Cabinet, you can improve your overall inventory management, patient safety, and medication security. Of further benefit to your patient safety bottom line, automated dispensing cabinets allow the pharmacy department to profile physician orders before they are dispensed. Automated cabinets can also enable providers to capture medication charges. Omnicell XT Automated Medication Dispensing Cabinet Choices. No other medication dispensing system offers more cabinet choices to meet the needs of acute and non-acute care sites. Medications and supplies can be combined in a single cabinet, adding convenience and saving space. Drawers can easily be added or changed on-site as clinical needs change.
- Omnicell Drug Dispensing System
- Omnicell Cabinet Troubleshooting
- Omnicell Cabinet Manual
- Omnicell Cabinets Prices
Creating a user manual in word 2013. An area of great progress in Healthcare technology has been the wide adoption of automated dispensing cabinets for medications and supplies in hospitals and other healthcare facilities. This technology employs the use of storage units that operate somewhat like vending machines for the medical products, but also have sophisticated software on the back-end that handles patient orders, medication dosing documentation, inventory management, and billing transactions. This post will cover automated dispensing cabinets as well as centralized pharmacy automation products.
Medication Dispensing Systems
In a hospital or other clinical setting, the units are installed at most units where patients are seen, such as General Medicine, ICU, the OR, and the ER. Supplies and/or meds are enclosed in the cabinets that are locked until the clinician accesses them. Here are the typical steps taken for a medication transaction:
- Physician enters an order for a medication in an electronic medical records (EMR) system
- The order is transmitted electronically to a server that manages communication to all of the dispensing cabinets
- Because the dispensing system gets patient information from the hospital’s registration system, it knows where all the patients are located
- The order is routed to the correct dispensing cabinet on the nursing floor
- A clinician such as a nurse goes to the dispensing cabinet:
– User logs into the cabinet with either a badge reader or fingerprint scanner. Older versions required a User ID and password typed in
– User selects the correct patient name
– User selects the order for the medication
– The correct drawer or door on the cabinet opens, giving them access to the medication
– When done, the user closes the drawers or doors on the dispensing cabinet and logs off - They will then administer the med to the patient. At this point, they may use a barcode reader at the bedside to scan the med and the ID bracelet of the patient to ensure they have the right med and patient
- An administration message will transmit back to the server, and then back to the EMR, showing a complete administration
- Another transaction will probably be created by the EMR to generate a charge for the med.
- Yet another transaction is generated for the pharmacy or Central Supply department that decrements the amount on hand in the cabinet. That count will be calculated toward a refill report to replenish the cabinet with supplies and meds.
A physician order is not required for some medical supplies, so when those are dispensed, the user just logs into the cabinet, then selects the patient and supplies. Also, some supplies are tracked under “floor stock” because they are general use supplies.
Automated Dispensing Cabinets Manufacturers
When looking at this market, we should consider that there are several product lines, including:
- Medication dispensing, administration, and management
- Supply distribution and management
- Cath Lab supplies
- Anesthesia carts
- Health Data Analytics
Manual download s1720 sharper image. For purposes of this article, I’ll focus mostly on the medication and supply management products.
Pyxis Corporation
The market leader for automated medication management is Pyxis Corp, based in San Diego. They were fortunate to be the first to the game with their MedStation products in 1990. They wasted no time in penetrating the hospital market with their first generation MedStations, and many hospitals have remained loyal and grown along with Pyxis. In the mid-1990s, Pyxis launched their SupplyStation line to manage the medical supply chain. This technology was initially built as an extension of their medication products, but was not nearly as successful, as supplies shouldn’t really be managed like medications. In 1996, Pyxis was acquired by Cardinal Health. Their growth continued, and they maintained between 60-70% of the market share for pharmacy dispensing systems that continues to now. In 2009, Cardial spun off clinical and medical product divisions, including Pyxis to form CareFusion. Then CareFusion was sold to Becton Dickinson in October 2014. In spite of the multiple buyouts, Pyxis has managed to stay fairly strong in the market.
