I’ve been at the ASHP Summer Meeting in Denver this week roaming the exhibit hall looking for interesting new products. One product that caught my attention was TraySafe by Aethon.

TraySafe is a medication tray management system. There are several such systems currently on the market, but what makes TraySafe different is its approach to the replenishment process. The system utilizes a combination of photo recognition and barcode scanning to analyze tray content and notify the user of items that are missing, in the wrong location, or about to expire.

TraySafe uses:

• 2D barcodes to manage and track tray inventory. This allows Aethon to embed several pieces of data in the barcode, such as lot number, expiration date, NDC number, and serialized identification; which allows the system to identify one epinephrine syringe from another, for example.
• 2D barcodes to manage and track each individual tray.
• Photo recognition. According to a company representative TraySafe snaps a 64MP photo of the tray and its contents when placed in the scanning station. The system then scans the photo looking for item location as well as item barcodes.
• Medication tray templates. Templates are built by the user to identify product quantity and location, i.e. 3 vials of epinephrine 1mg/mL – 30mL. Everyone is familiar with this concept as each medication tray type has its own layout and is content specific, i.e. an adult crash cart tray is different than an L&D anesthesia tray, which is different than a pediatric intubation kit, and so on.

Workflow:

1. Trays are placed in the TraySafe scanning station and scanned.
2. TraySafe images the tray and scans the unique 2D barcode on the tray for identification. This appears as a blue dot in the bottom left corner image below.
3. TraySafe analyzes the tray contents via barcode scan and notifies the user when items are missing, in the wrong location, or about to expire. As the system scans the contents, small green dots appear on the screen over each item. Items identified as correct are identified with a green dot. Items that are identified as incorrect – wrong location, wrong drug, ready to expire – receive a red dot. Pretty simple, but clearly visible to the user. See image below.

4. Once the scan is complete, TraySafe displays a secondary image of the tray layout showing pockets where there was a problem, i.e. where there was a “red dotted” item. See image below.

5. The user makes corrections and rescans the tray. Once the contents of the tray are deemed 100% accurate, the user prints a report and the tray is ready to go.

Overall, the TraySafe system is intriguing. Aethon has taken a different approach to the process, and while it’s not perfect – I can see potential holes in the process – it’ll be interesting to see how it plays out over the next few months.

Data surrounds us. We’re deluged by it in every facet of our lives, from the bank statements we receive in our personal life to the mountains of data collected in healthcare. Regardless of the data collected, there are basically three things that can be done with the information. It can be ignored, archived, or used. Unfortunately only one of those three things is truly meaningful, using it.

Many, especially in pharmacy, chose to ignore or archive data rather than use it. That’s not because the information isn’t valuable, but rather because they are overwhelmed with the amount of information they receive and simply have no idea what to do with it. Throw in the fact that the more data we collect, the more useful it becomes, and things get weird. Seems counterintuitive, but data collected from a single source, say one pharmacy i.v. room, offers little value.

Single source data creates several problems, such as potential bias, the inability to find trends that may be available in larger data sets, and failure to create usable comparisons to others that may offer insight into improved operations. Only when data is collected from several different sources does one truly begin to understand its value.

While this may sound daunting to many in my profession, it’s the simple truth of living in an era where big data is king. However, the bright side of living in the era of big data is that others have spent time creating methods for aggregating, mining, analyzing, and displaying vast amounts of information in a meaningful manner. And lest we forget that we live in the computer age, which gives us the ability to manage large amounts of data from disparate sources to create detailed composites.

For the most part, pharmacy has failed to realize the benefits of mass data collection from different sources, which is why I was so interested when I saw a demo for REINVENT by Aesysnt while roaming the exhibit hall at the ASHP Summer Meeting.

In a nutshell, Aesynt REINVENT is a tool that pulls in data from i.v.STATION customers that “opt in”. The data is scrubbed for personal health information, aggregated, mined, analyzed, and presented back to the user in a host of great visuals. Data such as production efficiency (number of doses, average prep time, etc), doses by user, preparation accuracy, etc. is presented to the user in a comparative manner, i.e. you get to see what your numbers look like compared to other (anonymous) hospitals. The user has the ability to filter graphs, drill down deeper, build their own graphs and trendlines, and so on.

The system as shown was quite powerful. It’s difficult to explain the importance this approach offers pharmacies. Say, for example, that you’re using an i.v.STATION robot to prepare batches of oxytocin bags and your average production time is 2 minutes per bag with 95% efficiency, i.e. losing 5% of bags due to variance outside defined parameters. With REINVENT you have the ability to look at the same batch preparation of oxytocin bags across multiple hospitals and analyze their efficiency. You may note that there are hospitals producing oxytocin bags faster and more efficiently. And of course you ask yourself why? At this point all you have to do is drill down and start looking at the data details. Are they using a different preparation process? Are they using a different final container, or final solution? And so on. There’s a treasure of data to be found.

Currently Aesynt has 11 customers signed up for REINVENT, and they are looking to add more. Each time another hospital opts into the program, the data becomes more powerful. I’m hopeful that all hospitals using i.v.STATION will opt into the program; if I were using it, I would.

I’m excited to see where this goes and hope to catch up with Aesynt again at ASHP Midyear in December to see what kind of progress they’ve made.

You can read a bit more about the system in this press release from April.

Show notes:
Host: Jerry Fahrni

The two surveys discussed in the podcast are below:

Pedersen, C. A., P. J. Schneider, and D. J. Scheckelhoff. “ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration–2014.” American Journal of Health-System Pharmacy 72, no. 13 (July 1, 2015): 1119–37. doi:10.2146/ajhp150032.

On Monday I spoke briefly about two articles in AJHP that summarize two recent ASHP surveys. The first covers Pharmaccy Informatics in U.S. Hospitals(1), while the second focuses on pharmacy practice in acute care hospitals(2).

Both surveys contain a wealth of information, and provide a snapshot of what pharmacies in the U.S. are doing. While conducted at different times by different groups, I think it’s more interesting to look at the two surveys together. As I mentioned in my podcast, the adoption of automation and technology goes hand in hand with pharmacy operations. You can no longer have one without the other.

One of the most confusing things about the pharmacy practice survey is their use of a “design-based analysis” with weighted results. It created a bit of confusion for me, which makes me wonder how many others are in the same boat, or worse, didn’t pay close enough attention to notice.

Let me give you an example of my confusion. Below is an image showing hospital characteristics from each paper – informatics survey on the left, practice survey on the right. I’m not really a statistics kind of guy, so I’m having a lot of trouble wrapping my brain around this. The percentage of respondents from the informatics survey (left) add up to 98.1%. Taking into account rounding, etc, that makes sense to me. The percentages of survey respondents for the practice survey (right) add up to 209.4%. You have to dig into the text to understand what’s going on. “To account for the sampling method, weights were assigned to respondents to adjust their contribution to the population estimate.” Ok, what impact does that have on the results? I still don’t fully understand exactly what happened there.

