By Lucy M. Moyer, RPh, and Lori Bertrand, RPh

THE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER operates three outpatient pharmacies, which dispense approximately 600, 350, and 200 prescriptions per day, respectively. Operating as an outpatient pharmacy for a large cancer center presents us with a number of specific issues. First, about 90% of our prescriptions are first fills for new patients, and we handle a lot of prescription transfers to our patients’ local pharmacies. Second, we dispense a lot of oral chemotherapies, Class 2 narcotics, and injectable drugs, and we also dispense investigational drugs.

In 1998, MD Anderson operated only one outpatient pharmacy, dispensing between 800 and 900 prescriptions a day. As our volume continued to grow, we began to look at automation as a way to increase our productivity, allow our pharmacists to spend more time on patient consultations, reduce the space needed for our inventory, and improve medication safety.

We started our search for an outpatient automation vendor at the ASHP Midyear Clinical Meeting. We ultimately chose ScriptPro for a number of reasons. One was size: Their dispensing equipment had a small footprint, which was important for our space-challenged pharmacy. Secondly, the ScriptPro SP 200 robotic dispensing system was reasonably priced compared to the other products available at the time. Third, ScriptPro’s robot was reliably engineered, an important feature as we could not afford system downtime. It was also critical that each drug be isolated in the robot and during dispensing to prevent the cross contamination of medications. The SP 200 dispenses each medication into a vial directly from its designated canister.

When selecting an outpatient automation system for your pharmacy, thoroughly evaluate your needs and how each available product will meet them. Visit other pharmacies that are using the products under consideration to determine other users’ level of satisfaction with the vendor’s products and customer service. Specifically, find out how much downtime they have experienced and how responsive their vendor was in bringing the equipment back online. Of course, price is always a consideration, as well. So be sure to calculate your estimated return on investment before making a final purchase decision.

System Features and Functions
Once a prescription order is received, a technician enters it into the ScriptPro SP Central Workflow System software. SP Central identifies and batches all of a patient’s prescriptions to ensure that we deliver the entire order to the patient. The ScriptPro robot, interfaced with SP Central, recognizes if a prescription is among its line items, and automatically fills, labels, and bar codes the prescription vial. Once the completed vial is dispensed, a pharmacist verifies the prescription by scanning its bar code at a computer workstation. SP Central generates a batch report for the pharmacist, informing him or her if that prescription is part of a multi-item order. The pharmacist then attaches a bar coded batch report to the prescription bag, and places it in a bin until the patient arrives to collect it. Prescriptions not filled by the SP 200 – such as injectables – are also bar coded and linked to the batch report in SP Central.

When the patient comes to pick up the prescription, the bar code on the batch report is scanned at the register, and a complete list of the medications in the patient’s order – and their location in the pharmacy – is displayed on the computer screen. This batching process helps move our patients through the cashier line quickly and ensure that each patient receives all of his or her medications. As a cancer center outpatient pharmacy, we dispense a good deal of injectable medications that have to be refrigerated. SP Central makes locating the various medications in a patient’s order much easier for our staff. Because we service discharged hospital patients, we also dispense discharge medications. Physicians may place three separate discharge orders for the same patient throughout the day. ScriptPro SP Central batches those separate orders to ensure the patient leaves the pharmacy with each of their medications. We are very comfortable knowing that our patients will receive all of the medications that were ordered for them.

After implementing the ScriptPro automation, our patient wait time – particularly for our fast-moving items and single prescriptions – decreased dramatically. In addition, it is not unusual for a patient to have 15 prescriptions to fill, and before the implementation, patients with only one or two medications would pile up behind the larger orders. ScriptPro helps us track those patients with smaller orders and move them quickly through the fill process. And because we fill such a large volume of prescriptions per day, we find it particularly valuable that SP Central matches patients to prescriptions in a systematic manner. It is not uncommon for us to service patients with very similar names. SP Central enables us to ensure that Joan Anderson does not leave the pharmacy with John Anderson’s medications. So our automated workflow has proved to be a useful tool in improving patient safety.

In automating our pharmacy, one of our objectives was to move to a paperless system. When you are filling 1,000 to 2,000 prescriptions a day across three pharmacies, managing and storing your paperwork can become an arduous task. SP Central allows us to scan hardcopy prescriptions to create a permanent, electronic record. Our insurance logs and HIPAA information are also stored in the system, eliminating the need for paper-based records. All in all, the ScriptPro technology has streamlined a significant number of time-consuming tasks.

Staff Satisfaction
ScriptPro’s bar coding features give our pharmacists increased peace of mind; they know they are dispensing the right prescriptions to the right patients. Furthermore, one automated fill process frees up our pharmacists to perform patient consulting and provide drug information to physicians. Our pharmacists are pleased to have a more professional – as opposed to technical – role.

Implementation Tips
Any outpatient pharmacy should establish a workflow that will reap the most benefits of an automation implementation. A dispensing robot’s purpose is to increase efficiency; if you install it in a location in your pharmacy that does not facilitate efficiency, you will lose the benefits of your investment. Therefore, the placement of the equipment itself is an important consideration to make. We credit ScriptPro with our smooth implementation. Their trainers stayed on until every member of the staff was comfortable with the equipment, and until we knew how to process every type of prescription that could go through the system. The ScriptPro staff was also able to help us develop a workflow that increased the efficiency of our overall processes.

Your IT people also need to be prepared for the installation of new technology and any IT needs that will arise from it. Having them onboard at the outset makes the installation much smoother.

Staff acceptance is also critical to the success of your implementation. Make sure they understand the technology is not there to replace them, but rather to improve their work environment and productivity, as well as allow them to take on more professional activities. Helping your staff understand that this is a positive change for the pharmacy, as well as your patients, is the first step towards a successful implementation.

A graduate of the University of Houston’s College of Pharmacy, Lucy M. Moyer, RPh, has served as the director of pharmacy operations for the University of Texas MD Anderson Cancer Center since June 2006.

Currently the manager of outpatient pharmacy, Lori Bertrand, RPh, has worked for the University of Texas MD Anderson Cancer Center for over 15 years. She is a graduate of the University of Houston’s College of Pharmacy.