Improvement Opportunities in Hospital Pharmacy

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Improvement Opportunities in Hospital Pharmacy Building on Automation with Intelligence Executive Summary 3 Contents 1 2 Medication Management Challenges 4 3 Goal of the Autonomous Pharmacy 5 4 Challenges of Adopting an Autonomous Model 6

Adding Data Intelligence to Automation 5 Drives Better Performance 8

6 Conclusion 9

Citations 10 1

Executive The cost, harm, and risks of manual medication Summary management are ever-increasing for hospital pharmacies. Incorporating automated processes on a path to zero-error medication delivery, however, improves patient safety, drives immense cost savings, and frees up clinicians to deliver better patient care. At the minimum, automated solutions need to consolidate data and give Chief Pharmacy Officers medication visibility to help them start solving inventory management problems.

But as the vision of the Autonomous Pharmacy coalesces, data intelligence solutions need to go beyond merely identifying problems; they must help pharmacies fix them—by delivering predictive intelligence, expert optimization services, and a workflow that makes it easy to take action and track improvements.

3 It’s not a new story. The lack of visibility and control across the medication supply chain continues to put a strain on hospital pharmacies, preventing clinicians from delivering the best patient care possible 2 and operating at the top of their license. With the gross cost of medication in the U.S. rising 5.2 percent to Medication $485 billion in 2018 and global spending predicted to exceed $1.5 tril- Management lion in 2023,1 accurate and efficient inventory management has never been more important. But manual workflows, limited technologies, Challenges and a lack of connectivity across data sets contribute to more than 70 million pounds of medication being wasted each year.2

Having inconsistent and siloed processes across health systems adds complexity, while also bogging down skilled pharmacists with manual tasks when they could be focused on improving medication outcomes. Stress and burnout rates remain at high levels,3 and there’s a limit as to how much work hospital staff can handle. Adding more administrators has not helped solve the challenges. While the rate of physicians has grown 200 percent since 1970, the number of healthcare administrators has grown 3000 percent.4 First, I cannot measure, Medication errors should be preventable but with manual processes “ so I cannot manage. still in place, these errors continue to risk patient safety, with 25,000 errors annually in hospitals dispensing 5 million doses.5 In addition, That’s an area of millions are paid each year to settle claims of mishandled controlled frustration for me substances, as diversion incidences continue to be a problem. and my management The adoption of advanced technologies is accelerating at a rapid pace team. Second, relying every year, changing the way products and services are delivered on manual processes across industries. Healthcare is no different, and the pharmacy care introduces error. Third, delivery model is currently undergoing its own transformation. although we’re using consultants, I still have Figure 1 to pull in resources that should be focused on patient care.” 1 in 10 250+ $72.5 billion A Administrative Director and healthcare active drug cost from Chief of Pharmacy Services for a workers will shortages in controlled nonprofit integrated healthcare system with a 586-bed acute care abuse drugs at hospitals per prescription drug Magnet®-designated hospital some point in year7 diversion and their career 6 abuse each year 8

4 The fully Autonomous Pharmacy is a strategic vision for the healthcare industry that seeks to apply connected automation and integrated data intelligence across care settings to complete previously 3 manual tasks and improve patient outcomes. It’s about eliminating manual workflows to achieve zero errors.

Goal of the Put simply, in the Autonomous Pharmacy every dose of medication Autonomous would have an equivalent digital node on the network. Each node carries valuable data about patients, medication inventory, and other Pharmacy details, allowing pharmacists to track a medication’s entire journey, and make informed decisions. The goal is complete visibility and regulatory compliance, with zero human touches until delivery of the medication to the patient, helping to ensure that 100 percent of a pharmacist’s time is spent on clinical activities.

As the vision of the Autonomous Pharmacy expands, the opportu- My autonomous nities to leverage the data from that automation become greater. “ pharmacy vision is to Data intelligence solutions can allow pharmacists to discover and act on insights that will impact inventory efficiency and help eliminate remove human touch diversion. Once realized, the fully Autonomous Pharmacy will include from the dispensing data intelligence that provides actionable information, a workflow that process and move supports taking action, and expert services to chart a strategic path forward and keep improving hospital outcomes. pharmacy to a zero- harm culture. We’ve The Autonomous Pharmacy Advisory Board, composed of leaders got to find creative in health system pharmacy from across the country, has defined the five stages toward achieving a fully autonomous pharmacy and the ways, using metrics benefits of progressing through each level. and comparative benchmarks, to develop Healthcare leaders can compare their organization to systems that decrease others on the autonomous path and learn more by variability and to downloading the Autonomous Pharmacy Framework decrease the number of white paper at autonomouspharmacy.com. human touch points in the dispensing process.”

A Ancillary Services Vice President at a 2,500-employee medical center with over a dozen facilities.