Omnicell
Randall Lipps had a child who was hospitalized at birth. As he kept vigil at the hospital, he noted the inefficiencies of the medical supply process. Taking input from nurses, and using his technical and operational background, he formed Omnicell in 1992. The first product line was the OmniSupplier cabinets. While the early Pyxis SupplyStations secured supplies as if they were medications, Omnicell saw that supplies needed a different workflow. The OmniSuppliers had clear Plexiglass-like panels on most sides, making it easier to see supplies. They also made it faster to get in, get supplies, and log out, and used a patented “guiding lights” technology to help users locate supplies in the cabinets.
While Omnicell began in the supply management side, they did not get into medication dispensing systems until 1996. Like Pyxis, they have launched or acquired other pharmacy automation products, such as anesthesia carts and central pharmacy systems. They have also acquired a healthcare analytics solution called Pandora, MACH4 Pharma Systems of Germany. Their newest acquisition was the AcuDose products in January 2016. Of the three largest vendors in this industry, they are the only one to retain their original corporate structure. Disclosure: I worked for Omnicell from 1995-1999.
AcuDose
AcuDose is the third largest pharmacy automation product line. They were originally formed as Automated Prescription Systems, Inc. of Pineville, La, and were acquired by McKesson in 1998. McKesson then sold off the business to Aesynt in 2013. Then they were sold yet again to Omnicell in January 2016. Their dispensing units have been recently redesigned, and offer a feature that allows nurses to hold their place in the workflow if they get interrupted and have to come back later. When the user logs back in, the system remembers where they left off. AcuDose also has the ROBOT-Rx central pharmacy automation product, which is covered in the next section.
Cerner RxStation
A newcomer that could actually turn out to be a game-changer is the RxStation system from Cerner. Cerner is one of the largest providers of enterprise EMR and clinical documentation software. What sets RxStation apart from the others is that it was developed by a major software vendor, built as an integrated solution on top of an existing product. Cerner claims that no interfaces are needed, as the dispensing cabinets are integrated with the Millennium products.
Capsa Healthcare
Capsa Healthcare is an Oregon based provider of automated medication carts, computing workstations, and pharmacy automation. Capsa proposes to have the best security for managing controlled medications, STAT/first doses and e-kits. Their hardware supports medications in a variety of packaging, from unit dose to punch cards and bulk supplies. They also have two robotic centralized pharmacy packaging machines.
Automated Dispensing Cabinets Workflow
Here is a diagram that covers many of the functions that occur in the course of operating automated medication dispensing units.
Pharmacy Automation
I’m going to switch gears from the point-of-care units to cover centralized pharmacy automation. This is a technology solution used in retail as well as hospitals and regional pharmacies that serve nursing homes and other long term care locations. Whereas the dispensing cabinets are used for Stat meds and orders written at the point of care, the centralized units are for longer term med orders. The units tend to be large, covering a good portion of the floor in a central pharmacy. They run continuously, creating packaged units of meds per patient, complete with a barcode dosing label and instructions. The packages then get delivered to the correct nursing unit or facility. They have the advantage of helping to manage large quantities of medications, and perform conflict and allergy checking.
Unlike the medication dispensing cabinets, the market of central pharmacy robots is more crowded. Some of the other suppliers of this technology are AmerisourceBergen, Dossette, and RxSafe.
