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I've been thinking about dry cleaners, prophets, Goofy, and sushi.
In the majority of U.S. hospitals, pharmacy personnel walk about hunting and
gathering medications to fill patient cassettes and fulfill
automated-dispensing cabinet (ADC) replenishment orders. Nearly 400 hospitals
have handed over cassette-fill to fully automated bar-code-literate robotics.
Between all-hands-on-deck and hands-free paradigms, around 800 hospitals have
brought in semi-automated carousels to assist technicians with ADC
replenishment and, in some cases, with patient-cassette fill, if not
first-dose picks.
The concept is similar to overhead conveyors dry cleaners have employed since
I was a kid. Clerks enter claim-check numbers on simple keypads (mine scans
their bar codes), then take payments and make change while pressed suits and
starched shirts wind their way to the point of sale. One could argue its roots
are religious: If the prophet will not go to the mountain, the mountain
must come to the prophet.
Disney employs similar storage-and-retrieval technology for issuing tens of
thousands of costume pieces each day to cast members at theme parks. Goofy
boys and pretty girls clock-in by scanning their ID badges, which activates
automated place-and-pick-to-light carousels that fetch floppy-eared dog heads
and blue-and-white dresses -- all while soon-to-be Goofy and Snow White are
making their way to costume pickup windows at dressing facilities. These
techno-gophers have saved the Mouse millions in labor costs.
Consider how carousels serve hospital pharmacies. Clerks scan bar-coded drug
products as they arrive in the pharmacy, triggering carousel rotation.
Software ensures that appropriate shelves appear, and lights direct
technicians to the correct bins. Before drugs are actually placed, bar codes
on bins are scanned for a match. For new formulary items, software
automatically locates and assigns empty storage bins, remembering where the
drugs are when they are needed.
When retrieving medications, operators scan bar codes on patient cassettes or
automated-dispensing cabinet order sheets. The correct shelves arrive, and
lights again direct operators to the right bins, preventing medication errors
upstream before they reach patients. It's not as sophisticated as the daVinci
robotics in OR, but it gets the job done more efficiently than
sneaker-retrieval and less expensively than shoeless robots.
While carousels enable
positive-product ID, they also result in positive-user experiences. Say
good-bye to multiple-alphabet inventories scattered about mazes of shelving.
Oh, darn. Staff members' feet and backs are spared for not having to endlessly
gopher this and bend for that. Thank you. Oh, and while we are talking about
feet, by using air rights in the pharmacy (carousels can extend 12 feet from
ground up through ceiling tiles), the footprint required for drug inventory
shrinks, making space for other activities. This is to say nothing of the
money saved from auto-tracing and tracking products through the supply chain.
After tucking this Thinking to bed, I headed out to Blue C Sushi --
"goodness in motion"-- where sushi-to-me conveyors reduce the number of
servers required, speed up table turns, and best of all, present a parade of
options for immediate consumption. The supply-chain benefits are also
impressive. Auto readers crunch the data residing in reprogrammable,
dishwasher-safe RFID chips embedded in the passing plates. Computer screens
prompt chefs to produce more California rolls, order more tuna, or remove
mackerel that's been on the belt past "beyond use" time stamping--much like
the inventory-management benefits medication carousels achieve with bar codes.
Though she said nothing of prophets or mountains, one pharmacy director who
believed and implemented pick-to-light carousels said the transformation
achieved in her pharmacy was a near-religious experience. Sort of like my
sushi lunch.
What do you think?
Mark Neuenschwander a.k.a. Noosh
mark@hospitalrx.com
http://twitter.com/hospitalrx
Now for some news...
- On-Demand Webinar - Pharmacy Face-Off: BCMA vs. CPOE, Which Comes First?
Pharmacy OneSource hosted a free webinar debate on September 23rd. John Poikonen took on Steven Rough in the first
"pharmacy face-off." These pharmacists debated on Bar Code Medication
Administration or Computerized Physician Order Entry and which should be
implemented first. Who won?
View the on-demand
webinar.
- Blumenthal Sends Open E-Mail Updating Public on 'Meaningful Use'
In an
open e-mail, National Coordinator for Health IT David Blumenthal calls
for health care providers to familiarize themselves with current "meaningful
use" recommendations and begin moving toward EHR adoption.