Items that I thought were worth highlighting can be found in the table below. Some items are mature, such as BCMA and ADCs, while others are still relatively new, such as I.V. Workflow Management Software. The maturity of the technology is reflected in the adoption rates.  Something that is not seen in the table is the disparity between large and small hospitals. Both surveys show that hospital size plays a role in the adoption of technology, with larger hospitals adopting faster than their smaller siblings. It’s unclear why there’s such a disparity, but it may have something to do with budget size and/or available resources to manage projects. I’ve written about this in the past.

Two items that are worth noting are the adoption rates for ADCs and BCMA. Whether you agree with their use or not, both have become universally accepted as best practice.

Items of note:

1. ADCs are still the most common medication distribution method for hospital pharmacies. Practice survey showing 63.5 percent of hospitals decentralized with ADCs, while the informatics survey showed 79.2 percent. I find that even though a hospital says they’re “decentralized”, what they’re really saying is that they decentralize as much as they can. Not everything can be put in an ADC. The push for decentralization of medication distribution waxes and wanes over time. I’ve come across more than a few facilities in the past couple of years that are decreasing ADC use in favor of more direct control of the process.
2. Compounding robots still aren’t ready for primetime. The pharmacy practice survey shows a 2.9% adoption rate (0.3% for hazardous drugs), up from 2.5% (0.1%) in 2011. However, it’s unclear whether or not adoption increased or surveys simply landed in the hands of a few more pharmacies with compounding robots. I personally don’t think this area of pharmacy technology is expanding. In my opinion robotic technology hasn’t matured enough to become mainstream in pharmacy practice.
3. “The use of remote video supervision of pharmacy technicians’ i.v. preparation activities was used by 10.2% of hospitals.”(2). What the heck does that mean? Do pharmacists actually watch technicians prepare iv’s in real time? I would hate to think that that is a real thing.
4. According to the Informatics Survey(1), “66.9% did not have plans to acquire i.v. drug workflow systems”. I’m surprised and disappointed by that number. The iv room is the most dangerous place in the pharmacy. It’s also the most ignored when it comes to innovation for safety. It’s not likely to change until pharmacies are required to have some form of technology for CSP production. Unfortunately, the terrible truth is that regulatory requirements drive change in pharmacy.
5. I didn’t see anything on whether or not pharmacies were still using the pull-back method for CSP preparation. Would like to have that information. I know people still do it, and it’s one of the most dangerous practices in pharmacy.
6. Are there really acute care pharmacies in the U.S. that don’t use a computerized pharmacy information system (PhIS)? According to the informatics survey there are. The article reports that 5.1 percent of respondents didn’t use a computerized PhIS.(1) That’s insane. What do they use?
7. According to the Pharmacy Practice survey 65% of hospital pharmacies have a USP <797> compliant cleanroom.(2) That number is completely skewed by the larger hospitals, with more than 93% of the hospitals with more than 600 beds reporting compliance. I’m not surprised by this. It goes hand in hand with the adoption of technology, i.e. budgets and resources. I wonder what the smaller hospitals are using for CSP production? Probably using CAIs or CACIs.
8. It would be interesting to know which hospitals responded to both surveys. From my experience, people that respond to surveys will respond to multiple when given the opportunity, and those that don’t, won’t.

As previously stated, both surveys provide a wealth of information, and I would encourage everyone to go through in detail. If you can’t get access to the articles due to the paywall, just drop me a line and I’ll snail mail you my hard copies of the journals. That’s still allowed, right?

———————–

• Fox, B. I., C. A. Pedersen, and K. F. Gumpper. “ASHP National Survey on Informatics: Assessment of the Adoption and Use of Pharmacy Informatics in U.S. Hospitals–2013.” American Journal of Health-System Pharmacy72, no. 8 (April 15, 2015): 636–55. doi:10.2146/ajhp140274.
• Pedersen, C. A., P. J. Schneider, and D. J. Scheckelhoff. “ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration–2014.” American Journal of Health-System Pharmacy 72, no. 13 (July 1, 2015): 1119–37. doi:10.2146/ajhp150032.

Show notes:
Host: Jerry Fahrni

Robots discussed:
i.v.STATION by Aesynt
RIVA by Intelligent Hospital Systems (IHS)
INTELLIFILL I.V. by Baxter
APOTECAchemo® by Loccioni Group

Nothing. It says nothing, which leaves things open to interpretation. That’s bad.

Beyond use dating (BUD) in USP <797> is pretty straightforward, but there’s really no language in there describing stock bags.

Here are some things to think about. When performing routine compounding, USP <797> states that in the absence of sterility testing, the assigned BUD must not exceed the following:

Here’s USP <797>’s stance on single-dose containers: “Opened or needle-punctured single-dose containers, such as bags, bottles, syringes, and vials of sterile products and CSPs shall be used within 1 hour if opened in worse than ISO Class 5 air quality, and any remaining contents must be discarded. Single-dose vials exposed to ISO Class 5 or cleaner air may be used up to 6 hours after initial needle puncture. Opened single-dose ampuls shall not be stored for any time period. Multiple-dose containers (e.g., vials) are formulated for removal of portions on multiple occasions because they usually contain antimicrobial preservatives. The BUD after initially entering or opening (e.g., needle-punctured) multiple-dose containers is 28 days unless otherwise specified by the manufacturer.”

Is a stock bag a single dose container or something else? I vote for the latter. However, some state boards have taken to treating stock bags as single dose containers, forcing pharmacies to discard unused portions within 6 hours of compounding. Should a stock bag really be considered a single dose container? It’s an interesting question. Without being specifically addressed in writing, state boards can pretty much do as they please. It’s beyond me how the state board can interpret a stock bag differently from any other low-risk or medium-risk level CSP, but they are. At least that’s how things are in California at the moment.

Low-Risk Conditions—

1. The CSPs are compounded with aseptic manipulations entirely within ISO Class 5 or better air quality using only sterile ingredients, products, components, and devices.
2. The compounding involves only transfer, measuring, and mixing manipulations using not more than three commercially manufactured packages of sterile products and not more than two entries into any one sterile container or package (e.g., bag, vial) of sterile product or administration container/device to prepare the CSP.
3. Manipulations are limited to aseptically opening ampuls, penetrating disinfected stoppers on vials with sterile needles and syringes, and transferring sterile liquids in sterile syringes to sterile administration devices, package containers of other sterile products, and containers for storage and dispensing.

I suppose one could argue that low-risk compounding is limited to “not more than two entries into any one sterile contain or package of sterile product or administration container/device to prepare the CSP”. Does that still count if one uses a CSTD or other port that prevents re-entry via the stopper? The basic understanding for CSTDs is that they should not be used to extend BUD. However, does this prevent multiple entries into the bag by creating a sealed barrier between the product and the direct compounding area (DCA)? I believe it does, at least in most cases. It is interesting to note that the media-fill test procedure for low-risk compounding includes transferring four 5-mL aliquots of TSA into a single 30-mL vial. Hmm.

