Technology Pearls. Automated Inventory Management: Madigan AMC Pilot Update. Kyle Nebelsick, CPT, USA, Madigan AMC 11/4/2016

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1 CPE Information and Disclosures Technology Pearls CAPT Kyle Nebelsick, Eric Spahn, Maj Jin H. Kim declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. LTC (Ret) David Andersen declares that he owns stock in Rite Aid and his spouse owns stock in Pfizer. The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. CPE Information Learning Objectives Target Audience: Pharmacists & Technicians ACPE#: L04-P/T Activity Type: Knowledge-based 1. Describe examples of innovative pharmacy activities using technology. 2. Explain how pharmacists and technicians have overcome challenges to deliver better care using technology. Self-Assessment Question Automated Inventory Management: Madigan AMC Pilot Update Kyle Nebelsick, CPT, USA, Madigan AMC Potential pharmacy benefits for adopting an automated inventory management solution include which of the following? A. Reduce expired inventory returns B. Reduce carrying costs & out of stock items C. Increase inventory turnover rate D. A & B E. All of the above 1

2 Background Value Proposition Lack of standardized DoD pharmacy automated inventory system Priority issue guidance AR 40-3 (April 2013) 2013 OTSG-MEDCOM Policy Letter (13-034) Medications are largest pharmacy expenditure Defense Medical Logistics Standard Support (DMLSS) used for procurement, not inventory management Recapture prescriptions from retail network Minimize expired medication return Automated inventory management Reduce carrying cost, partial fills, out of stock Increase inventory turnover rate Madigan AMC Outpatient Pharmacy ~2,500 prescriptions per day ~$2.4 million monthly medication inventory expenditures Typical staffing Outpatient pharmacy: pharmacists, technicians Supply/Support pharmacy: 6 technicians Internal locations Main outpatient, refill, drive-thru, discharge External locations Inpatient, pediatrics, hem/onc, investigational Initial Observations / Challenges Excess inventory of expired and in-date items manual replenishment based on physical observation Challenges locating inventory Prescriptions filled with QTY greater than requested Rx 90 bottle of 100 Item changes without corresponding CHCS updates Unit of measure errors leading to ordering/dispensing discrepancies Inaccuracy of automated counting devices Madigan AMC Automated Inventory Management Timeline 10 Feb 16: Inventory baseline data 13 Feb 16: 100% inventory and automated inventory management system activated Feb-Mar 16: System configuration, build, training 20 Mar 16: Second 100% inventory 16 May 16: Army reciprocity ATO submitted for DMLSS interface Madigan AMC Automated Inventory Management Timeline May 16: ~16 hours of automation downtime Manual CHCS prescription filling without corresponding automated inventory deductions Mitigation plan Offline fill workflow DMLSS reconciliation Lack of contingency plan during extended periods of automation downtime Sep 16: Implementation & Operations Guide for DoD customers developed by automation vendor 2

3 Automated Inventory Pilot Baseline Functionality Establish inventory centers Upload DMLSS NDCs Identify standard QTYs Limit items dispensed as package (inhalers) Prefer standard metric QTYs (tab, cap, gm, ml) Outpatient and supply pharmacy staff training Storage locations Expedites filling and cycle counts Staff time commitment Inventories, cycle counts, adjustments, troubleshooting Future Functionality Requirements Develop robust controlled medication accountability Feature not currently available for DoD pharmacies Define roles and limit user access Develop ability to distribute to vault customers Develop vault reporting capabilities DMLSS interface pending reciprocity ATO Increase staff efficiency placing/reconciling orders via automated process (save ~45-60 minutes/day) DMLSS data for items not available or partially filled Inventory Management System Transition Requirements Inventory Management System Transition Requirements Pharmacy size/volume considerations Staff, prescription volume, remote locations Robust and precise inventory management capability Defined storage locations Established inventory roles Dedicated pharmacy supply/inventory team Staff commitment to maintaining accurate inventory Primary automated inventory champion DMLSS interface Implementation of metric QTY standard Plan for inventory management procedures during automation downtime Consider projected date of new DoD EHR (MHS GENESIS) Key Points Answer to Self-Assessment Question Madigan AMC automated inventory pilot resulted in several system enhancements and opportunities for other DoD pharmacies Potential to reduce overall costs and increase pharmacy supply/staff efficiency System requires a dedicated team of pharmacy staff to maintain accurate perpetual inventory Must have defined procedures for inventory management during periods of automation downtime Potential pharmacy benefits for adopting an automated inventory management solution include which of the following? A. Reduce expired inventory returns B. Reduce carrying costs & out of stock items C. Increase inventory turnover rate D. A & B E. All of the above Sites should consider the timeline of MHS GENESIS perpetual inventory solution adoption 3

