An area of great progress in Healthcare technology has been the wide adoption of automated dispensing cabinets for medications and supplies in hospitals and other healthcare facilities. This technology employs the use of storage units that operate somewhat like vending machines for the medical products, but also have sophisticated software on the back-end that handles patient orders, medication dosing documentation, inventory management, and billing transactions. This post will cover automated dispensing cabinets as well as centralized pharmacy automation products.
Medication Dispensing Systems
In a hospital or other clinical setting, the units are installed at most units where patients are seen, such as General Medicine, ICU, the OR, and the ER. Supplies and/or meds are enclosed in the cabinets that are locked until the clinician accesses them. Here are the typical steps taken for a medication transaction:
A physician order is not required for some medical supplies, so when those are dispensed, the user just logs into the cabinet, then selects the patient and supplies. Also, some supplies are tracked under “floor stock” because they are general use supplies.
Automated Dispensing Cabinets Manufacturers
When looking at this market, we should consider that there are several product lines, including: https://cleverlab748.weebly.com/blog/redfueljumpstartersl161usermanualpdf.
For purposes of this article, I’ll focus mostly on the medication and supply management products.
Automated Dispensing Cabinets. Omnicell's automated dispensing cabinets (ADCs) improve medication management in hospitals and residential aged care facilities at the point of patient medication delivery. Omnicell XT Automated Medication Dispensing Cabinet Choices. No other medication dispensing system offers more cabinet choices to meet the needs of acute and non-acute care sites. Medications and supplies can be combined in a single cabinet, adding convenience and saving space. Drawers can easily be added or changed on-site as clinical needs change. Automated dispensing cabinets (ADCs) were introduced in hospitals in the late 1980s. ADCs do not improve safety unless the cabinet’s design and use are planned with attention to the following factors: Patient Profiling. Such as robotic dispensing or manual cart fills, which include several built-in redundancies. Cabinet, you can improve your overall inventory management, patient safety, and medication security. Of further benefit to your patient safety bottom line, automated dispensing cabinets allow the pharmacy department to profile physician orders before they are dispensed. Automated cabinets can also enable providers to capture medication charges.
Pyxis Corporation
The market leader for automated medication management is Pyxis Corp, based in San Diego. They were fortunate to be the first to the game with their MedStation products in 1990. They wasted no time in penetrating the hospital market with their first generation MedStations, and many hospitals have remained loyal and grown along with Pyxis. In the mid-1990s, Pyxis launched their SupplyStation line to manage the medical supply chain. This technology was initially built as an extension of their medication products, but was not nearly as successful, as supplies shouldn’t really be managed like medications. In 1996, Pyxis was acquired by Cardinal Health. Their growth continued, and they maintained between 60-70% of the market share for pharmacy dispensing systems that continues to now. In 2009, Cardial spun off clinical and medical product divisions, including Pyxis to form CareFusion. Then CareFusion was sold to Becton Dickinson in October 2014. In spite of the multiple buyouts, Pyxis has managed to stay fairly strong in the market.
Omnicell
Randall Lipps had a child who was hospitalized at birth. As he kept vigil at the hospital, he noted the inefficiencies of the medical supply process. Taking input from nurses, and using his technical and operational background, he formed Omnicell in 1992. The first product line was the OmniSupplier cabinets. While the early Pyxis SupplyStations secured supplies as if they were medications, Omnicell saw that supplies needed a different workflow. The OmniSuppliers had clear Plexiglass-like panels on most sides, making it easier to see supplies. They also made it faster to get in, get supplies, and log out, and used a patented “guiding lights” technology to help users locate supplies in the cabinets.
While Omnicell began in the supply management side, they did not get into medication dispensing systems until 1996. Like Pyxis, they have launched or acquired other pharmacy automation products, such as anesthesia carts and central pharmacy systems. They have also acquired a healthcare analytics solution called Pandora, MACH4 Pharma Systems of Germany. Their newest acquisition was the AcuDose products in January 2016. Of the three largest vendors in this industry, they are the only one to retain their original corporate structure. Disclosure: I worked for Omnicell from 1995-1999.