Automated Dispensing Cabinets Comparison
Company | Pros | Cons |
Pyxis | First to market, loyal customer base, deep operational knowledge, strongest in medication systems | Weaker in supply management products |
Omnicell | Advanced technical expertise, Guided Lights feature, broad integrated product line, original corporate structure remains | Relatively low medication systems market share |
AcuDose | Products recently re-engineered, “hold my place” feature, strong ROBOT-Rx product | Before being acquired by Omnicell, they were a distant third in market share. Not an issue now |
Capsa | Claims to be more affordable than the larger ADC providers | Not a broad offering of products |
Pharmacy Automation Benefits
When medication and supply dispensing cabinets first became popular, Healthcare facilities were very focused on hard dollar savings, which is not a bad thing. It did take some time for organizations to learn how the use the systems to their greatest capacity and also recognize the soft savings in terms of user productivity. Some of the benefits that have emerged are:
- Increased charge capture
- Lower inventory costs
- Reduction of stock-outs
- Increased patient safety via bar code verification
- Increased satisfaction of users from more organized inventory
Here are some case study numbers for the top three vendors:
- CHRISTUS Spohn Health System saw a 62.5% reduction in the medication pick process using Pyxis automation
- South Jersey Healthcare System lowered medication distribution Time by 85% using Omnicell systems
- Peninsula Regional Medical Center reported less training time and reduced impact of interruptions using AcuDose systems
Pharmacy Automation Jobs
Because this is where I got my start in Healthcare IT, I do have a special appreciation for this career choice. If you are looking to get started in Healthcare IT, have basic technology skills, and are willing to travel, you have a decent chance of getting a job as an Implementation Consultant or Field Engineer. Having some Microsoft or Network+ certification helps, as well as having a pharmacy tech background. If you have programming and/or HL7 experience, then you would have a good chance at a developer position.
Next Up:
In 1994, a nurse at Colmery-O'Neil Veterans Affairs Medical Center in Topeka, Kansas had an epiphany. She realized that the ubiquitous use of barcode scanning in other industries might be able to help with the administration of medications in a clinical setting. The backdrop for ..
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Automated Dispensing Cabinets | Pharmacy Automation
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Automated Dispensing Cabinets and Pharmacy Automation. Learn about Pyxis, Omnicell, AcuDose, Capsa, and ROBOT-Rx systems used in hospitals and retail pharmacies.
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Automated dispensing cabinets (ADCs) were introduced in hospitals in the late 1980s. These decentralized medication-distribution systems provide computer-controlled storage, dispensing, and tracking of drugs at the point of care in patient-care units. Although adoption of the technology started slowly, as of 2008, more than 80% of hospitals were using ADCs to replace manual floor stock systems or medication carts that had previously held a 24-hour supply of drugs in individual patient cassettes.
BENEFITS OF AUTOMATIC DISPENSING CABINETS
ADCs offer a variety of benefits to organizations and users:
- Nurses have increased access to drugs in patient-care areas and can facilitate administration in a timely way.
- The medications are locked up in patient-care units, and controlled substances and other drugs are electronically tracked.
- The stocking and distribution of medications are tracked to improve inventory control.
- When ADCs are interfaced with the pharmacy computer, they support the clinical review of medication orders by a pharmacist before administration.
- ADCs can be interfaced with other external databases, such as the facility’s admission/discharge/transfer system and billing systems; as a result, the efficiency of drug dispensing and billing is enhanced.
- ADCs can be interfaced with barcode technology to automate the restocking process and to track dispensing of medications.
- If ADCs are linked to point-of-care bar-coding systems, an electronic match between the prescribed and selected medication is ensured.
WHAT THE RESEARCH SHOWS
On the basis of these benefits, ADCs have been recommended as a potential way to increase efficiency and reduce medication errors. A small body of evidence has been published regarding the impact of this technology on error rates. In 2003, Oren et al. published a meta-analysis that identified only seven controlled studies linking ADCs with medication-error rates or other secondary endpoints. In general, after ADCs were implemented, these studies identified:
- lower rates of dispensing errors in filling ADCs compared with manual filling of traditional unit-dose cassettes.,
- fewer errors in drug administration (mostly drugs given at the wrong time) and fewer missing doses.,
- fewer drug-administration errors in a cardiovascular surgery unit but more errors in an intensive-care unit (ICU).
- an increase in errors (by more than 30%) in six of seven nursing units evaluated.
