Strong Memorial Hospital, part of the University of Rochester Medical Center, is a quaternary care, level 1 trauma center with a licensed bed count of 739, and includes a pediatric hospital, burn center, psychiatry hospital, and heart transplant center. The inpatient pharmacy employs approximately 110 FTEs comprising pharmacists, technicians, clinical specialists, administrative personnel, and other support staff. We employ a hybrid-dispensing model using the Swisslog PillPick system as the key component of our centralized distribution process, and the Pyxis system as the decentralized component.

Identifying Challenges and Solutions
Prior to seeking an automated inventory system, we faced challenges common to any manual system. Maintaining an adequate supply of critical medications while avoiding costly overstocking was difficult to achieve on a consistent basis. In addition to negatively affecting our costs, overstock also took up valuable space in the pharmacy. After considering various automated storage options, we decided on Swisslog’s BoxPicker system due to its efficiency and safety features. We ended up implementing two BoxPicker units; one unit is refrigerated, and stores approximately a third of the inventory stored in our non-refrigerated unit.
Other than raising the ceiling to accommodate the height of the devices, we only had to make minimal changes to our physical space. We also had to make modifications to our HVAC system to provide chilled air for the refrigerated unit. We were fortunate that we did not have to reinforce the floor, which likely would have been necessary had we decided on a carousel array. Our networking needs included creating an interface between the BoxPicker system and our Pyxis automated dispensing cabinets (ADCs). We also modified the interface to our pharmacy information system (PIS) to accommodate patient specific dispensing, and created an interface to our wholesaler to allow for automated reordering and invoice processing.

Improving Security and Efficiency
We store approximately 85% to 90% of our inventory in the BoxPickers. Inventory that is not stored in the system includes oversized fluid bags and fast-moving, inexpensive floor stock items such as ibuprofen or acetaminophen. While orders can be sent directly from our PIS to the BoxPicker, we rely on Swisslog’s PillPick system for patient specific dosing. Thus, we use the BoxPicker primarily to re-stock other areas, including refilling our ADCs. All items dispensed by the BoxPicker are affixed with bar code labels, ensuring accuracy during the ADC restocking process.

Automating the reordering process has improved the efficiency of our inventory stocking as it now is based on PAR levels, which can be automatically adjusted based on use. We experience significant time savings and the virtual elimination of expired drugs being dispensed, as the BoxPickers automatically check for expiration dates.

Workflow Changes and Benefits
With automated ADC replenishment, orders are created by the technician and automatically dispensed from the BoxPicker based on the current count and PAR levels. These orders are captured along with the additional dispensing from the BoxPicker, creating appropriate reorder quantities for our wholesaler. The PAR level then can be adjusted based on trends in daily use.

Bringing the BoxPicker system on-board has led to several practice improvements. We are realizing more timely replenishment of our ADCs, which leads to faster turnaround and reduces the frequency of stock-outs, a critical goal in maintaining patient safety and service to nursing. We also have additional safety precautions that ensure accurate dispensing for each medication (i.e., bar code verification of each drug removed from the BoxPicker and bar code verification at the ADC for each item), and more accurate inventory replacement through our wholesaler order in the stockroom. The refrigeration system has built in redundancy to protect the integrity of the medications stored in that unit. We also have a robust service contract that places a dedicated Swisslog technician on site approximately 25 hours per week, and includes 24/7 on-call service.

Conclusion
The most apparent effects of the BoxPicker have been the significant initial reduction in inventory, and the ongoing savings as a result of wasting less expired drugs. The security of a single dispensing and loading point provides peace of mind regarding access and accountability. The BoxPicker also is customizable, so manipulations as to the number of workstations available and their placement (i.e., on the same or alternate side of the unit) help conform to your existing pharmacy layout and operations. Ultimately, improved processes for inventory management and order processing provide more of the most valuable resource in hospital pharmacy practice—time. The BoxPicker has allowed our storeroom staff to focus more on critical service issues and improve our efficiencies around managing stock.

David F. Webster, RPh, MSBA, is associate director for inpatient services at the University of Rochester Medical Center. David received a BS in biochemistry from Saint Bonaventure University, a BS in pharmacy from State University of New York at Buffalo, and a MSBA in operations management from the Simon School of Business at the University of Rochester.