AcuDose
AcuDose is the third largest pharmacy automation product line. They were originally formed as Automated Prescription Systems, Inc. of Pineville, La, and were acquired by McKesson in 1998. McKesson then sold off the business to Aesynt in 2013. Then they were sold yet again to Omnicell in January 2016. Their dispensing units have been recently redesigned, and offer a feature that allows nurses to hold their place in the workflow if they get interrupted and have to come back later. When the user logs back in, the system remembers where they left off. AcuDose also has the ROBOT-Rx central pharmacy automation product, which is covered in the next section.
Cerner RxStation
A newcomer that could actually turn out to be a game-changer is the RxStation system from Cerner. Cerner is one of the largest providers of enterprise EMR and clinical documentation software. https://cleverlab748.weebly.com/blog/delonghi-coffe-maker-bar-32-user-manual. What sets RxStation apart from the others is that it was developed by a major software vendor, built as an integrated solution on top of an existing product. Cerner claims that no interfaces are needed, as the dispensing cabinets are integrated with the Millennium products.
Capsa Healthcare
Capsa Healthcare is an Oregon based provider of automated medication carts, computing workstations, and pharmacy automation. Capsa proposes to have the best security for managing controlled medications, STAT/first doses and e-kits. Their hardware supports medications in a variety of packaging, from unit dose to punch cards and bulk supplies. They also have two robotic centralized pharmacy packaging machines.
Automated Dispensing Cabinets Workflow
Here is a diagram that covers many of the functions that occur in the course of operating automated medication dispensing units.
Pharmacy Automation
I’m going to switch gears from the point-of-care units to cover centralized pharmacy automation. This is a technology solution used in retail as well as hospitals and regional pharmacies that serve nursing homes and other long term care locations. Whereas the dispensing cabinets are used for Stat meds and orders written at the point of care, the centralized units are for longer term med orders. The units tend to be large, covering a good portion of the floor in a central pharmacy. They run continuously, creating packaged units of meds per patient, complete with a barcode dosing label and instructions. The packages then get delivered to the correct nursing unit or facility. They have the advantage of helping to manage large quantities of medications, and perform conflict and allergy checking.
Unlike the medication dispensing cabinets, the market of central pharmacy robots is more crowded. Some of the other suppliers of this technology are AmerisourceBergen, Dossette, and RxSafe.
Automated Dispensing Cabinets Comparison
Pharmacy Automation Benefits
When medication and supply dispensing cabinets first became popular, Healthcare facilities were very focused on hard dollar savings, which is not a bad thing. It did take some time for organizations to learn how the use the systems to their greatest capacity and also recognize the soft savings in terms of user productivity. Some of the benefits that have emerged are:
Here are some case study numbers for the top three vendors:
Pharmacy Automation Jobs
Because this is where I got my start in Healthcare IT, I do have a special appreciation for this career choice. If you are looking to get started in Healthcare IT, have basic technology skills, and are willing to travel, you have a decent chance of getting a job as an Implementation Consultant or Field Engineer. Having some Microsoft or Network+ certification helps, as well as having a pharmacy tech background. If you have programming and/or HL7 experience, then you would have a good chance at a developer position.
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Automated Dispensing Cabinets | Pharmacy Automation
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Automated Dispensing Cabinets and Pharmacy Automation. Learn about Pyxis, Omnicell, AcuDose, Capsa, and ROBOT-Rx systems used in hospitals and retail pharmacies.