5 There is still a reluctance, however, on the part of some healthcare leaders to pull the trigger on implementing the kind of transforma- tive changes that will unify data systems and optimize medication 4 inventory. The first roadblock may be based on a fundamental mis- understanding: The Autonomous Pharmacy doesn’t replace humans, it replaces human error. Hospital pharmacy staff are not replaced Challenges of by advanced robotics and automated processes—they are instead Adopting an reallocated to realize the full potential of their clinical roles, resulting Autonomous in better outcomes across the board. Model When it comes to technology, the siloed approach and complexity of hospital pharmacy IT systems currently in place is already daunting. Managing that tangled infrastructure is often a full-time job unto itself, so administrators are often hesitant to make structural changes that would impact current workflow.

And then there’s cost. With drug spend on the rise, it’s also some- times difficult for decision makers to justify the short-term cost of automated solutions, even if they understand that the investment in transformation will pay off in the long term.

Lastly, the lack of visibility across medication inventory is mirrored by pharmacy systems’ inability to see opportunities for improvement, or to implement recommendations altogether. How does one take advantage of insight if there’s no workflow to assure that action is taken?

Our goal is to make our patients safer and to “ control drug spend. From a pharmacy automation and technology standpoint, to be successful we need all of our key centers tied together on one enterprise database.”

A Administrative Director and Chief of Pharmacy Services for a nonprofit integrated healthcare system with a 586-bed acute care Magnet®-designated hospital

6 With advanced inventory automation solutions, it’s no longer just about automating processes for savings, accuracy, and efficiency. Imagine if pharmacists had access to predictive intelligence that 5 could send actionable workflows to technicians, allowing them to make adjustments at the cabinet level, and calculate those savings and efficiency levels in a scorecard, which would be viewable by the Adding Data pharmacy administrator. Imagine an advanced diversion elimination Intelligence to tool that could offer true closed-loop medication dose reconciliation of all controlled substances, analyzing behavior patterns, and Automation assigning risk identification scores to streamline the process. Drives Better Across the enterprise, data intelligence solutions enable businesses Performance to analyze operations and make real-time decisions to facilitate improvements. These solutions, offered as a subscription service, often use cloud-based predictive intelligence. Cloud-based technology plays a key role in digital transformation, offering the speed and affordable cost of the cloud with the security and control of your own environment. 9

Healthcare software-as-a-service platforms convert data visibility into pharmacist insight and action, and may include a team of data scientists and clinical strategists who collaborate with pharmacy leadership to develop optimization plans and performance improvement strategies.

The decision to augment automation with data intelligence solutions can be made at any point on the path to the Autonomous Pharmacy. If a healthcare system has already committed to transformation but hasn’t yet completed all stages—or is in need of hardware/system upgrades—embracing the associated pharmacy intelligence solutions is the best way to get the most out of an investment that’s already been made.

The channels where advanced intelligence solutions and tailored partnership and support have succeeded thus Government Academic Community National Standalone far include a diversity of size medical health health hospitals and scale, such as: centers systems systems

7 In summary, the issues that plague medication management are being overcome by the adoption of automated technology and processes in hospital pharmacies. Formerly manual tasks are now 6 being performed with zero error, leaving nurses and pharmacists to concentrate on delivering better patient care. Innovation in automated pharmacy solutions is also catching up to the digitization of insights Conclusion and workflows in other industries.

As healthcare systems get closer to realizing the vision of the fully Autonomous Pharmacy, it is the combination of cloud-based data intelligence, visibility, action-based workflows, and expert services that will drive future innovation and implementation.

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We can reallocate resources to support population health “ initiatives. Rather than focusing on medication inventory work in the pharmacy, our staff can get out on the floor to interact with nurses, physicians, and patients from the point of admission to discharge, which will help lead to improved patient outcomes.”

A Director of Pharmacy Operations at a 1,300-bed health system on three campuses

8 1. The Global Use of Medicine in 2019 and Outlook to 2023. (January 2019). Citations IQVIA INSTITUTE for Human Data Science

2. Based on 2016 Stericycle data, this includes RCRA and non-RCRA pharmaceutical waste: https://www.stericycle.com/services/compliance/hospitals-and-healthcare-systems

3. The American Journal of Health-System Pharmacy (AJHP) reported that 53.2% of health-system pharmacists experience a high degree of burnout on at least 1 subscale of the Maslach Burnout Inventory–Human Services Survey (MBI-HSS)

4. Bureau of Labor Statistics; National Center for Health Statistics; and Himmelstein/ Woolhandler analysis of Current Population Survey (CPS).

5. Poon, China, Churchill, et al. Ann Intern Med 2006; 145(6):426-434

6. Katie Looze Bronk. Joint Commission issues Quick Safety advisory on drug diversion and impaired health care workers. The Joint Commission, April 16, 2019.Reducing IV Compounding Errors at a Pediatric Hospital : May 2015 https://www.pppmag.com/article/1684

7. Drug Shortages Statistics https://www.ashp.org/Drug-Shortages/Shortage-Resources/Drug-Shortages-Statistics

8. AHIA, Drug Diversion Prevention and Detection, July2018 https://ahia.org/AHIA/media/WhitePapers/DrugDiversionPreventionAndDetectionJuly2018.pdf

9. Pointnext on digital transformation | HPE https://www.hpe.com/us/en/insights/reports/hpe-pointnext-on-digital-transformation-1711.html

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