Implementing Automation and Technology Systems

1. Implementing Automation and Technology Systems When Its Good, Its Very, Very Good, And When Its Bad… Marian Daum Christopher Lambert Roosevelt Gillespie

2. OJBECTIVES • Evaluating your needs: • Choosing the right equipment for your operation • Other factors to consider - • Maximum Output • Minimum Requirements • Reliability • Service Contracts

3. OJBECTIVES • Pre-implementation – who needs to be at the table • Within your department • Within your facility • Within your medical center • Are your timelines realistic • Are there any other issues? • What does a good installation look like?

4. OBJECTIVES • Doesn’t the machine do the work for you? • Setting up a Training Program • Assessing Competence • Common Training Pitfalls

5. OBJECTIVES Can the system generate the reports you need? Do you have the right medication in the machine? Are your par levels set too high or too low? What else is the system telling you?

6. Automating a ProcessChoosing the Right Equipment for your Program Why can’t I get a replicator and a transporter unit ???? Marian Daum

7. AUTOMATING A PROCESS • What to you want to get out of automating your process? • Lower inventory, better turn around time • The same amount of medication stored using less space • Tight control of a process with accountability at each step

8. AUTOMATING A PROCESS MANUAL PROCUREMENT PROCESS

9. AUTOMATING A PROCESS • What are your options? • McKesson MedCarousel • SwissLog Box Picker • Omnicell WorkflowRx • Talyst AutoCarousel • Automed FastFind

10. AUTOMATING A PROCESS

11. AUTOMATING A PROCESS

12. AUTOMATING A PROCESS

13. CHANGING EXISTING AUTOMATION Why do you want to change your process? Process time starts out okay in the morning, but have a processing time of over an hour by 2PM. Problem prescriptions go into an exception file and you find this out when the patient comes up to the pickup window to complain.

14. CHANGING EXISTING AUTOMATION • Is it reliable? • Do you get adequate support from the vendor’s help desk? • Is there newer, more efficient technology out there?

15. CHANGING EXISTING AUTOMATION Is this machine still able to handle your current workload? • Look at hourly processing time in VistA Bingo Board Manager Program • Is your staff waiting for the machine to finish processing prescriptions? • Is there work that you can shift to another time?

16. CHANGING EXISTING AUTOMATION • Upgrade vs. Replacement • Cheaper and Less Disruptive • Newer Version or Higher Capacity Version of Same Vendor’s Equipment • Same interface, staff familiarity, disruptive • Change to another vendor’s equipment • Most disruptive, staff retraining, patient inconvenience

17. Changing Existing Automation • Why are you making the change? • Table of requirements and desires ranked from most to least important • Map out the process. What are the holes in your system?

18. Changing Existing Automation Biggest requirement - Prescription filling capacity during peak hours of operation. ScriptPro SP200 is the existing equipment - Upgrade with RCM model

19. Implementation & Installation: Avoiding the Pitfalls Christopher Lambert

20. You Bought It: NOW WHAT?How to Build an Implementation Team • Identify the Pharmacy Project Manager • Identify the Departments Involved / Departments Impacted • Identify Responsible / Key Staff within Each Department • Schedule Implementation Meetings • Distribute the Timeline

21. Identify the Pharmacy Project Manager (That’s you, sucker)That’s you sucker

22. Identifying the Departments Involved • Manufacturer Implementation Manager • Information Resource Management (IRM) • Data Drops / Telephone Lines / Server Housing • Information Security Officer (ISO) • If equipment is on the VA network • Engineering / Interior Design / Biomed • Prepare space for equipment • Infrastructure upgrades (electricity – compressed air)

23. Identifying Impacted Departments • Nursing • Procedure Changes • Medication Packaging Changes • Pharmacy Staff • Assignment/Responsibility Changes

24. Identify Responsible / Key Staff within Each Department Request that each involved department assign a staff member and a back-up contact for the project.

25. Implementation MeetingsGood Communication is Key to a Successful Project • All involved departments and Manufacturer Implementation manager • Clarify each departments responsibility • Review Manufacturer Timeline • Schedule follow-up meetings • Keep and distribute minutes

26. Timeline-Delegate but Verify -Each assignment is assigned to a specific Implementation Team Member. -Completed assignments Verified by Pharmacy Project Manager. -Verify Manufacturer is staying on schedule

27. Pharmacy Implementation Preparation • How will the work get done during Implementation? • Plan contingencies • Schedule for off peak periods • Limit annual leave • Prepare for implementation to take much longer than planned

28. What Can Go Wrong: Don’t Let this Happen to You

29. Automation Training and Competency Does anybody know how to work this thing???? Roosevelt Gillespie

30. Fallacy: Automation equipment does the work Truth is real live human beings do the work, and the automation equipment is just a tool they use to do the work, either: Faster In greater volume More accurately etc.