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An automated dispensing cabinet (ADC) is a computerized drug storage device or cabinet for hospitals and many other healthcare settings. ADCs allow medications to be stored and dispensed near the point of care while controlling and tracking drug distribution. They also are called unit-based cabinets (UBCs), automated dispensing devices (ADDs), automated distribution cabinets or automated dispensing machines (ADMs).[1][page needed]
Overview[edit]
A Pyxis SupplyStation at Campbell County Memorial Hospital in Gillette, Wyoming
Hospital pharmacies have traditionally provided medications for patients by filling patient-specific cassettes of unit-dose medications that were then delivered to the nursing unit and stored in medication cabinets or carts. ADCs, which are designed to replace non-automated floor stock storage, were introduced in hospitals in the 1980s and have facilitated the transition to alternative delivery models and more decentralized medication distribution systems.[1]
While no one method for medication distribution works for every facility, implementing automated dispensing cabinets as part of a decentralized or hybrid medication distribution system can improve patient safety and the accountability of the inventory, streamline certain billing processes, and ultimately, lead to increased nursing and patient satisfaction.[2]
Because automated dispensing cabinets track user access and dispensed medications, their use can improve control over medication inventory. The real-time inventory reports generated by many cabinets can simplify the fill process and help pharmacy track expired drugs. Furthermore, by restricting individual drugs – such as high-risk medications and controlled substances – to unique drawers within the cabinet, overall inventory management, patient safety, and medication security can be improved. Automated dispensing cabinets allow the pharmacy department to profile physician orders before they are dispensed.[2]
Automated cabinets can also enable providers to record medication charges upon dispensing, reducing the billing paperwork pharmacy is responsible for. In addition, nurses can note returned medications using the cabinets' computers, enabling direct credits to patients' accounts. Since automated cabinets can be located on the nursing unit floor, nursing have speedier access to a patient's medications. Decreased wait time for medication can lead to less frustration for nursing staff and prevent conflict between the pharmacy and nursing staff. Also, shorter waiting time ensures improved patient comfort and care.[2]
ADCs were originally designed for hospital use. However, in the 2000s the technology began to be deployed into other care settings where medication doses were stored onsite and higher security methods were needed to control inventory, access, and dispensing of each patient dose. Settings that now deploy ADCs include long-term care facilities, hospice, critical access hospitals, surgery centers, group homes, residential care facilities, rehab and psych environments, animal health, dental clinics, and nursing education simulation. All of these diverse care settings share a common need to safely store, account for, and dispense individual doses of medications (especially narcotics and high-value medications) at the point of care.
Role of automated dispensing in healthcare[edit]
Automated dispensing is a pharmacy practice in which a device dispenses medications and fills prescriptions. Automated dispensing cabinets, which can potentially handle hundreds of different medications are available from a number of manufacturers. Though members of the pharmacy community have been utilizing automation technology since the 1980s, companies are constantly refining and improving ADCs to meet changing needs and health standards in the industry.
Several goals can be met by implementing an automated solution in a healthcare facility. The most important thing a hospital pharmacy should enforce is patient safety. Wrong drug and wrong dose errors are the most common errors associated with ADC use. Look-alike drug names and drug packages are common variables that lead to selection errors. For example, morphine and hydromorphone are two different opioid analgesics that frequently get confused.[1]
Omnicell Drug Dispensing SystemKey features[edit]
ADCs are more than automated teller machines for drugs and reflect how design advances as well as, specific technologies, such as barcode scanning and clinical decision support, can improve medication safety. Over the years, ADCs have been adapted to facilitate compliance with emerging regulatory requirements such as pharmacy review of medication orders and safe practice recommendations.[3]
Automated dispensing cabinets incorporate sophisticated software and electronic interfaces to synthesize high-risk steps in the medication use process.[3] These unit-based medication repositories provide computer controlled storage, dispensation, tracking, and documentation of medication distribution on the resident care unit. Since automated dispensing cabinets are not located in the pharmacy, they are considered 'decentralized' medication distribution systems. Instead, they can be found at the point of care on the resident care unit. Tracking of the stocking and distribution process can occur by interfacing the unit with a central pharmacy computer. These cabinets can also be interfaced with other external databases such as resident profiles, the facility's admission/discharge/transfer system, and billing systems.[4]
ADCs are designed to meet the exact needs of the nurses and pharmacists that use them. When ADCs are purchased for a facility, the order is customized for whatever the cabinet will be specifically used for.
The drawers are available in a variety of configurations including locked, matrix, and sensing. Many ADC units include built-in tamper-evidence technology.
Most ADC providers offer scalable systems since several important factors vary widely by facility: Budget (and who is paying for the unit, the pharmacy or the facility); physical room size (frequently ADCs are stored in a 'med room'); patient population/demographics (e.g., a 100-bed LTC facility's medication storage needs will differ from a 15-patient hospice facility); type of healthcare facility (e.g., large IDN, medium-size senior care facility, or specialized surgery center). Therefore, ADCs can be countertop-sized for smaller budgets, spaces and patient population needs. They can be a free-standing cabinet for larger storage needs. Or multiple cabinets and refrigerated units can be networked together as one computer controls access to each specific bin, drawer, refrigerator door, or locked cell.
See also[edit]References[edit]Omnicell Automated Dispensing Cabinet User Manual Software
Omnicell Automated Dispensing Cabinet User Manual Free
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