Automated prescription system helps hospital disperse drugs

The Carolinas Hospital System implemented an automated prescription system to disperse medications. See how this system helped the hospital save money and improve patient safety.

The implementation of Pyxis software and a Talyst carousel helped the Carolinas Hospital System disperse medications faster and with fewer errors. The system has also cut inventory at the hospital's pharmacy by 30%, because medications are ordered only when needed. Read more about the success of the Pyxis software and Talyst hardware installation in this case study.

Six years ago, the Carolinas Hospital System lacked an automated prescription system and found itself filling prescriptions four times a day. Although the hospital's own pharmacy eventually was able to reduce deliveries to once a day, it became one technician's full-time job.

That person came in at 8 a.m. and used a Pyxis software system from CareFusion Corp. to fill and deliver prescriptions all day, said Edwin Weill, R.Ph, pharmacy informatics manager at the Florence, S.C., hospital. "We also pulled another person to help that tech -- about 12 to 16 hours full-time."

Moreover, pharmacy technicians had to eyeball their medications' inventory, meaning that some supplies were over-ordered, while the supply of other medicines was inadequate.

A new director at the hospital asked Weill about areas that could be improved, and gave him the green light to research potential solutions to the prescription inventory and distribution headaches.

Pyxis software, Talyst carousel provide a prescription for change

With the board of directors' consent, Carolinas Hospital's pharmacy selected AutoCarousel (a device for sorting and storing medications) with AutoPharm inventory management from Talyst Inc.

This system was designed to improve productivity, and reduce storage and retrieval costs for virtually all medications in the hospital pharmacy. It supports bar code and medication-description verification to improve accuracy and inventory control, Weill said.

"No matter how efficient the carousel is, if your Pyxis system is inefficient, you can only expect so much from the carousel itself," Weill explained.

Hospital administrators approved the carousel in summer 2007, and installation was set for later that year. Before that could happen, though, Weill recommended the installation of newer, more accurate Pyxis software. Without it, pharmacy staff would continue to pull medications off shelves by hand, then deliver medications to each hospital floor -- a process that took an entire day, he said. Intravenous drugs were delivered separately; that took two technicians a total of about three hours per day, he noted.

To find more suitable Pyxis software, Weill visited two other hospitals' pharmacies to see their systems in use. Based on this research and feedback from the hospital board, Carolinas Hospital selected a system that included an updated version of the Pyxis software boxes, as well as Talyst's AutoPharm, AutoCarousel, AutoPack and AutoLabel products.

Before any new technology went live, Weill spent a lot of time preparing for its arrival. "I worked on the formulary, making sure all the drugs in our pharmacy were loaded before the carousel was in and installed," he said. He also separated similar-sounding or -looking pills: "I have them separated, so it's very difficult to make a mistake, even if a tablet fell."

To take advantage of the Pyxis software's bar-coding capabilities, Weill made certain all bar codes and National Drug Codes (NDCs) were on file and scanned to prevent the need for en masse scanning on day one of the system's use, he said.

It took about a month to load AutoCarousel, Weill said. During that time, he trained one other pharmacist, who in turned helped him train other pharmacists and technicians.

"My goal in the beginning was to get everybody to where they could pull drugs, understand the system. Three months after [that], we made everybody go through competency training," Weill said, adding that employees have undergone annual training since then.

The benefits of an integrated, automated prescription system

Carolinas Hospital's automated prescription system went live in January 2008, less than six months after Weill's research began. The facility has realized two main benefits -- one that saves money and the other that potentially saves lives.

"My goal in the beginning was to get everybody to where they could pull drugs, understand the system. Three months after that, we made everybody go through competency training.

Edwin Weill, pharmacy informatics manager, Carolinas Hospital System

For starters, the hospital has cut inventory by 30%, because the carousel system sends alerts when drugs reach a minimum level, Weill said. In addition, technicians spend far less time delivering medicines to hospital floors. They pull drugs through the Pyxis software system in the morning and deliver medications -- both pills and IVs -- between 1:30 p.m. and 3 p.m., he said.

In addition, the pharmacy within Carolinas Hospital has reduced medication errors. It does take longer to log medications once they reach the pharmacy, because they are placed onto AutoCarousel one at a time as opposed to unloaded onto shelves. But the extra time can prevent medication mistakes, because it is impossible for a technician to place a medicine into the wrong drawer because of the bar-coding, he noted. (In South Carolina, technicians as well as pharmacists can pull medications to fill orders, without a pharmacist's check.)

"If the tech doesn't have the right drug-bin combination, they can't proceed," Weill said. "Usually, when we have a medication error, it's completely human error and something was bagged wrong. It's impossible to return one to the wrong bin, so we've totally eliminated that."

This feature has reduced the number of errors at the pharmacy from 15 to 20 per week to just one or two, Weill said. This means that technicians can spend time doing other tasks, such as checking expiration dates and conducting unit inspections. This boosts the techs' job satisfaction and the pharmacy's overall operations, he noted.

Now that the Talyst carousel and Pyxis software implementation has been in place for a year and a half, Weill frequently discusses potential changes, feedback and product requests with his regional Talyst sales representative, and has opened his pharmacy's doors to prospective Talyst clients.

"I'm very interested in the automation and the way the system works together. I want to learn as much as I possibly can, and don't mind taking on that responsibility," Weill said.

In addition, the success of the automated prescription system has allowed the hospital's marketing department to promote the safety of patients' medication, Weill noted.

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