A CSP prepared under low-risk conditions receives a 48 hour BUD when stored at controlled room temperature. So if you were to prepare a single ingredient stock bag and leave it in the hood, why not give it 48 hours?

Medium-Risk Conditions—

When CSPs are compounded aseptically under Low-Risk Conditions and one or more of the following conditions exists, such CSPs are at a medium risk of contamination.

1. Multiple individual or small doses of sterile products are combined or pooled to prepare a CSP that will be administered either to multiple patients or to one patient on multiple occasions.
2. The compounding process includes complex aseptic manipulations other than the single-volume transfer.
3. The compounding process requires unusually long duration, such as that required to complete dissolution or homogeneous mixing.

A CSP prepared under medium-risk conditions receives a 30 hour BUD when stored at controlled room temperature. Crud, even compounds prepared in high-risk conditions get 24 hours at controlled room temperature.

If you would have asked me a couple of months ago what BUD to assign to a stock bag, I would have said 30 or 48 hour depending on conditions. However, with news of recent surveys here in California that’s no longer my advice. Until things are sorted out, you’re better off going with six hours. While I do not agree with treating a stock bag as a single-dose container, it is wise to follow current best practice when it comes to the board of pharmacy.

Hopefully the USP committee will address this issue in the next revision of USP <797>.

Regardless of what everyone thinks, the healthcare industry is in the infancy of “big data”. The concept isn’t new, but we still have a long way to go, especially in pharmacy. I recall sitting at conferences years ago listening to sessions describing data collection and manipulation. The problem has been that data, especially that found in pharmacies is scattered across disparate systems without an effective method for connecting the dots. The adoption of electronic health records (EHRs) has made things better, but much of the data collected in an average acute care pharmacy is outside the EHR’s reach.  And to say that most pharmacies have their collective heads buried in the sand, would be putting it kindly.

Those on the outside often find it difficult to understand the sheer volume of data that’s produced in a pharmacy. Unfortunately, the data sources are mostly stored in disparate systems creating silos, which makes each system blind to the others. Is is possible to connect the systems and exchange data? Sure, but few if any are doing it.

Data sources in pharmacies come from places like clinical interventions, inventory management, cost containment strategies, regulatory compliance, internal communications, and so on.

Take for example the simple goal of managing all the drugs used in an acute care pharmacy. It’s not uncommon for pharmacies to have several sources of data from various systems within the pharmacy:

• Room temperature items stored on shelves, carousels, or robots.
• Refrigerated and frozen items stored in refrigerators or freezers that may be tied to the room-temperature inventory management system, or maybe not. Refrigerated and frozen medications may use a completely different method such as an RFID-enabled cabinets tied to a secondary source of control.
• IV room inventory may be tracked, or more likely not tracked, once it leaves the “main pharmacy” area. It’s not uncommon for me to see IV room inventory treated as a location in which inventory is sent, i.e. no longer in inventory when it hits the IV room.
• Controlled substances, the bane of pharmacy productivity, is stored and managed separately from all other medications. Does it have to be? No necessarily, but the currently accepted practice is driven mainly by regulatory compliance and fear. Don’t you think it’s entirely possible to design a system that would more easily manage controlled substances? Of course! But that’s not the way we roll. We prefer the most difficult, least efficient system possible. Mission accomplished, because that’s exactly what we have.
• Management of medication kits, trays and transport boxes (trays). The amount of inventory stored in these trays is significant, and are often lost from pharmacy oversight upon reaching clinical areas. It’s amazing that medication trays are exactly the same as when I jumped into pharmacy practice nearly 20 years ago. It’s shocking just how poorly this area of pharmacy is managed. Some of my thoughts on the process can be found here.

Consider the amount of effort that goes into data collection for the soul purpose of regulatory compliance. Things like refrigerator and freezer temperatures, air flow and pressure differential in the cleanroom, documentation of blackbox warning drugs, and so on forever, create a mountain of information that is often collected on paper and stored in binders in some forgotten area of the pharmacy. It’s amazing in this is often considered best practice. I’m certain that much of this can be automated. Do other industries use such an antiquated system for data collection? I don’t know, but it shouldn’t be too difficult to find out.

I’ve mentioned only operational data to this point. What about clinical intervention data or financial information? The list goes on. Do pharmacy interventions really impact patient care in a positive way? I don’t mean in soft dollars, I mean in genuine, life altering ways? Possibly, at least in small studies. How about on a large scale? Don’t know. Can pharmacists actively improve pharmacy operations or the bottom dollar when engaged as part of the healthcare team? Don’t know.

What’s worse is that the data collected from all areas of pharmacy is rarely, if ever, pulled out of silos and incorporated into other data sets. What’s the value of that, you ask? Trends. It’s obvious to me that there are things within pharmacy data that we fail to see because the information is never compiled, stripped, joined, and analyzed. How big is the ripple effect of making a formulary change? Hard to say without looking at large groups of targeted data.

It’s staggering to think of what we’re missing by not taking full advantage of the data being generated in a pharmacy each and every day. Not to mention what could be found by compiling data from several, or several thousand pharmacies at once. The value of collecting and digesting massive amounts of data from national, regional, and local pharmacy practices is infinite.

Imagine being able to build true data-driven practices in both the clinical and operational pharmacy activities. Is there value in documenting that a patient is taking a drug with a black box warning? Maybe, but we don’t know. All we know is that some regulatory agency said we have to do it, so we do. But does it prevent anything? Who knows. Does drawing vancomycin troughs before the fourth dose improve outcomes, prevent toxicity, and decrease morbidity? Based on what I know, I think so. Has any of that ever been proven? Perhaps on a small scale, but nothing that I’m aware of that involves millions of data points. Then why do we do it? Because that’s the way it’s always been done. That’s the true definition of a non-data driven practice.

Is there a “best” way to handle sterile compounding? Is there a “best practice” for monitoring patients on heparin? I’m not talking about guidelines based on expert opinion, here. What I want is for someone to compile data from thousands of pharmacies across the country and really take a hard look at what’s is being done in pharmacies.

We’re seeing some of this in practice areas like UCSF’s precision medicine and many pharmacogenomics programs across the country. We should take their lead and apply those methods across the board. Data is power, and that power can be used to improve pharmacy practice. It seems to me that we have the ability, but thus far have failed to execute.

Someone call Google. They have a kind of data collection thingy, right?

Show Notes:
Host: Jerry Fahrni

PillPick by Swisslog¹
BoxPicker by Swisslog¹
RIVA by ARxIUM (formerly Intelligent Hospital Systems)

———————
1. Make sure to check out the videos for both PillPick and BoxPicker at the Swisslog website.