31. Typical enthusiasm storyline • Vendor states equipment can fix all problems = High enthusiasm • Getting $$ appropriated to buy gizmo = Less enthusiasm • Coordinating delivery and installation = Significant dent in enthusiasm • Fixing and solving all interface issues, populating databases, assigning privileges = BIG drain in enthusiasm • Discovery that the installed equipment didn’t solve all problems as promised = Last drops of enthusiasm drained • Desire to train staff on equipment use = ENTHUSIASM TANK EMPTY  DON’T FORGET TO TAKE A BREATH, REGAIN YOUR COMPOSURE AND FUEL UP FOR TRAINING!

32. Staff Training: The Pen-Ultimate installation step Frequently used and high value pieces of equipment all have the same thing in common: • Competent staff who really know how to use the equipment • Confident staff who know what they are doing with the equipment

33. The most effective staff have often been…. • Trained by the vendor at the time of installation at least once  • Trained yet again shortly after by the local super user (someone they know and trust) • Trained yet again by themselves where they can “tinker” answer their own questions by trial and error in private

34. The worst training possible Whatever staff in attendance that Friday are gathered during lunch break for an un-announced training session on new equipment. The installer runs through the equipment use, point to an operating manual and a CD that also contains the manual. The 1-800 number on the machine is referenced. The installer smiles at the group, asks if there are any questions on what they just demonstrated and when there are no questions has the group sign the training sheet……….

35. Better training • All staff (including nights/weekends/part time) are included • Training time is after breakfast, but well before lunch • Groups for training are smaller and more intimate when possible • Extra staff coverage is provided during trainings sessions, so staff do not feel they are falling behind with their regular work • Staff know what equipment is, what it does and have questions prepared in advance • HANDS ON, HANDS ON, HANDS ON!! Staff should be using equipment during training, and each member should repeat the same training, not just one brave volunteer. • Vendor trainer is available after training sessions are complete for one-on-one questions and mini demonstration during the rest of the day

36. Installer is gone. Now What? • Somebody at your site needs to be a designated Super User. It can be ANYBODY and you would be surprised at who that might be. Consider EVERYBODY in your staff as a potential super-user • For physical use of the machine, vendor provided video can be a very good reference • For equipment with a computer interface, strongly consider SCREEN SHOTS of the interface as an aid for navigation through screens and menus.

37. Prove your good training with a competency assessment form! When boiled down, most assessments are the same • Employee can start up and shut down the equipment • Employee can calibrate/prepare the equipment • Employee can load and replace “consumables” in the equipment • Employee can demonstrate use of the equipment • Employee can clean and maintain the equipment • Employee knows both local support and technical support contacts in the event of a malfunction.

38. Simple is better Remember the following points about competency assessment forms and documentation: • Most regulatory/internal reviews focus on “missing” competency assessments - not their content. Make them simple and executable. • Manufacturer provided “competency” forms have gotten much better (though many stink ). Don’t overlook them as a source (vs. making your own from scratch.) • Keep the competency assessment separate from Policy and Procedures. Competency assessment shows staff can operate the equipment, and that is it.

39. Avoid the following at all costs, or your equipment will surely DIE • Nobody knows what equipment is going in, or why they are getting it, or what it is supposed to do when they get it. • Everyone is scared of the equipment due to cost, or damage risk, or complexity. • Only one person in the pharmacy knows how to run the equipment and there is no staff rotation through the equipment. • There is no reference material or “how to use” sheets available for individuals to look at. • Harsh or punitive measures when the equipment breaks or an “accident” happens (well, at least the first time )

40. Maximizing Use • Using Reports to Increase Efficiency • Its all in the report… Marian Daum

41. Maximizing Use • Automation will expose any weakness in your processes • Gaps in the database • Stock out/stock not moving • Too many manual processes • Not looking at usage data • Operator Error • Don’t forget to push the green button….

42. Maximizing Use • Reviewing the Use of Narcotics • A Surveillance Program • Discrepancies Poor Practice vs. Diversion Involve key staff

43. Maximizing Use • Misadventures in Narcotic Use • You found What above the false ceiling? • 15 minutes of fame that you can do without

44. Maximizing Use • Other Narcotic Surveillance Reports • Usage Compared to Other Personnel • Witness Pairs • Number of Discrepancies

45. Maximizing Use • What about that installation? • What did you get out of the change in process? • Better Inventory Management • Better Turn Around Time

46. Maximizing Use • Unexpected Benefits • The law of unintended consequences can sometimes be a good thing. • Are you able to demonstrate additional benefits to your recent upgrade?

47. Maximizing Use • What if I want to kick it up a notch? • Advanced Report Writing • Custom Reports • Combining VistA and the automation reports

48. Maximizing Use • Please share with the entire class • http://vaww.national.cmop.va.gov/pre/default2/default.aspx • Please post your best practices on the automation Sharepoint discussion board

49. Automation • Choosing the best equipment for your service • Developing an implementation plan for a smooth installation • Developing a comprehensive training and competency assessment program • Evaluating the performance of the equipment on an on-gong basis

50. Questions??