The following is a guest article by Gee Mathen, Assistant Director of Pharmacy Applications and Technical Services, Texas Children’s Hospital.
The largest children’s hospital in the U.S. has implemented a phased rollout of automation solutions from Omnicell to minimize dosing risks unique to pediatric care, realize real-time inventory visibility and control, and save millions annually.
One succinct way of describing Texas Children’s Hospital (TCH) is that we’re very large and very good. We’re the largest children’s hospital in America, and for ten consecutive years, U.S. News & World Report ranked TCH #4 of 200 pediatric hospitals in the country. This year we rose to the number-three spot.
Constantly striving for excellence of care—which of course most hospitals and health systems aspire to, regardless of their size—comes with an array of challenges. Doing that while operating at massive scale comes with even more. Perhaps nowhere are these challenges more evident than in medication management, where substantial amounts of money are tied up and—more importantly—lives can hang in the balance.
TCH has long been committed to harnessing technological innovations to drive better outcomes. Over the past two years, we’ve deployed a phased implementation of the automated medication management platform from Omnicell, and our vision and investment are already paying off handsomely in improved patient safety, workflow efficiencies, and cost savings.
Drug waste and inventory blindness
Hospitals and pharmacies across the U.S. lose billions annually due to expired or unused medications. At TCH we purchase more than $150 million in pharmaceutical products each year. Yet until recently, we had zero real-time visibility into that inventory. To truly know what we had, how much we had of it, and where we had it, our only recourse was to search manually. That’s time-consuming and inaccurate. As a result, we annually threw out $2.5 million in expired medications and $17 million in dead stock inventory.
Add to that enormous price tag of inefficiency other costs such as the lost opportunity for pharmacy staff to focus on more important tasks or patients themselves. According to an American Society of Health-System Pharmacists national survey conducted in 2015, pharmacy directors estimate that 76 percent of staff time is devoted to non-clinical activities. When repetitive and tedious, those activities offer less satisfaction to staff and less value to patients—while simultaneously risking dangerous inaccuracies.
Human error and patient safety
Above all other automated-versus-manual considerations, patient safety is the most compelling. As a system, TCH prepares 5,000 doses of medication a day and ninety percent of those are hand-manipulated. Studies show that per 1,000 doses of medication prepared, human accuracy is 97 to 98%. By comparison, robotic compounding is accurate 99.9% of the time. Any amount of variation is unacceptable, but that’s particularly true in a pediatric setting. The small, developing bodies of neonates and children require precisely calibrated dosing.
As TCH’s Chief Safety Officer Dr. Joan Shook is fond of saying, “If we’re not safe, nothing else matters here.” The only sure way to mitigate dosage error and achieve complete inventory control is by reducing the number of human touchpoints.
Getting real-time visibility into inventory
The first and foundational phase for achieving pharmacy automation is the migration from manual processes to a medication management software program. TCH did that with Omnicell in early 2018. The software tracks every individual drug dose in TCH’s facilities, and as a result we now enjoy 95% real-time visibility into our inventory. We’re notified of pending expiration dates, enabling us to move medications to higher-use locations, and with accurate inventory and usage data our medication purchases can be optimized for actual need. Soon, our drug waste will be reduced to almost zero.
Automated picking, dispensing, compounding, storage, and replenishment—with less error
This past year we took the next steps into automation by installing an intravenous-fluid-compounding robot from Omnicell, the Robotic IV Insourcing Solution, and five Omnicell XR2 Central Pharmacy System robots across our system. The XR2s are back-end workhorses, each capable of picking, scanning, and bagging an average of 700 medications an hour, 24 hours a day, 7 days a week. According to our own study, each robot is at minimum 583% faster than humans and dramatically less error-prone.
Interfacing with the medication management software and TCH’s electronic medical record (EMR) system, the XR2 robots dispense ordered medications along with destination information. Our pharmacy technicians arrive at work to find medications bagged, tagged, and ready for distribution. The robot knows what medications need replenishing in our automated cabinets (each holds 90,000 items and the modular design allows easy expansion) and, interfacing with the drug distributor’s system, orders new drugs to replenish inventory.
By insourcing IV compounding, which we did before manually, a hospital can reduce costs and store on-site, thereby reducing potential outsourcing delays and communication errors. But now that our solutions are robotically prepared in a sterile environment, they’re largely free of both human error and contamination, and can be stored up to 30 days while human-prepared solutions can expire in just eight hours. That’s big.
Enormous upside, very little downside for TCH
Incredible as it may be to hear, with so much upside there’s been little downside to TCH’s journey to medication management automation. Even the considerable capital investment in Omnicell’s autonomous pharmacy infrastructure should be recovered almost immediately with the annual 16-percent reduction in medication costs that we predict. Moreover, automation hasn’t reduced staff but rather offered us the opportunity to redeploy resources to higher-value work. For instance, pharmacy technicians that previously compounded are now freed up for quality-control functions or preparing doses that require specialized attention such as those for chemotherapy.
The pharmacy of the future
For other hospital and systems considering automation, you’ll obviously need organizational buy-in for the capital outlays. But you’ll also need strong buy-in for the required support once it’s deployed. It’s all about technology-enabled consistency and accuracy, which doesn’t necessarily mean reducing staff. But there’s no getting around the fact that this minimizes human touch where it’s inefficient, costly, imprecise, and detrimental—and empowers human focus where it’s welcome and needed.
The autonomous pharmacy is pharmacy of the future, and with it TCH is streamlining workflows, driving cost savings, and transforming patient care. I’m proud that TCH in partnership with Omnicell is leading the way, and I hope we’ll serve as an inspiration and a model for other hospitals and systems.