Multi-dose packaging has been a part of pharmacy for longer than I’ve been a pharmacist. It’s mostly been limited to long term care (LTC), such as nursing homes, rehab facilities, etc. It’s not something that’s commonly used in acute care hospitals for a host of reasons, most notably medication regimens frequently change in acute care settings. Multi-dose packaging works best when the patient is stable and medications can be dispensed for multiple days, hence the popularity in LTC.

Recently articles have been cropping up for companies attempting to use multi-dose packing technology in the ambulatory care setting, i.e. outpatient pharmacy. The most recent of which is an article in the Tampa Bay Times, describing the M5000 robot (1) by MTS Medication Technologies, an Omnicell company. Check the video below.

I question whether this is a real solution to a problem, or more of a solution looking for a problem. The technology that’s covered in the video is nothing new; perhaps this particular robot, but not the concept of using technology to create multi-dose packets.

Several questions enter my mind when I see technology like this.

Is this technology less expensive than other options? Probably not, but someone would have to run the numbers over a 3-5 year period to see the return on investment for a million dollar robot. In addition to the cost of the robot, there’s the cost of disposables such as ribbon, packaging, etc. And regardless of what people think, most robots don’t fully automate a process. They may reduce some part of the labor equation, but someone has to operate the robot, fill it with medication, replace the blister packs or packaging tape, and so on. I’ve seen this firsthand while doing research on iv room robots.

Is this technology safer? Yes, no doubt in my mind. However, without studies to confirm my thoughts it’s only speculation. But when properly deployed, robots are insanely accurate. They do exactly what they’re supposed to do. The only weakness in robot accuracy that I’ve witnessed is when humans set them up incorrectly.

Is this technology faster? Without seeing the various methods in action I can’t really say, but I will say that to date I have not seen a pharmacy robot outpace a human technician. Pharmacy technicians can be quite fast, often performing tasks much faster than a robot. This is something I also witnessed during my research into iv room robots. However, I would be remiss if I didn’t say that technician speed comes at a price, i.e. more errors.

Is this technology effective in improving patient satisfaction and adherence? That’s really the question that needs to be addressed. It’s the elephant in the room. The concept of multi-dose packets may appeal to some, but to others it’s a nightmare. This is especially true when the patient has several disease states with multiple medications – something this article says is perfect for the MTM robot. I have my doubts.

The difficulty with complicated patients is the number of healthcare providers, the number of medications, and frequency in which these medications change. I witnessed this firsthand while caring for my mom during the last year of her life. She was a complicated patient, and her medication regimen changed frequently depending on which physician she was seeing, and which disease was the focus of treatment; the old whack-a-mole approach to medicine. Even as a pharmacist I found it difficult to keep her on track. There were times when I would re-sort and organize her weekly medications three times in a ten day period. What do you do if your medications are packaged together in a single packet? You either tear them out or throw them away and start over. Neither option is acceptable. With that said, there will certainly be patients that prefer multi-dose packets to dealing with loose tablets.

My opinion is that adherence strategies are still in their infancy. There are so many variables when it comes to ensuring that patients take their medications, least of which is getting the patient to take stake in their own disease management. That’s the primary goal to adherence, the rest is window dressing at this point.

——–

1. There’s a video at the site showing a bit more detail – http://bcove.me/8u1r21sr. Couldn’t find a way to embed it in this post. Wish companies wouldn’t make it so hard to share their videos.

Jerry talks about the use of RFID technology in pharmacies, specifically the use of RFID in refrigerated consignment programs and medication tray management.

Show Notes:
Host: Jerry Fahnri

Current setup:
Blue Microphones Yeti USB Microphone – Blackout Edition
Dragonpad Pop Filter
Sony MDR-V150 Headphones

RFID-enabled refrigeration [4:25]:
Cardinal consignment programs [PDF]
FFF Enterprises

RFID-enabled medication tray management systems [7:00]
Intelliguard Kit and Tray Management System by MEPS
KitCheck by KitCheck

Pondering the need for an IV workflow management system (IVWMS)? You’re not alone if you are. According the most recent PP&P State of Pharmacy Automation Survey, 15% of facilities have already implemented something and another 29% plan to do so in the next few years. The only surprise is the relatively low percentage of facilities planning on implementation in the near future.

There are plenty of IVWM systems to choose from, even though the PP&P SOPA Survey doesn’t reflect that. (1) Every system is designed with the same goal in mind, but don’t let that fool you. Each vendor puts their own spin on the process with varying degrees of functionality, cost, ease of implementation, customer support, and so on.

With such a range of products you really can’t go wrong, right? Not true. Depending on the needs of a facility, one could definitely make a regrettable decision.

Here are the global pros and cons of IVWMS as I see them, in no particular order:

Pros:

• Improved safety: bar code scanning during CSP preparation, imaging for volume verification, +/- gravimetrics
• Decreased compounding errors
• Remote verification, i.e. removal of a pharmacist from the IV room. Some don’t see this as an advantage, but I certainly do.
• Improved data capture. Whether or not the information gets used is anyone’s guess, but it’s there for the taking.
• Improved documentation for regulatory compliance. Lot numbers, expiration dates, images of product components, etc. Part of the benefits of data capture.
• Workload tracking. Also part of data capture.
• Decreased cost from fewer wasted doses, i.e. items that won’t get made because the doses fall out of the work queue when discontinued. This doesn’t always happen in a manual system.
• Consistent workflow, possibly streamlined.

Cons:

• Financial and labor resources needed to purchase and implement. Depending on what projects one has in the hopper, this can have a significant impact on a facility.
• Financial and labor resources needed for continued system maintenance.
• Another disperate system added to the mix, including another database to manage and maintain.
• No true interoperability. Some systems offer rudimentary interfaces, i.e. one way data transfer, but not true interoperability between systems. This is the Holy Grail for third party vendors.
• Change, especially in workflow.
• Addition of hardware to the cleanroom. This varies from system to system, but remember that anything added to the cleanroom environment has the potential to impact airflow and must be cleaned.

Not all pros and cons apply to each system. For example, some systems are much less expensive than other, some require fewer resources to maintain, some offer much more robust functionality, some have a smaller physical footprint in the cleanroom, and so on. The goal for anyone looking at these systems is to maximize the Pros and minimize the Cons.

Feel free to leave additional Pros and/or Cons in the comment section.

—————

1. The 2015 SOPA Survey shows the following vendors “under consideration”: DoseEdge by Baxter, BD Cato by BD, i.v.SOFT by Aesynt, Pharm-Q by Envision, IVTrac by PlusDelta, and Script Pro’s Telepharmacy. Pharm-Q by Envision no longer exists as the IP for the product was gobbled up by BD, and ScriptPro is a small player in this space. The vendors listed in the survey do no represent a good cross section of available systems. There are others.

