Staying abreast of evolving inventory management technologies is key to ensuring efficient pharmacy practices and safe medication delivery. The University of Tennessee (UT) Medical Center, the region’s only academic medical center, Magnet-recognized hospital, and Level I trauma center, is committed to employing technology solutions to deliver effective patient services. The 581-bed hospital supports adult and pediatric kidney transplants, a comprehensive stroke center, a Level III neonatal intensive care unit, and six centers of excellence.

UT Medical Center’s pharmacy department, which employs approximately 60 pharmacists and 60 certified technicians, utilizes a decentralized model supporting a unit-based pharmacy practice. When the medical center initially implemented automated dispensing cabinets (ADCs), connectivity between the cabinet inventory and the centralized pharmacy was not an available option. Medications were pulled manually for floor stock for the ADCs and on a patient-specific basis for cart fill. The centralized pharmacy inventory was stored in small bins on wire carts; technicians had to walk from area to area to locate medications, a lengthy and arduous process that poses risk for stocking and picking errors and complicates inventory level tracking.

Later, the advent of an automated centralized inventory via the pharmacy information system significantly improved medication safety, as well as inventory tracking. Based on our previous experience implementing unit-based cabinet technology, we felt that also adopting a centralized carousel system would herald significant improvements in our medication distribution workflow and cost savings through robust inventory management.

The next step was to identify which carousel system would best suit our needs for medication storage in the pharmacy. Critical considerations included identifying a carousel with a small footprint, as space in the central pharmacy was limited, and the ability for the carousel to integrate with the ADCs and the pharmacy’s wholesaler. Ultimately, the team selected two vertical, 20-foot shelf carousels, which extend into overhead ceiling space, thus consuming less floor space than our previous inventory system. Likewise, the carousels integrate easily with our wholesaler and dispensing cabinets.

Managing the Transition
Prior to purchasing any technology solution, pharmacy engaged the hospital informatics team to ensure that there were no connectivity issues, that sufficient data ports existed, and discussed the labeling process. Approximately one month prior to go-live, the pharmacy team, consisting of the operations manager, director, purchasing personnel, and informatics representatives, met to identify current on-hand inventory, determine which products would be stored in the carousels, and address the changes required to current stock and workflow, as well as any additional issues that had been identified. The informatics team designated a member to begin adding medications to the database, a process that could take up to 2 weeks. During the carousel construction period, mobile shelving units were used to store active pharmacy inventory.

Subsequent to the formulary review, pharmacy worked with the carousel vendor to create bar codes for each product and trained staff on the process for adding bar codes and products to the carousels. Par levels were established based on ADC and historical purchasing data. To determine where each item should be stored within the carousels, pharmacy worked with the vendor’s technical support team to identify the top 300 medications utilized by the medical center. Further fine-tuning consisted of assigning the most frequently used items to one carousel and maintaining slower moving and bulk items in the second carousel. This was instrumental in decreasing the number of steps technicians took to obtain medications. Moreover, pharmacy worked overtime to ensure that refrigerated stock was included in the workflow. 

Look-alike/sound-alike items were separated to ensure safety when picking these medications. Thereafter, pharmacy worked closely with the medical center’s IT department and the vendor to ensure that medication labels would print correctly from the pharmacy information system. At the same time, pharmacy identified which staff members required carousel training and began this process, utilizing super-users and a train-the-trainer method. The vendor assisted in identifying information to include in a staff training booklet and checklist.

Although unexpected challenges commonly accompany new technology adoptions, having a detailed action plan facilitated a smooth transition. Moreover, while new technology implementations often bring about a certain level of trepidation among staff, the medical center team members quickly realized that implementing the carousels reduced the time spent locating medications, ensured patients received their medications in a timely manner, and reduced the potential for medication errors. For these reasons, staff acceptance of the carousels was high.

Carousel Benefits
The security of knowing that patients are receiving the correct medications, as well as the operational efficiencies gained, were the most significant benefits of implementing carousels. UT Medical Center also realized meaningful financial benefits; the pharmacy monitored total cost of inventory on hand pre- and post-implementation and identified a decrease in carried inventory of approximately $300,000 after implementation. We continue to seek new opportunities to innovate and improve our carousel technology, including expiration date tracking.

