For instance, “Did everyone scrub in? Was the patient given an antibiotic? Is blood on hand?” Four or five items that Gawande calls the “dumb stuff” which too easily can be overlooked to the detriment of patients. He appeals to healthcare stakeholders to incorporate such lists in their various areas of pr...