Full Cycle Automation Increases Safety at Military, Other Federal Pharmacies

by U.S. Medicine

July 8, 2014

By Annette M. Boyle

TAMPA ‑ What price safety? About $100,000. That’s the cost of replacing manual bagging and retrieval of prescriptions with automated tracking and secure storage for 1,000 prescriptions per week ‑ and substantially increasing patient safety.

Pharmacy technicians swipe their individually unique microchipped badges in order to retrieve the illuminated bin containing a patient's prescriptions at the 6th Medical Group on MacDill Air Force Base last summer. Air Force photo by Senior Airman Michael Ellis

Pharmacy technicians swipe their individually unique microchipped badges in order to retrieve the illuminated bin containing a patient’s prescriptions at the 6th Medical Group on MacDill Air Force Base last summer. Air Force photo by Senior Airman Michael Ellis

MacDill Air Force Base in Florida installed its first Global Script Locator (GSL) system in April 2013 and found the benefits to staff and patients so significant that the system has now been implemented in the main base clinic pharmacy and the Brandon pharmacy and will soon be operational in the refill pharmacy, as well. So far, MacDill has installed six cabinets. The expansion to the refill center will take an additional five cabinets.

Besides MacDill, the Chickasaw Nation Medical Center and the Irwin Army Community Hospital have also implemented the GSL system.

“It’s not a cheap system, but it allows us to track prescription barcodes all the way through the process from receiving a prescription to handing it to the patient,” said Lt. Col. Douglas M. Odegaard Jr., BSC, chief of MacDill’s inpatient pharmacy. “The system wasn’t intended to save money. It’s designed to increase patient safety. You can’t put a pricetag on what an error would cost.”

The system’s software registers prescriptions when they are first generated and uses radio frequency identification technology to track when they are filled and where they are stored in special, secure cabinets. To retrieve the prescription, a pharmacist or technician scans the barcode on a patient’s identification card and enters the birthdate. Those two bits of information trigger a light to blink in the proper cabinet and shelf, indicating the location of the patient’s prescription.

The pharmacy staff member then swipes his or her badge to open the cabinet and retrieve the appropriate bin, which may hold more than one medication as long as they belong to the same patient. Alarms sound if someone attempts to open the cabinet without the proper badge or if a team member picks up the wrong bin.

“The system doesn’t save time initially,” Odegaard said, “but once you’ve worked through the processes for each pharmacy, then it becomes much more efficient. We’ve probably increased efficiency by 10%, which may not seem like a lot. But when you look at that across 646,000 prescriptions per year, it represents a significant amount of time.”

The system also saves space and reduces staff fatigue. “The cabinets replace the old totes and bags of prescriptions on big shelves. The cabinets take about one-third of the space the shelves did,” Odegaard noted. In addition, staff no longer must repeatedly scan long shelves to find the right prescription for each customer; they simply look for the illuminated bin.

MacDill’s pharmacies found that the software worked well in each setting without customization. “But each location had different challenges and a different way of handling patients that required some tweaking to our processes as we implemented the system,” Odegaard said. They are asking for one additional capability: text alerts.

“We are finalizing the process so we can automatically text patients when their prescriptions are available,” he added. Right now, text alerts go through a separate system.

The increases in efficiency and patient safety have attracted the attention of other organizations. “Since we implemented it, we’ve gotten a lot of phone calls about the system,” Odegaard said.

Other Air Force facilities also have expressed interest. In an analysis done for the 9th Medical Group at Beale AFB in California, Maj. Stephanie Stichert Forsythe, PharmD, found that MacDill pharmacy staff generally favored the GSL system. She also noted a notable decrease in errors, from one in 7,000 prescriptions, or about one per month, using the previous bag and shelf system to none in 67,000 prescriptions after implementing the automated system.

Forsythe concluded that “the GSL solutions equipment and software has eliminated dispensing errors due to misbundled, misfiled and mispicked prescriptions.” In addition, she noted that “patients had an overwhelming positive response to the GSL Solutions equipment and identified no issues with not receiving medications or receiving the incorrect medications.”

Fixing the “misbundled, misfiled and mispicked” errors will go a long way toward improving patient safety, but the Air Force and other pharmacies relying on automated equipment may still need to monitor “misfilled” prescriptions such as those recently experienced in the automated system at the Kittyhawk Pharmacy at Wright-Patterson AFB in Ohio.

In that incident, which remains under investigation, eight patients received prescription bottles with a mix of muscle relaxant and acetaminophen pills. Reports indicate no patients were harmed by the mix-up.

“They used a different automation system in Ohio,” Odegaard explained, “and the problems occurred in the refill pharmacy. I feel very comfortable with the machine here and our systems for protecting patient safety.”

The 6th Medical Group at MacDill serves 215,000 people and processes more prescriptions than any other single military treatment facility catchment in the DoD healthcare system, according to Odegaard. With that many people relying on the system, he said, “we have to stay focused on closing all avenues for potential prescription errors. This system was well worth the money spent.”


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