Except for wrong-time errors, these studies showed mixed results for reducing drug-administration errors with ADCs. Similar results were noted in a government-funded compilation of evidence related to ADCs. However, many of these studies had been conducted before important software and hardware enhancements were available, such as interfaces between ADCs and pharmacy computers and cabinets with individually lidded compartments. Although few studies clearly link the design and use of ADCs to the error rates, error-reporting programs have uncovered several factors that can affect the ability of ADCs to reduce medication errors.
FACTORS THAT INFLUENCE SAFETY
ADCs do not improve safety unless the cabinet’s design and use are planned with attention to the following factors:
Patient Profiling. If the ADC is linked to the pharmacy computer, a pharmacist can review each new medication order and screen it for safety before the drug can be removed from the cabinet. Without this feature, nurses might not be alerted to unsafe doses, potential allergic reactions, duplicate therapy, contraindications, drug interactions, or other important drug information. An example that was reported to the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program (MERP) follows.
A patient died after receiving 10 mg of intravenous (IV) colchicine. The physician had prescribed “colchicine 1.0 mg IV now,” but the decimal point was hardly visible. This flaw and the use of a trailing zero led the nurse to believe that the dose was “10 mg.” If a pharmacist had prescreened the order, the nurse would have been instructed to remove 1 ampule of colchicine (1 mg) to administer the dose. However, the patient was affected by the error because the ADC was not profiled to the pharmacy computer and there was an excessive quantity of colchicine in storage (10 1-mg ampules). Thus, these conditions made it easy for the nurse to remove enough ampules to administer the fatal dose.
Overrides. Even when patient profiling is used, this feature is sometimes overridden to allow the removal of drugs in an emergency. However, the misuse of overrides has resulted in errors, as in the following example:10
A physician prescribed Zosyn (piperacillin/tazobactam) for a patient. The first dose was given in the emergency department, and a second dose was given on the medical unit. Both doses were retrieved from an ADC before the pharmacy review. However, when the pharmacy reviewed the order, it was noted that the patient had a documented allergy to penicillin. Fortunately, the patient did not experience a serious allergic reaction.10
Overrides are not the only examples of work-arounds used to access medications from ADCs. Other types of work-arounds include the use of the “inventory” function (which is designed to determine the current number of doses of a particular medication on hand); gaining access to medications for patients before pharmacy screening; removing a larger quantity of drugs than that ordered for one patient; and removing medications for more than one patient while the cabinet is open.
Omnicell Drug Dispensing System
Insufficient number and wrong placement of ADCs. If the number of ADCs on the medical unit is insufficient, nurses might remove doses ahead of time because of limited access during busy drug-administration times. Placement of an ADC in areas with high traffic or low illumination can also lead to distractions and to the misreading of screens or labels.
Look-alike drug names on the screen. Choosing the wrong drug from an alphabetical list of choices may also contribute to errors arising from look-alike drug names. An example from the MERP follows:
One hospital reported several mixups between injectable diazepam (Valium) and diltiazem (Cardizem) when the drugs were removed from an ADC in the ICU. In each case, the nurse incorrectly chose diazepam on the screen, which was listed directly above the intended product, diltiazem. In one case, diazepam was given at the prescribed dose for diltiazem. In another case, the error was discovered before the patient was affected when a physician noticed the amber-colored vial and the product label was rechecked. The nurses in these cases thought that they had removed the correct product from the ADC. Thus, they failed to inspect the product label carefully, missing opportunities to catch the original selection error.
Excessive quantities of drugs. ADCs that contain a wide assortment of or an excessive quantity of medications can also increase the risk of errors, as in the colchicine incident described earlier, especially if the ADCs are not profiled to the pharmacy computer. The following example from the MERP shows how a carefully limited stock in the ADC can offer a safety net:
After the pharmacy was closed, an order was written for “1 gram calcium gluconate IV.” Each 10-mL vial contains 1 g of calcium gluconate, which is equivalent to 93 mg of elemental calcium. The nurse misunderstood this information on the label and thought she needed about 10 or 11 vials to prepare the 1-g dose. Fortunately, the ADC contained only six vials. The 10-fold error was discovered and averted when the nurse contacted a pharmacist about the need for additional vials.