A little more than a week ago the most recent ASHP Section of Pharmacy Practice Managers Chair’s Message(1) landed in my inbox. I don’t typically read these messages carefully as they’re mostly full of the same old rhetoric. However, this particular message caught my attention because it included information on the ASHP Section of Pharmacy Practice Managers new strategic plan for 2015-2016.

According to the email:

“…the Executive Committee recently completed an extensive update to the Section’s strategic plan, which is now available on the Section webpage.  Our intent was to set a structure that would help us continually remain focused on the most important needs of practice managers. We have worked to carefully align the Sections plan with the overall ASHP Strategic Plan. This alignment eliminated the need for separate Section goals, which greatly streamlined the plan.  We also identified critical areas for practice managers.  The critical areas identified for 2015-16 are:

• Leadership Development
• Innovation Management
• Management of the Pharmacy Enterprise
• Patient Care Quality
• Multi-Hospital Health System Pharmacy Executives”

These are all great areas of focus.

Much more detail can be found the actual strategic plan document, which can be found here. I read through the document, much of which is what you’d expect, but there are some interesting items in the strategic priorities and goals section. Three bullet points caught my attention: 1) Expand pharmacy practice in ambulatory clinics and other primary pharmacy care settings, 2) Produce an Innovative and Timely Professional Journal, Website, Drug Information Compendium, and Other Publications that Meet the Needs of Members and Other Customers, 3) Improve the Discoverability of ASHP Digital Content Assets.

Expand pharmacy practice in ambulatory clinics – There was a time when I thought all pharmacists should practice in a hospital setting, but my views on that have slowly changed over the years. The most appropriate time for pharmacists to have a meaningful impact on patient care is before they’re hospitalized, i.e. in the ambulatory care environment. We are the medication experts, and nowhere is there more inappropriate medication use than in the outpatient setting. I think it is wise for pharmacy managers to spend more time focused on this practice area.

Produce innovative and timely information – Times have changed. The amount of readily available information is growing at an exponential pace. Unfortunately not all information is reliable. ASHP has made only small strides in the past several years in improving speed and access to information. Information affecting practice areas like operations, management, and technology should be made available at breakneck speed as it does not require the same rigorous vetting that clinical information does. It is no longer acceptable to wait a year for someone to present their findings at ASHP Midyear, or for AJHP to take months to publish something that is relevant now.

Improve discoverability of ASHP digital content – This would be a welcome change. ASHP has created a mountain of valuable information, but it’s scattered and difficult to find, cross reference, etc. I could go on and on about this, but suffice it to say I would love to see an improved content management style.

Let’s hope that Dr. Hoffman is able to make good on his promises. I’m going to hold him to his word.

——

1. The ASHP Section of Pharmacy Practice Managers new chair is James M. Hoffman, Pharm.D., M.S., BCPS, FASHP. With all those initials after his name he must be good.

The Vaccine Smart-Fridge is an interesting concept for ambulatory care. It appears to be a consignment vaccine distribution system. Reminds me of a refrigerated single-point automated dispensing cabinet (ADC).

There’s a lot to like here.

By using a consignment model, the vendor offers an ambulatory care clinic low cost, low risk access to vaccines. It also decreases the chance of something sitting in the cabinet beyond it expiration date, or going bad because the temperature is out of range. The company supplying the items has a vested interested in making sure that everything inside those refrigerators is ready for use, and that waste is kept to a minimum.

I believe that the consignment model for pharmaceuticals will only continue to grow. The largest budget item in many pharmacy is inventory, by a wide margin. Refrigerated medications seem to be the main target for consignment, but it’s possible that the model could creep into other spaces as well, especially with the introduction of biosimilars.

The system provides real-time alerts on inventory shortages and temperature. Automated temperature monitoring ensures that things stay within their appropriate temperature range. Heat is bad for lots of medications, especially vaccines. This information can be viewed from a computer or mobile device. I like that it’s proactive.

Single-item access is a great concept for an ADC. This style of distribution is frequently used for controlled substances – morphine, fentanyl, etc. It provides better security than open access trays, drawers, and bays, thus minimizing opportunity for diversion. Does it make sense for everything? No, not really, but in this case it fits.

The system provides access to real time analytics and historical dispensing data. This information could be linked to other systems for easy access to vaccination records.

Pharmaceutical refrigeration is in need of a little disruption, so when I see something like this I’m encouraged that someone is thinking about it. There’s nothing new about this technology, but it does provide a new paradigm to think about.

The USP Compounding Expert Committee has published a Notice of Intent to Revise for General Chapter <797> Pharmaceutical Compounding—Sterile Preparations.

I knew this was coming. I’ve talked to several people this year that indicated that revisions to Chapter <797> were imminent, especially with the introduction of USP <800> Hazardous Drugs—Handling in Healthcare Settings.

According the USP notice:

The General Chapter has been under review since 2010 and has been significantly revised to clarify requirements, and reflect stakeholder feedback and learnings since the last revision became official in 2008.

Major revisions of the General Chapter include:

1. Reorganization of existing sections and placement of procedural information in boxes
2. Collapsing of the three compounded sterile preparation (CSP) microbial risk categories (e.g. low-, medium-, and high-risk) into two categories (Category 1 and 2) distinguished primarily by the conditions under which they are made and the time within which they are used.
3. Removal of information on handling hazardous drugs and added cross-references to <800> Hazardous Drugs—Handling in Healthcare Settings
4. Introduction of the terminology “in-use time” to refer to the time before which a conventionally manufactured product used to make a CSP must be used after it has been opened or punctured, or a CSP must be used after it has been opened or punctured.

Items #2 and #3 are significant.

Most hospitals do not currently make CSPs that fall into the microbial high-risk category. Altering these categories could have significant impact on acute care pharmacies.

The introduction of USP Chapter <800> Hazardous Drugs – Handling in Healthcare Settings will make any mention of hazardous drugs in the current Chapter <797> obsolete. I suspect that the Compounding Expert Committee will likely remove management of hazardous drugs from Chapter <797> and simply defer to USP <800>, which has yet to be published in anything other than draft form.

I will be spending the next week or so going through the proposed changes to better understand what the USP Committee is thinking. Remember, these revisions aren’t final.

Revisions to General Chapter <797> will be published for public comment in Pharmacopeial Forum (PF) 41(6) [Nov.–Dec. 2015] on November 2, 2015. You can view the proposed revisions with line numbers in advance of publication here [PDF].

“Those who cannot change their minds cannot change anything.” ― George Bernard Shaw …you people know who you are.

So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts…

As predicted, The Martian was #1 at the box office last weekend, pulling in a just over $54 million in its opening weekend. It’s a good movie. Highly recommended. I expect The Martian to hold the #1 spot for a bit longer. Who’s going to challenge it, Pan?

Speaking of movies, my younger brother came up to Fresno last Sunday and took me to see Everest. The movie recreates one of the worst climbing disasters in history. I don’t usually go in for movies like that, but Everest was really quite good. Another film I would recommend.