Amy Flatt, PharmD, is the associate director of pharmacy at The University of Tennessee (UT) Medical Center in Knoxville. She received her doctor of pharmacy degree from The UT Allied Health Sciences and completed an ASHP-accredited residency program at UT Medical Center.

James V. Hinkle, BS Pharm, is the lead parenteral pharmacist at The UT Medical Center in Knoxville. He received his pharmacy degree from the University of Maryland and completed an ASHP-accredited residency program at Harris Methodist Hospital in Fort Worth, Texas.

Kimberly C. Mason, PharmD, is the director of pharmacy services for The UT Medical Center in Knoxville. She received her doctor of pharmacy degree from the University of Mississippi and completed a pharmacy practice residency followed by a critical care/nutrition residency at The UT Medical Center.

MedCarousel, a vertical medication storage and retrieval system from Aesynt, automates the medication management process from order fulfillment, to cabinet replenishment, to medication dispensing and restocking. Pharmacies can reduce dispensing errors, lower operating costs, improve workflow efficiency and productivity, and realize space savings. The carousel offers a high weight and line-item capacity, rotating shelving, pick-to-light functionality, bar code scanning, and comprehensive, integrated workflow software to guide pharmacy technicians to medication storage locations for improved picking speed and accuracy. The system enables cycle counting and expiration date management; paperless, bar code-driven pharmacist verification; and electronic wholesaler order creation. Embedded MedShelf-Rx functionality can be used to manage items stored externally, extending bar code scanning and perpetual inventory management. The Connect-Rx common software platform enables MedCarousel and other Aesynt solutions to communicate and operate without interfaces, minimizing the need of external and duplicative interfaces to hospital, pharmacy information, or automated dispensing cabinet systems.

From Aesynt

The BoxPicker automated pharmacy storage system from Swisslog features increased storage capacity for the same footprint, multitasks to reduce picking times, and increases efficiency. Multiple operator stations enable pharmacy staff to multitask while reducing bottlenecks. This improves workflow by reserving one station for STAT orders so scheduled dispenses are not interrupted; decreases interruptions by allowing loading and unloading at the same time; and increases productivity by splitting the workload between two people. By limiting the number of medications exposed during dispense, the opportunity for picking errors is reduced. The BoxPicker also increases staff safety by reducing the number of moving parts to which users are exposed.

From Swisslog Healthcare Solutions

PharMax software and carousel automation from PHARMOVATIVE combines cost-effective inventory management software with the InnoStore VC automated vertical carousel to help optimize pharmacy operations. PharMax works with pharmacy systems to prioritize the drug fulfillment process. The integrated system increases inventory turns and accuracy while reducing inventory levels, thus reducing picking and turnaround times. The software manages inventory levels and locations within the carousel system, static shelving refrigerators, stockrooms, and satellites. Pick-to-light technology directs the user to the exact pick location, indicates the quantity to pick, and then the medication is bar code-scanned to ensure accuracy.

From PHARMOVATIVE

Driven by AutoPharm Enterprise software, the AutoCarousel HD secure, automated medication storage from Talyst improves medication safety and enhances workflow efficiency and inventory control. Patient safety is improved with accurate order filling, including pick-to-light indicators and bar code verification. The carousel enables comprehensive, accurate tracking and control of all stored items, and enhanced security with physical barriers and password-protected access. Additionally, the carousel increases efficiency by decreasing the number of staff and hours required to stock items and fill orders, while reducing the required storage space. AutoCarousel HD streamlines the returns process to save time and reduce errors, and its efficient, vertical design ensures maximum storage in a compact footprint. It is backed with a 10-year guarantee and is available in a variety of sizes to meet each pharmacy operation’s needs.

From Talyst

The Omnicell Medication Carousel is part of the Omnicell suite of central pharmacy inventory management solutions that provide perpetual inventory across the hospital enterprise. Integration with central pharmacy management software allows intelligent grouping of medication retrievals, priority management, and synchronized picking with multiple carousels. In addition, medication errors are reduced as the right medications are stored and retrieved from the right locations. As part of Omnicell’s Unity platform of medication and supply technology, the medication carousel provides single database management and a consistent user experience across all of Omnicell’s automated dispensing solutions. 

From Omnicell