Stocking procedures. Stocking medications in ADCs is primarily a pharmacy function, although nurses sometimes return unused doses to the ADC. However, this is an error-prone practice that the ISMP does not endorse. Cabinets that do not have bar-coding technology rely on a double-check system before medications leave the pharmacy. This process is vulnerable to errors because rarely is any system used to verify that the correct drug has been placed in the correct drawer. Examples submitted to the ISMP and to the Pennsylvania Patient Safety Authority involved erroneous stocking of the following drugs or strengths, many with look-alike drug names or packaging:
- Nubain (nalbuphine) was placed in an adjacent drawer intended for Buprenex (buprenorphine)
- Fioricet (acetaminophen, butalbital, caffeine) was placed in a drawer intended for Fiorinal (aspirin, caffeine, butalbital)
- HYDROmorphone 4-mg syringes were placed in a drawer intended for morphine 4-mg syringes.
- tiZANidine (ZANAflex) was placed in the compartment intended for tiaGABine (Gabitril). Samsung wb100 manual download.
- A Carpuject syringe of digoxin was placed in a drawer intended for ketorolac (Toradol).
![Omnicell Automated Dispensing Cabinet User Manual Omnicell Automated Dispensing Cabinet User Manual](/uploads/1/3/3/2/133280270/158263876.png)
Storing medications with look-alike names or packaging next to each other in the same drawer or bin can also cause stocking and retrieval errors, particularly during emergencies, when the patient profiling system is bypassed. An example of this type of error was reported to the Pennsylvania Patient Safety Authority:
During a cardiac catheterization, a nurse received a verbal order for IV Lopressor (metoprolol). She accidentally removed Levophed (norepinephrine) from the ADC, which was stored in a bin adjacent to Lopressor. The patient received the incorrect medication and needed treatment and observation during and after the procedure.10
Omnicell Cabinet Troubleshooting
SAFETY PRACTICE RECOMMENDATIONS
Before ADCs were available, technicians prepared doses, pharmacists checked their work, and the medications were dispensed to patient-care units in carts or were placed in nurse servers. Nurses then acted as a final independent check of the dispensed medications.
Omnicell Cabinet Manual
With ADCs, if medications are stocked and removed without bar coding, the same level of redundant checking systems no longer exists, even when the pharmacist verifies the medication order before the nurse can access the medication. Therefore, it is crucial to use ADC systems with minimal bypasses so that safety is on par with other methods of dispensing unit-dose medications, such as robotic dispensing or manual cart fills, which include several built-in redundancies.
Omnicell Cabinets Prices
In 2007, the ISMP convened a national forum of stakeholders to develop interdisciplinary guidelines for promoting safe practices for the use of ADC technology. The guidelines were finalized in March 2008.11
The immediate implementation of all elements in the guidelines is an ambitious goal. Even now, many steps can be taken to improve safety associated with ADCs. The guidelines are meant to support organizations and vendors in making decisions about resource and strategic planning as well as in facilitating ongoing safety enhancements.
The ISMP also produced a self-assessment for ADC technology, which is available free to all health care providers.12 The ISMP encourages all organizations that use ADCs to form interdisciplinary teams to review the guidelines and complete the self-assessment to maximize safety.
Footnotes
The reports described in this column were received through the ISMP Medication Errors Reporting Program (MERP). Errors, close calls, or hazardous conditions may be reported on the ISMP Web site (www.ismp.org) or communicated directly to ISMP by calling 1-800-FAIL-SAFE or via e-mail at gro.pmsi@ofnipmsi.
REFERENCES
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