I’ve always been a drip coffee guy, probably because that’s how I got started drinking coffee. I’ve tried various methods – pour overs, coffee press, running by Dutch Brothers twice a day – but I always come back to drip. Recently my tried and true Mr. Coffee Coffeemaker took a turn for the worst and I had to replace it. Instead of simply getting another Mr. Coffee, I wanted to try something different. I did a little online research and finally decided on a Bonavita 8-Cup Original Coffee Brewer. While the Bonavita is still makes coffee via “drip”, the water comes down onto the grounds in a sort of showerhead fashion, and the “pot” is a carafe that keeps the coffee warm for several hours. There is no warmer under the carafe. It works very well. I’m quite satisfied with the coffee it brews. The only thing that’s a bit of a bummer is that you can’t pull the carafe out before it’s finished brewing when you just can’t wait five minutes for it to finish. I used to grab the carafe on my old Mr. Coffee as soon as I had enough black gold to warrant a cup. The price we pay for good coffee.

Microsoft had an epic event this week in New York. The company introduced some of the most exciting new products that I’ve seen in years. The company took their already class-leading line of Surface machines and introduced the new and improved Surface Pro 4. The Surface Pro 4 has updated internals, a slightly larger display, improved pen technology with a better inking experience, and a better detachable keyboard. And the best thing of all is that you can custom configure the device to your liking at the Microsoft Surface site. But that’s not all. Microsoft also introduced what I think is the most innovative piece of hardware that’s come along in a while, the Surface Book. The Surface Book offers a crazy new design, making it both a complete laptop and a full-fledged tablet. It also gives users the ability to configure the Surface Book to rival any 13-inch high-end laptop on the market. It’s what a modern ultrabook-tablet should be. Surface Book is quite literally my idea of the perfect machine torn from my brain and turned into reality. It’s the most excited I think I’ve ever been for a piece of new consumer technology. It’s beautiful, and I must have one.

Here’s an interesting website: http://easypcpicker.com/. “Easy PC Picker exists to simplify the process of buying a new computer. We ask you three simple questions (price, operating system, and features) and then provide a recommendation hand-picked by our staff of experts.” I played with it a little bit. It’s not perfect, but it kicks out some solid choices for anyone looking for a new machine.

Who would have thought that Velcro could be dangerous? I’ve managed to get a few nicks and cuts on my hands from unstrapping and re-strapping my leg brace several hundred times over the past few weeks. I’m theorizing that the little hooks on one side of the Velcro strap are able to grab tiny pieces of skin that are loose. And when they grab hold, they don’t let go.

Speaking of Velcro, it “is the brainchild of Georges de Mestral, a Swiss engineer who, in 1941 went for a walk in the woods and wondered if the burrs that clung to his trousers — and dog — could be turned into something useful. After nearly eight years of research (apparently it’s not so easy to make a synthetic burr), de Mestral successfully reproduced the natural attachment with two strips of fabric, one with thousands of tiny hooks and another with thousands of tiny loops. He named his invention Velcro, a combination of the words “velvet” and “crochet,” and formally patented it in 1955. Though the first Velcro was made out of cotton, de Mestral soon discovered that nylon worked best because it didn’t wear with use.” And the moral of the story? Take time to go for a walk in the woods. (source: Time)

Have I ever told you how awesome 3D printing is? There’s a lab at the University of California San Francisco (UCSF) –  <cough>… my alma mater – that’s using living cells as the substrate to 3D print human tissue. “Zev Gartner, PhD, has focused on the next best thing: His lab is building fully functioning 3-D human tissue, cell by cell. It sounds straight out of a Frankenstein novel, but Gartner is working to grow the milk-producing tissues of the human breast to create a living, working model of the human mammary gland that grows, ages and responds to hormone signals just like the real thing. This means growing the ducts, arteries and connective tissue in the same environment.” Crazy.

How long before we all have 3D printers in our houses to print everything from our breakfast cereal to a new spray nozzle for our hose? It’s not as far off as one would think. It could even happen before I decide to checkout for good.

This week the FDA told ASHP that it has “not cleared or approved any syringes for stand-alone use as ‘closed container systems.’” Oh boy, that’s a biggie. You can read my initial thoughts about the announcement here, but I think it’s going to cause some problems for pharmacies.

Variety: “Consumers are now using mobile phones more often to search Google than desktop PCs…“We are getting over 100 billion searches every month,” Singhal said. Mobile overtook the desktop as the number one source of traffic this summer, he said.” – I talked about this a few years ago during a presentation I gave at a SoCal HIMSS Meeting. Those things in your pocket aren’t phones, they’re computers. My thought is that there has to be a way for pharmacy to leverage that knowledge to improve patient care. Really hasn’t happened yet.

You really should stop whining about your commute. Take a look at what happens when people return from vacation in China. Dude, that’s some traffic right there.

And just like that the Cardinals broke my heart. I said last week that the Rams defense was good, and they gave Palmer fits all afternoon. The Cardinals play the Lions tomorrow. I think it’s a winnable game, but the Lions have nothing to lose, which makes them dangerous. Expect the Cardinals secondary to have their hands full with the Lions long-ball.

Ugh, the Bruins took one in the shorts last Saturday night. Hats off to Arizona State, they punched UCLA in the throat. No game for the boys in baby blue this weekend. Good thing, as they have Stanford up next on the schedule. They’ve had trouble with the Stanford running attack and defense over the past few years. Fingers crossed.

Have a great weekend everyone.

Jerry talks about the problem with storing medications in plastic syringes and potency loss. Recently the FDA notified ASHP that no plastic syringe is approved for use as a final storage device. Jerry discusses the issue and how it will impact pharmacies in the near future.

Show Notes:
Host: Jerry Fahnri, Pharm.D.

Articles discussed in podcast:
Initial Reaction to FDA Stance on Syringes As Standalone Storage Container [JerryFahrni.com]
No Syringe Is Approved as a Standalone Storage Container, FDA Says [ASHP]
ISMP Comments On BD Syringe Potency Issue [ISMP]
Compounded or Repackaged Drugs Stored in Becton-Dickinson Syringes: FDA Expands Warning [FDA Alerts]

Current setup:
Blue Microphones Yeti USB Microphone – Blackout Edition
Dragonpad Pop Filter
Sony MDR-V150 Headphones

USP <800> is still in draft form. The official date of the chapter has not yet been determined and is dependent on several factors, but expect it to become official some time in mid to late 2016. And while USP <797> is in the process of being updated, the current version is still the one everyone has to live with.

Information contained in USP <800> is in addition to information found in USP Chapter <797> Pharmaceutical Compounding – Sterile Preparations and USP Chapter <795>  Pharmaceutical Compounding – Nonsterile Preparations.

In its current iteration, USP <797> and USP <800> requirements for hazardous drugs (HDs) differ.  However, HD compounding in the upcoming revision to <797> will be harmonized with Chapter <800>. Actually, it looks like USP will simply defer all HD compounding to USP <800>, which makes sense.