4 Closing Remarks CPT Kyle Nebelsick Assistant Chief, Pharmacy Department Madigan Army Medical Center (253) Ask a Pharmacist App Eric Spahn, Pharm D, Program Analyst VHA Pharmacy Benefits Management Self-Assessment Questions Ask a Pharmacist App According to 2011 USPHS Report to USSG: Pharmacists are uniquely positioned(through their, expertise and experience) to play a much larger patient care role in the U.S. health care delivery system A significant contribution to health reform by the pharmacy profession may be to increase to patient care services, Pharmacists are the most health care professionals in the United States and have always been one of the most trusted professions. If you are a Veteran, the Ask a Pharmacist App enables you to access information about pharmacies and medications easily with the comfort of knowing the information is valid and from trusted sources. If you have a verified My HealtheVet account (credentials for VA s personal health record), you can link to pharmacy and Secure Messaging services via the app, allowing you to quickly go to your personal medication and health information as well as learn about pharmacy-related topics. In the VA App Store Home Page The Ask A Pharmacist application is accessible through a browser search or from the VA site also resides on the VA mobile app Launchpad The Ask A Pharmacist Learn currently about has My 5 HealtheVet s main Pharmacy features Services, to access including information the ability to about refill and track pharmacy your services VA prescriptions. and medications easily with the comfort of knowing the information is vetted by VHA Staff and from trusted sources. 4

5 My HealtheVet Pharmacy Services Rx Labels and Pill Identification Hover-over text to preview content before selection Learn about My HealtheVet s Pharmacy Services, including the ability to refill and track your VA prescriptions. Hamburger Menu for mobile desktop allows user to easily navigate back to home page features, such as Pill and Bottle Information Learn about what s included on a VA prescription label VA Rx labels explained Rx Labels and Pill Identification The innovative patientcentric VA prescription label, the result of a 2011 research study Improving Veteran health-literacy and safety through implementation of a novel, evidence based, patientcentered outpatient prescription label. Forgot what that blue pill is for? Find out here! Pill Identification VA Trusted Medication Resources Pillbox is the National Library of Medicine (NLM) medication identification application. Currently, the VA Medication Image Library (MIL) is the primary source of medication images displayed and used in the Pillbox application. Access reliable, VAapproved resources about drug information as well as administering and disposing of medications. 5

6 VA Trusted Medication Resources About VA Pharmacies Access reliable, VAapproved resources about drug information as well as administering and disposing of medications. Ability for user to see additional features upon scrolling Easily locate a VA pharmacy, and learn how VA pharmacies operate. Link to VA National Formulary FAQs and search tool About VA Pharmacies Send a Secure Message Easily locate a VA pharmacy, and learn how VA pharmacies operate. Learn about sending a Secure Message to your VA care team. VHA Pharmacy and Secure Messaging VHA Pharmacy Utilization of Secure Messaging..by Service All VISNs with SM Triage group containing PHARM 112 Primary Stations with SM Triage group containing PHARM = 557 SM Triage Groups containing PHARM 368 for General Pharmacy Services 152 for Clinical Specialty Services 20 for PACT Services 17 for HBPC Services 6

7 VHA Pharmacy Utilization of Secure Messaging..by Specialty Ask A Pharmacist user training User Manual Quick Start Guide Slideshow FAQs *VA Connected Care also provides an internal communication toolkit for staff to promote the app Thank you. Key Points Ask: Veterans deserve access to comprehensive pharmacy services to help promote full participation in the successful management of their medication treatment plans A Pharmacist: The most accessible healthcare profession will participate and promote multidisciplinary team based care via their Pharmacist On My HealtheVet and VA Mobile Health: The most patient friendly platforms in the VA which promote internal sites and services while reducing patients waiting on the phone or at the pharmacy window Answers To Self-Assessment Questions According to 2011 USPHS Report to USSG: Pharmacists are uniquely positioned(through their accessibility, expertise and experience) to play a much larger patient care role in the U.S. health care delivery system A significant contribution to health reform by the pharmacy profession may be to increase access to patient care services, Pharmacists are the most accessible health care professionals in the United States and have always been one of the most trusted professions. Communication fosters Trust Trust fosters Communication Eric Spahn, Pharm D, VHA Pharmacy Benefits Management Eric.Spahn@va.gov 7

8 Self-Assessment Questions SharePoint Rx Checkout Desk Major Jin Kim USAF What is the most common issue when using the Rx Checkout Desk? A) Increased patient wait time B) Patient dissatisfaction C) Patient checking in prematurely at the pharmacy D) All of the above E) None of the above Overview Introduction Introduction Requirements Process Lessons Learned Conclusion What is Rx Checkout Desk? A tool to expedite patient check in process at the pharmacy How is it done? Patient checks out at the reception desk at any of the clinics within MTF What is the impact? Patient wait time reduction Requirements Process SharePoint Leadership Approval/Support Training Communication Clinic Resources Pharmacy Resources SharePoint Expert Rx Checkout Desk is a Microsoft Access database Data can be entered by Tabbing from 1 column to the next OR Clicking on the New tab generates a fillable form 8

