Safety and Savings in IV Automation

12/14/22 • 21 min

The Future of Pharmacy, presented by Omnicell

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...

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?

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

Previous Episode

Texas Children’s Hospital Leverages Technology and Automation ¬¬for Medication Management

Episode Highlights

Q: Please tell our audience about your pharmacy background and experience leading key areas in pharmacy and respiratory care at Texas Children's Hospital.

Jeff Wagner: I oversee our pharmacy, respiratory care, and ECMO services across Texas Children's Hospital. Texas Children's has three hospitals in the greater Houston area with nearly 900 licensed beds. According to the U.S. News and World Report, the system consistently ranks among the top children's hospitals in the United States. Across the enterprise, we have close to 5 million patient encounters and 35,000 inpatient admissions annually, especially for our pharmacy operations and a team of over 600. We rely on automation and advanced technology to support safe and efficient medication use processes and provide care to our community's children and women. As an innovative leader, Texas Children's has sought the most advanced technology available, including automated medication dispensing systems and robotics to interface directly with automated dispensing cabinets.

Q: Can you please tell us more about how you use pharmacy technology and automation at Texas Children’s?

Gee Mathen: We can track every node within our environment within the visibility piece. So, this is the first step into a multi-layered process as we move forward. Our goal is to track individual doses from all seven stages of the medication management process, from procurement, storage, ordering, dispensing, administration, monitoring, and reporting. So, all of these pieces start with automation, and technology is a crucial component. The software aligns it as well to integrate the systems. I think that’s key to the success we’re trying to drive here.

Q: Can you tell us more about your role and how Texas Children’s has used automation to transform your pharmacy to benefit your patients?

Gee Mathen: My role here is the fun part. I get to put in the technology and ensure that we accomplish the vision and dreams that Texas Children's have set forth before us. We're a leading pediatric hospital, and super excited that we're number two this year in the U.S. News and World Report. We want to keep our patients safe, especially when the lives of children, mothers, and babies are at stake.

We chose a central pharmacy dispensing service, an automated central pharmacy system, and robotics to gain all the benefits, including increased medication safety through 100 percent barcode scanning, heightened inventory visibility, decreased redundant tasks, and reduced medication waste.

Texas Children's was already using automated dispensing cabinets to dispense about 1.3 million doses annually. Before we adopted the extra two automated central pharmacy systems from Omnicell, the hospital used a different solution to restock cabinets. The solution caused medication waste, was error-prone, and excessively relied on pharmacy personnel for manual labor and inconsistent practices. With the substantial use of automated dispensing cabinets, we needed to simplify the patient-specific dispensing process of the new automated central pharmacy system to improve the ADC restocking procedure to drive visibility and efficiency in drug dispensing throughout our healthcare system.

Q: Recognizing the difficulties in previous restocking workflows, what solution did you identify and implement?

Jeff Wagner: We partnered with our medication management technology partner to employ the automated central pharmacy system to fit our institution's specific requirements by dispensing patient-specific and cabinet restock medications to address the problems with previous restocking processes.

Q: How did you prepare to deploy the pioneering workflow at your hospital?

Gee Mathen: Over two years ago, Texas Children's and Omnicell collaborated on the automated central pharmacy system and robotics, which was improved to restock ADCs. Jeff and I had the privilege of going and taking a look at this in the early inception stages. When we saw it, we said, hey, our future will be different. It was a light bulb moment. Our pharmacy informatics teams ran several tests to ensure a smooth transition. When we finally moved forward with our new robots. They developed a workflow to restock the ADCs from the automated central pharmacy system. We also had interdepartmental cooperation amongst the executives, pharmacy informatics team, pharmacy inventory team, and other participants. They were all essential to the workflow's success.

Q: When and where did you begin the new workflow? And can you walk our listeners through a typical day of that workflow?

Gee Mathen: The cabinets are organized by the areas they service. The autom...

Next Episode

Improving Adherence and Outcomes in Specialty Pharmacy: A Real-World Case Study

Host:

Ken Perez, Vice President, Healthcare Policy and Government Affairs

Guest Experts

Sarah Kester, PharmD, Pharmaceutical Program Manager, Omnicell Specialty Pharmacy Services
Matt Manning, PharmD, Senior Director of Operations, Health Systems, Omnicell Specialty Pharmacy Services

Episode Highlights

Q: What does an advanced clinical adherence monitoring program entail and what does the Omnicell Specialty Pharmacy Services team do to impact adherence to XIFAXAN?

Sarah Kester:The process for our team starts at the very beginning of the lifecycle of the prescription. In a typical big box or PBM pharmacy scenario, when a prescription for XIFAXAN is received and prior authorization (PA) is needed, then the pharmacy would send that insurance rejection back to the provider and basically do nothing until they hear back from the provider that the prescription has been approved. Meanwhile, the patient languishes without their medication.

When you send your prescription to your health-system-owned pharmacy, as soon as we receive the referral and it's determined that a PA is needed, the pharmacy goes right to work on completing the PA. Our team members are very well versed in the requirements for PAs and we have a PA approval rate of over 92%.

Once your PA is approved, then our clinical team takes over and we contact the patients. We provide them with in-depth counseling, check for any drug interactions, and educate the patient on the medication and desired outcomes for treatment.

After the initial counseling and delivery of the medication, we continue to perform clinical follow up on a monthly basis for each patient. Seven to ten days before their refill is due, follow up calls are made to every patient. At that time, we monitor for side effects, efficacy of the medication, and any hospitalizations the patient may have experienced. We also provide monthly reminders that the patient should be on this medication for long-term maintenance and should not stop unless directed by their provider. We provide 36 months of follow up for the patient as part of our partnership with Bausch

Q: Now Sara, what benefits do you see from this intensive follow up with patients?

Sarah Kester: Our most important finding is the increase in days on therapy for our patients versus the national average. The average days on therapy for all XIFAXAN patients is around 5.4 months. However, patients that participate in our program are on therapy for about 9 months.

What's the importance of a patient getting a few more months of treatment? Quite simply, it results in patients living longer, having a better quality of life, and staying out of the hospital.

One of my favorite stories involves a patient who started on our program after being prescribed XIFAXAN after an episode of hepatic encephalopathy. This episode of HE resulted in him losing his driving privileges. When we started out, we had to speak with his caregiver because his cognitive deficit was too great for him to speak with us directly. But, after getting him established on treatment, his symptoms abated and now we're able to speak with him. He was even able to start driving again and every month he mentions that when we do our follow up. Getting his freedom to be independent back was such a great experience for him.

Q: Let's take this up a level. Patient adherence is just one of the many challenges associated with operating a specialty pharmacy and optimizing results. Matt, what are some other common core challenges that impact specialty pharmacies and how can health systems ensure they are positioned for success?

Matt Manning:There are a lot of considerations when it comes to launching and scaling a specialty pharmacy and we're energized to support health systems and position them for success. Let's start with manufacturer relations. Manufacturer limited drug distribution can be a huge barrier for a new specialty pharmacy. Many drugs today are distributed through a limited network of pharmacies at the discretion of the manufacturer. These drugs could be limited for a variety of different reasons — whether it's REMS considerations, storage considerations, or cost.

I recently read that 48% of the specialty pharmacy pipeline consists of products aimed to treat orphan disease states. When you include Oncology, that number is 80%. Those are the hallmark disease states that are going to be challenging to get access to. A new specialty pharmacy will need to validate its operation, providing manufacturers with confidence that they possess the capabilities and expertise necessary to handle their drug and serve patients.

Omnicell Specialty Pharmacy Services wants to ensure you gain ...