Until all the USP Chapters are on the same page, here are some highlighted differences between Chapters <800> and <797>:

• Requirement of compounding supervisor
• Applies to sterile as well as non-sterile compounding
• No longer allowed to store, unpack, or manipulate HDs in positive pressure areas
• Elimination of exemption that allowed low volumes of HDs to be compounded in a non-negative pressure room. All quantities of HDs must be compounded in a separate, negative pressure room
• C-SCAs may be used to compound low- and medium-risk HDs
• CSTDs are recommended for compounding and required for administration

Perhaps the greatest impact will come from elimination of the current USP <797> exemption for small volumes of HDs to be compounded in a positive pressure room. USP <800> handles this by allowing low- and medium-risk HDs to be compounded in a containment segregated compounding area (C-SCA). C-SCA is a new concept, and is defined as “a separate, negative pressure room with at least 12 air changes per hour (ACPH) for use when compounding HDs. Low- and medium-risk HD compounded sterile preparation (CSP) may be prepared in a BSC or compounding aseptic containment isolator (CACI) located in a C-SCA, provided the beyond-use date of the CSP does not exceed 12 hours“.

EMR & EHR: “Of all the things that irrationally inflate health costs, one of the top concerns is people who just don’t take their prescribed medications. Medication adherence doesn’t sound like a high-tech issue, but a lot of interesting technologies are being thrown at the problem…. At the recent Connected Health Conference I talked to several companies taking on the difficult adherence problem from different angles. Medisafe aids patients in self-monitoring, Insightfil creates convenient packaging that groups pills the ways patients take them, and Dose doles out medication at prescribed times.”  – The author goes on to describe some of the technology. The content is worth a few minutes of your time.

Here’s the thing, technology may not be the solution.

Vestigo is web-based Investigational Drug Service (IDS) software made by the McCreadie Group, Inc., a privately held pharmacy software company out of Ann Arbor, Michigan. The McCredie Group is a small boutique company that builds software for niche markets like IDS.

I’ve worked in pharmacies that have an IDS, and let me just say that there’s a lot of record keeping involved and attention to detail is important. One would think that the “the drug” would be the most important thing, but that’s not really the case. Records, logs, and traceability are key.

Anyway, one of the products offered by the McCreadie Group is Vestigo. I’ve come across the product in pharmacies while traveling, but never really given it much attention. Because it’s such a niche product I couldn’t even tell you who they’re competing against.

Don’t go Googling for information on Vestigo, because you’re probably not going to find much. The company has done a pretty good job of not marketing their product and keeping relevant information off the internet. Not sure how that’s possible in this day and age, but I wasn’t able to find more than some old reference articles and press releases.

I have verified with the company that they will be at the 50^th ASHP Midyear Clinical Meeting and Exhibition in New Orleans in early December. I’m interested enough in the product to drop by their booth and have a look. Until then, here’s what the McCreadie Group site has to say about Vestigo:

Vestigo increases IDS safety and compliance…

• Protocols structured in a logical and safe manner
• Product selection limited to drugs used for the current protocol
• Automated checks for expired products and IRB approvals
• Patient management functions prevent dispensing to patients not enrolled
• Accurate, electronic drug accountability records
• High-quality, safe labels with barcodes
• Built-in workflow for safe practices
• Logging and audit trails required for HIPAA and 21 CFR Part 11 compliance

…and improves IDS efficiency and reduces costs

• Electronic protocol managementFully automated protocol billing (increases revenue and reduces the cost of generating the bill
• Electronic inventory management including tracking patient-specific items, returns and destructions
• Reduced paperwork and handwriting
• Integrated dispensing with automatic label generation
• Extensive reporting to track operations, workload and financials

So if you’re in the market for an IDS solution, you might give Vestigo a look and request a demo.

This year’s ASHP Midyear Clinical Meeting was held at the Ernest N. Morial Convention Center in New Orleans, Louisiana on December 6 through December 10, 2015.  For many, the Midyear Meeting is about the latest in clinical advances, but for me, it’s an opportunity to see all the new pharmacy automation and technology. And the best place to see the latest and greatest technology is in the exhibit hall.

Below you will find my thoughts on what I saw while roaming the exhibit hall. By no means is this an exhaustive list, but rather items that I think are worth mentioning and thinking about.

PHARMACY CLEAN ROOM

“Sterile compounding is a significant but perilous core pharmacy process in dire need of improvement.” – ISMP Jan 2015

The pharmacy clean room (a.k.a. iv room) continues to get a lot of attention, and rightly so. With the introduction of USP Chapter <800> and proposed changes to USP Chapter <797>, the clean room is on everyone’s mind. This year’s exhibit hall was a direct reflection of this.

• The clean room automation and technology space is It was bound to happen. Over the past few years, several vendors have introduced products designed to help pharmacists with compounding sterile products or meeting clean room regulatory requirements.
  • Aesynt is now part of Omnicell and CareFusion is part of BD. BD has had more time to ramp up their messaging and it was obvious in their exhibit this year.
  • The Plus Delta Technologies booth was empty. Plus Delta’s products include PD, a medication tracking system, and IVTtrac, a semi-automated iv workflow management system. It is unclear whether the company has been sold, has gone belly up, or is simply keeping a low profile
  • APOTECA was not present in the Midyear Exhibit Hall this year. If you recall, APOTECA is the company responsible for APOTECAchemo, a robot for compounding hazardous drugs. Last year about this time they introduced APOTECAps, a semi-automated iv workflow management system. The company was conspicuously absent.

• There was a good number of booths offering clean room consulting. More than I’ve seen in past years.
• Aesynt – previously McKesson Automation, now part of Omnicell – was focused on data analytics in the clean room with two new products: REINVENT and Formulary Tool Kit (FTK). I wrote about REINVENT after the ASHP Summer Meeting in Denver. FTK is a tool designed to help pharmacies extend BUD in the cleanroom.
• BD and Baxter seem to be running parallel races. Baxter had a press release at the meeting that focused on DoseEdge BD did the same for Cato. Baxter will be pushing their Epic integration in the coming year.
• Baxter was showing off their DoseEdge scales for the first time ever at a Midyear event. DoseEdge has had gravimetric functionality for quite some time, but the concept has never been popular with their customers. Apparently that has all changed. Based on conversations with insiders, this appears to be a direct result of pressure from BD’s gravimetric-centric approach.

Imaging platform and scales from DoseEdge (left) and BD Cato (right)

• MedKeeper showed off a new booth at Midyear with Verification front and center. Verification is MedKeeper’s semi-automated iv workflow management system. Something that caught my eye while I was in the MedKeeper booth was the images captured by Verification. They’re really quite good. I was especially surprised to find that some of the images I was looking at were taken from outside an isolator. That’s right, the device was mounted outside the isolator, thus limiting the hardware in the hood.