- Talyst and RXinnovate Partner on Pharmacy Automation Implementation
Talyst, announced a partnership with RXinnovate, a healthcare consultancy,
to offer implementation services to Talyst's clients in the acute care
industry. Source:
StreetInsider.com
- New Orleans Health System Rolls Out Anesthesia IT
The Ochsner Health System, goes live with Docusys anesthesia information and
drug management system at 41 locations. The system provides physician
advanced decision support for the documentation of national quality measures
and incorporates bar-code scanning of anesthesia drugs and advanced narcotic
tracking. Source:
Healthcare IT News, September 15, 2009
- Hill Country Memorial Hospital Stands Out With Medicine Verification
Launch
Hill Country Memorial Hospital (Fredericksburg, TX) implements Bedside
Medication Verification (BMV) system. Source:
Mason County
News, September 2, 2009
- Requirements for Radio Frequency Identification in Healthcare
This paper is a part of the research project MaISSI (Managing IT Services
and Service Implementation) where the aim is to implement an automated
identification system (AIMC) for our case hospital's medication care. The
AIMC uses the RFID technology for patient identification and the bar code
technology for medication identification. Source:
Stud Health Technol
Inform. 2009;150:720-4.
- Enhancing Transfusion Safety with an Innovative Bar-Code-Based
Tracking System
In an effort to reduce transfusion errors, a bar-code-based tracking system
for matching patients, blood samples and blood products was created and
deployed at a major academic medical centre. The researcher estimate that
the system is 10 times safer than the manual system previously employed at
the institution and may be 15-20 times safer than most systems employed in
the United States. Source:
Ryan W. Askeland, Steve P. McGrane, Dan R. Reifert and John D. Kemp
Healthcare Quarterly, 12(Sp) 2009: 85-89
- Two Suits Filed Against Fertilization Center
At least two class-action law suits have been filed against a suburban New
Orleans hospital that has suspended operations at its fertilization center
claiming label mix-ups from in vitro fertilization. Source:
Tri-Parish Times,
September 27, 2009
- New Tag System to Avoid IVF Error in Liverpool Hospital
A new 'tagging' system to help prevent mix ups with IVF babies is being
introduced at a Liverpool hospital. An electronic system which can identify
and track a couple's sperm and eggs throughout the process of IVF will be
available at Liverpool Women's Hospital as part of a 5.5 million pounds
expansion to its Hewitt Centre for Reproductive Medicine. Source:
The London Evening Standard
- Indiana Hospital and Doctor Sued Over Patient's '02 Death
A man serving as personal representative for his late father's estate is
suing Parkview Hospital after he says a nurse administered an incorrect drug
to his father in 2002 that allegedly ignited an ultimately fatal brain
hemorrhage. Source:
Fort Wayne News Sentinel, September 17, 2009
- UK Doctor "Bitterly Regrets" Giving Painkiller Overdose
A UK doctor gave a patient six times the correct dose of a painkiller. Dr.
Michael Stevenson, "As far as I can remember, I saw 5mg. How I came to do
that I cannot say. It may be that I was expecting to see that figure.
Clearly I bitterly regret the error." The patient died. Source:
UK Times & Star, September 3, 2009
- VeriChip Acquires The Steal Vault Corporation to form PositiveID
Corporation
VeriChip
Corporation, a provider of RFID systems for healthcare and
patient-related needs, announced that it has agreed to acquire The Steel
Vault Corporation, a provider of identity security products and services and
will form PositiveID Corporation to offer identification tools and
technologies for consumers and businesses.
- The Hong Kong Hospital Authority to Scanning to Avoid Medical
Blunders
The authority is also set to adopt advanced technology such as 2D barcode to
reduce human error in patient identification and the handling of blood
specimen. Officials also plan to explore radio- frequency identification on
corpses. Source:
The Standard
- Physicians Sometimes Overlook Electronic Alerts, Study Finds
Physicians who receive electronic alerts about abnormal test results fail to
follow up with patients in nearly 8% of cases,
according to a study published in the Archives of Internal Medicine.
Source:
ihealthbeat.org
- Some Health IT Vendors Offer 'Meaningful Use' Compliance Guarantees
Although the federal government has yet to issue a final definition for the
"meaningful use" of electronic health records, several health IT vendors are
offering guarantees that their products will meet the requirements. Source:
Modern Healthcare
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