Parkland Health & Hospital System, based in Dallas, Texas, serves as the primary teaching hospital for the University of Texas Southwestern Medical Center. Parkland serves the greater Dallas community with specialty care centers focused on trauma, burns, spinal cord injuries, cancer, endocrinology, epilepsy, gastroenterology, cardiology, and orthopedics. With a total of nine pharmacy sites currently—five Community Oriented Primary Care (COPC) pharmacy sites and four main-campus sites, with an additional COPC pharmacy site due to open in June 2009—Parkland fills an average of 6000 prescriptions daily.

Obviously, maintaining such a large patient population, spread over several pharmacies was a daunting process for us to handle. We needed to fully automate our ambulatory prescription dispensing to improve patient safety while increasing staff efficiency and controlling costs. In the past, we were working with a collection of technologies from different companies, so we felt it would be more practical to work with a single vendor platform. We also had a need for updated patient safety features such as bar coded labels, image scanning of prescriptions, stock replenishment via bar coding, and the ability to store and track NDCs, lot code, and expiration dates on stock within the automation system.

Revamping Our Technology Platform
The pharmacy driven search for a more comprehensive system led us to implement Innovation’s PharmASSIST technology platform across all nine of our pharmacy sites in November 2008. PharmASSIST’s Symphony workflow management software serves as the core workflow platform, and we also included automated filling technology via the PharmASSIST ROBOTx for those sites with higher volumes of prescriptions. As our configuration varies among the different pharmacy sites, we were able to determine the areas that needed more advanced, robotic solutions, and those that could be handled using manual filling. In either case, we employed a combination of PharmASSIST robots, cabinets, and Smartscales at each ambulatory site. Prescription volumes followed by space constraints were the factors that determined the type of technology deployed at each site. As the footprint of the new automation was relatively small, we actually gained storage space and extra walkway room inside most of our pharmacies.

How the New System Works
By employing the PharmASSIST Symphony workstations throughout our workflow, we could easily manage all stages of prescription administration, from order entry and prescription imaging and filling (both automated and manual), to verification, will call, and patient pickup. With PharmASSIST, a pharmacist enters prescriptions on the front line and the drug is diverted for filling to a robot, cabinet, or manual-filling queue. A technician will then retrieve the filled drug from the robot, fill the drug using the cabinet, or manually fill the drug using the Smartscale. The prescription is then placed in a packing box to be verified by a pharmacist. Once verified, the prescription is stored in a will call location to await pickup by the patient.

Training and Results of the New System
The PharmASSIST platform proved very easy to learn, as it is a logical system for the user to operate. Because it is user-friendly, training was very straightforward. Innovation provided an online training module, as well as on-site training at our pharmacy sites prior to going live. Innovation staff was present at our training sessions and made themselves available during our go-live stage to address questions or issues that developed. Overall, our pharmacy staff is very pleased with the new system. We have realized im­provement in inventory management and control, reporting, and productivity, all which contribute to our governing goal of increasing patient safety.

I would advise pharmacies to examine their projected volume and staffing requirements and weigh the benefits and detractions of automation versus additional staff. From an efficiency standpoint, the PharmASSIST platform has added much needed structure and has helped us streamline our entire fulfillment process, enabling us to reduce our turnaround times by 30%.

 
Vivian B. Johnson, PharmD, MBA, FASHP, is director of pharmacy services at Parkland Health & Hospital System in Dallas, Texas. She received her BS in pharmacy from Florida A&M University in Tallahassee, Florida, a doctor of pharmacy from Mercer University in Atlanta, Georgia, and a MBA from the University of Dallas. Her practice interests include medication safety, process improvement, clinical practice systems, clinical research, and operations management. She has worked at Parkland for 23 years.