9 Process Process Step 1: DoD ID Step 2: DoB of patient Step 3: Patient s cell phone number Step 4: Number of prescriptions Source: Process Process Step 5: Priority Step 6: Clinic Step 7 (optional): Clinic comments Using Add New Entry Function Lessons Learned Conclusion Patient shows up early Ensure clinic staff monitor projected wait time before directing patients to pharmacy Other common error types No new Rx Incorrect/incomplete DoD ID DoD/DoB mismatch Rx too soon Wrong site Requirements Process Lessons Learned 9

10 Key Points Answers To Self-Assessment Questions Rx Checkout Desk is a valuable tool that streamlines patient check in process What is the most common issue when using the Rx Checkout Desk? A) Increased patient wait time B) Patient dissatisfaction C) Patient checking in prematurely at the pharmacy D) All of the above E) None of the above Closing Remarks Maj Jin H. Kim USAF Jin.h.kim40.mil@mail.mil Non-Sterile Compounding Documentation using MS Excel Dave Andersen Staff Pharmacist, Palmetto Health-Tuomey Overview Self Assessment Questions Discuss the use of MS-Excel workbooks to satisfy the requirements of USP-795 (Revision Bulletin, January 1, 2014) Explain how this documentation will lead to better patient care and outcomes 1. How does using a software solution for documentation improve patient care? 2. How does this software solution provide a means for sharing formulas? 10

11 Why?? Why?? USP 795 now not only applies to hospital and institutional pharmacies, but it s rules and definitions are being applied to all pharmacies governed by the South Carolina State Board of Pharmacy. The requirements ensure greater continuity and quality of product to our patients. Consistent Beyond Use Dates (BUD) Complete and consistent directions for compounding Literature citations for stability data, required equipment, etc. Ability to document post-compounding quality control issues USP 795 now not only applies to hospital and institutional pharmacies, but it s rules and definitions are being applied to all pharmacies governed by the South Carolina State Board of Pharmacy. The requirements ensure greater continuity and quality of product to our patients. Consistent Beyond Use Dates (BUD) Complete and consistent directions for compounding Literature citations for stability data, required equipment, etc. Ability to document post-compounding quality control issues How How The technician (or preparing pharmacist) will gather all ingredients Create an assigned control (Local Lot) number Document Mfg, Lot #, Exp Date, Qty of each ingredient Use stability information plus ingredient expirations to calculate Beyond Use Dating (BUD) Print directions and labels to prepare product Pharmacist checks the product, documentation, and performs any QC procedures required Digitally performs final check in workbook, creating the readily retrievable final report (Compounding Record). Attaches sample label to the report Ensures preparer and final check pharmacist have signed report Pharmacist will document and QC problems or adverse reactions as required Sharing Master Formulation Records Master formulation records may be exported to other facilities These records may then be imported into these Excel workbooks for later use Excellent documentation will lessen the pain of outside inspection USP-795 Documentation What are documentation requirements of USP-795 Master Formulation Record Assigned name, strength and dosage form Calculation required Ingredients and quantities Compatibility/Stability Information Equipment required 11

12 USP-795 Documentation USP-795 Documentation What are documentation requirements of USP-795 Master Formulation Record (cont) Mixing instructions Sample Label Container used Packaging and storage requirements Description of final product QC procedures What are documentation requirements of USP-795 Compounding Record Same information as in Master Formulation Plus: Master formulation referenced Sources, lot # s and expiration dates of components Beyond Use Date (from stability information) Name of persons who prepared, checked, and performed QC Duplicate label Results of any QC issues and adverse reactions USP-795 Documentation Software Availability What are labeling requirements of USP-795 Generic name and quantity or concentration of each active ingredient Assigned BUD Storage and packaging requirements Prescription or control number Along with other legally required information These workbooks are available at no charge on my personal website Other Master Formulas as completed will be available for download and importing. PDF manual, sample reports and labels, and a competency assessment form (MS Word format) available in the total download package or available as single file download Key Points Answers To Self-Assessment Questions Documentation has always been required of our compounded products. Documentation was not always legible, easily retrievable, or even accurate Using a software solution ensures that all required elements are documented correctly and legibly A software solution provides an efficient means for sharing compound formulas with sister organizations. 1. How does using a software solution for documentation improve patient care? Creates a Master Formulation Record that includes all required elements of USP-795 s requirements Ensures consistent product through concise instructions Provides method for QC and ADR documentation from user or caregiver Ensures accurate labeling and BUD calculations 12

13 Answers To Self-Assessment Questions 2. How does this software solution provide a means for sharing formulas Provides a means to export formulas to other facilities Provides a means to import these formulas for use in the receiving facility Closing Remarks Dave Andersen Staff Pharmacist Palmetto Health Tuomey andersendav@gmail.com 13