In a health care structure as large and complex as that of the Department of Veterans Affairs (VA), with more than 1,700 sites of care and serving more than 9 million enrollees, numerous systems work together to deliver care to veterans. The VA Pharmacy Benefits Management Services is one of those crucial elements.
Automated dispensing cabinets with drawers containing patients’ individual medication orders provide another example. When the nurse goes to that dispensing cabinet for a particular patient’s medication only the drawer that has the specific medication ordered for that patient will open.
Within that system, pharmacy automation is the integration of the physical processes – like medication vials moving along a conveyer belt in the VA’s mail-order pharmacies – with complex and detailed information technology. It is sometimes visible to patients and sometimes behind the scenes, and constantly evolves with changing technologies and veterans’ needs. And those processes, whether in inpatient or outpatient settings, ultimately result in increased patient safety, reduced cost due to pilferage, detection of diversion, and the enhanced ability of pharmacists to provide patient care.
“VA pharmacy services started using automation back in the 1980s, so it does have a long history and it has certainly come a long way,” said Lynn Sanders, PharmD, associate chief consultant, Clinical Informatics for Pharmacy Benefits Management at the VA.
Because of the complexities and differences in size and type of facilities, including large, complex medical centers, community-based outpatient clinics, and other ancillary care services, Sanders said the VA utilizes a variety of automation technologies to prepare and deliver medications to patients.
It could be a simple automated system like a pill counter with associated information technology, including inventory management and patient safety features. Or, Sanders said, “There may be something very complex, such as treating a patient with chemotherapy and all of the algorithms and processes that are involved in that, as well as IV robotics. In some cases, we’re looking at inventory systems or point-of-care systems for the patient to be used by nursing. There’s a preponderance of different approaches you can use, and we do tailor the systems that we have in practice based on the needs of the particular [facility] and the populations they serve.”
Regardless of the system utilized, Sanders said, “All of them must comply with the VA standards and regulations and they have to be able to communicate with the VistA [Veterans Health Information Systems and Technology Architecture] system, our VA electronic health records system, through our standardized interfaces.”
There are many examples of how automation augments safety. “One of the first advances with automation, and VA was certainly involved with that, was barcode medication administration, where the packaging of the medication with a barcode had to match the patient’s barcode identity bracelet,” Sanders said. “I think that was one of the most significant advances in health care in terms of patient safety for medication use in the inpatient area.”
Automated dispensing cabinets with drawers containing patients’ individual medication orders provide another example. When the nurse goes to that dispensing cabinet for a particular patient’s medication, Sanders said, only the drawer that has the specific medication ordered for that patient will open. “They wouldn’t be able to open the drawer for another medication and thereby give the wrong medication to the patient or engage in undetectable medication diversion,” she said.
IV smart pumps also enhance safety. The pharmacy works with nursing to program the dosage and administration rate of intravenous medications into the pump, Sanders said, avoiding the medication being administered at the wrong dose or the wrong rate because it’s linked to the product identification that’s in the pump.
Safety features are also built into the system and linked to patients’ electronic health records to include warnings about potential adverse drug interactions, medication allergies, drug recalls, or unsafe dosages. “In VA, we’ve been working and have technologies now with our systems called the Medication Order Check Healthcare Application, or MOCHA,” said Sanders. Within that system, for example, “we have safeguards that if the dosage ordered is too high, an alert will trigger to the prescriber as well as to the pharmacist to intervene on the processing of that order.”