Verification by MedKeeper – images shown on screen taken from outside an isolator

• Talyst had Talyst IV Room on display. Talyst IV Room is part of the company’s mobile inventory management solution and offers users the ability to build IV kits utilizing barcode scanning for verification, as well as the ability to track sterile preparations throughout the compounding process.

Talyst IV Room product on display

• Grifols introduced a new hazardous drug compounding hybrid robot, Kiro Oncology. Kiro is a bit different from previous robots as it uses two robotic arms to compound sterile preparations. It’s an interesting concept.

Kiro Oncology robot from Grifols

• Compounding robots were out in full force: Aesynt with v.STATION, ARxIUM with RIVA, and Grifols with Kiro Oncology.

RFID-ENABLED TECHNOLOGY

RFID-enabled technology was more prevalent at this year’s ASHP Midyear than I can recall in previous years. Booths that had RFID-enabled products on display were typically busy, and the people in those booths were engaged in conversation.

Does this mean that pharmacy has finally turned the corner on RFID? Perhaps, but the technology still has some barriers, both real and perceived to overcome. It is clear to me, however, that RFID has niches in pharmacy and vendors are finding those niches.

Three booths that I thought were particularly busy were MEPS Real-Time, Inc., Kit Check and FFF Enterprises.

• MEPS Real-Time, Inc. was showing off their Intelliguard RFID system, which includes an RFID-enabled medication tray management system, controlled temperature cabinets (CTCs) – both refrigerated and room temperature – and a virtual logbook for tracking medication trays.
• Kit Check had their “Little Blue Box” scanning station in the booth, which is part of their RFID-enabled medication tray management system. In addition, Kit Check was showing off their RFID-enabled Anesthesia Check system, which I thought was pretty cool. The design is well thought out and offers some nice functionality.
• FFF Enterprises is a distributor of plasma products, vaccines, biopharmaceuticals, and biosimilars. Part of their product line includes Verified Inventory Program-Consignment (VIPc), which includes RFID-enabled refrigerators that offer automatic track and replenishment for their product line. Cardinal Health does something similar.

SencorpWhite was on hand with a small booth providing information on their RFID capable carousels. They didn’t have a physical carousel in the booth as in previous years, but instead opted for literature and a looping video to support their product offering.

PharMEDium announced that they will be making pre-filled syringes with RFID tags embedded in the labels. This is big, but the announcement went unnoticed by many. I wouldn’t have known about the move had I not been speaking to one of the vendors mentioned above. I verified this with one of the PharMEDium executives and was informed that the RFID-enabled pre-filled syringes will not be proprietary to any single company, and will be made available to anyone looking for pre-filled syringes with embedded RFID tags.

COLD CHAIN TECHNOLOGY

It has been clear for quite some time that refrigeration is going to be important for the next generation of pharmaceuticals, including biologicals. Pharmacies will need to invest in and utilize better security, as well as real-time monitoring for temperature, humidity, and inventory.

• The exhibit hall was full of vendors offering real-time monitoring. Have a data connection, i.e. “the internet”? If so, then you have everything you need to use many of these systems. Vendors are offering cloud-based storage of information, which means anytime, anywhere access to data. Real-time monitoring and alerts mean that pharmacy directors will have peace of mind that their pricey inventory is in date, properly stored, and in stock. It’s a win-win.
• All the major pharmaceutical grade refrigerator vendors had a presence in the exhibit hall: Helmer, Follett, Migali Scientific. Not to mention seeing many other vendors with one of these brands in their booth. Partnerships and alliances appear to be the most efficient method of ensuring that you can offer a refrigerated solution to your customers.

Some items that I felt were particularly interesting in the cold chain area:

• RFID-enabled refrigerators. See the section on RFID for more detail.
• The Evolve line of pharmacy-grade refrigerators from Phononic were quite impressive. These refrigerators are powered by SilverCore™ Technology. They have no compressor, meaning they have no mechanical parts, run quiet, use less electricity, and generate less heat. The refrigerators use solid-state heat pump technology coupled with a non-hazardous, non-toxic refrigerant. In addition, the units provide alerts for temperature, door, battery, memory, loss of Wi-Fi, and loss of power. Check the image below showing the solid-state “pump”.

Phononic compressor-free refrigeration technology

• Vaccine Smart-Fridge. I wrote about this back in September. The Smart-Fridge is an interesting concept. The system offers single-point access to vaccines, providing real-time alerts on inventory shortages and temperature. Automated temperature monitoring ensures that things stay within their appropriate temperature range, and analytics and historical dispensing data are collected and made available to the user.

STRIP PACKAGING FOR AMBULATORY CARE

Strip packagers have been around for a long time. They were popular in acute care for a while, but not so much anymore. However, there appears to be renewed interest in the technology for use in ambulatory care pharmacy, especially as a method of improving medication adherence. I spoke to several strip packaging vendors that are seeing renewed interest in the technology. Most attribute this to the introduction of strip packaging as a medication adherence platform made popular by recent coverage of PillPack.

I wrote about PillPack back in February of 2014.

MISCELLANEOUS

DYNALABS DVx™ Onsite Drug Verification System. DVx allows users to quickly and easily verify drug identity and strength (concentration) in real-time. The demo was impressive. The representative that I spoke with said that DYNALABS currently had a limited reference library, but were adding new drugs all the time.

ScriptCenter by Asteres. Think of ScriptCenter as something similar to the Amazon Locker model. Pharmacies fill medications, place them in the ScriptCenter kiosk, and allow users to pick them up at their convenience. Kind of an ATM-style solution to medication refill pickup. The system sends messages to patients when their prescription is loaded and ready. Users can pay with credit card or payroll deduction. You can even load OTCs into ScriptCenter. I spoke to Dana Darger, Director of Pharmacy at Regional Health in Rapid City, SD about ScriptCenter. He has been using the unit to provide employees with 24/7 access to medication refills. So far he’s been pretty happy with the results. Dana commented that ScriptCenter has helped alleviate congestion in the outpatient pharmacy as well as give hospital employees easy access to their refills.

ScriptCenter by Asteres

Cactus Smart Sink. I wrote about the Cactus Smart Sink while attending Midyear. The Smart Sink is a pharmaceutical waste disposal container that renders its contents “unrecoverable, non-retrievable and unusable”. It’s small and unassuming. I thought it was pretty slick.

Swisslog Nexus Station. One has to wonder how a tube station can be exciting. Well, if you’ve ever worked in a pharmacy where items are queued up due to volume, then you’ll appreciate the Swisslog Nexus Station. The Nexus allows users to load up to five tubes at a time in a Lazy Susan-like configuration. Tubes can be loaded as non-secure or secure and the Nexus will keep track. Much more efficient than a “one-up” tube station.

Nexus Station by Swisslog

A PDF version of this report may be downloaded here.