Louis & Clark is not a typical retail pharmacy, with only about 5% walk-in business. Located in Springfield, Mass., the third-largest city in the state, the pharmacy serves facilities within a 30-mile radius. The decision to seek out automation came down to looking at the number of patients currently using its adherence packaging system, says Louis & Clark owner Skip Matthews. He could see the growth in potential patients in different settings in the community and knew there was an unmet need to service with compliance packaging.
To provide multidose cards to 300-plus beds in long-term care and assisted-living facilities, as well as independent individuals residing in the community, the Louis & Clark staff had been filling four seven-day cards per resident manually before a pharmacist QA check. The pharmacy’s manual workflow at the time, says Jim Muzzy, director of facility pharmacy services, wouldn’t have been able to handle new business. One priority when Muzzy and Matthews first looked at automation was to retain the MTS seven-day cards currently used.
During a site visit in Ohio, Muzzy and Matthews discovered that the automation for the cards in use held only 40 canisters, and the canisters needed to be calibrated by the company for each drug and NDC change, says Muzzy. “With our diverse customer base and the number of drugs that they take, the processing of an order for a facility would have required that we have an additional supply of one hundred or more cassettes that could be swapped out when filling an order,” he explains.
Muzzy then heard about a company in Montreal, Canada, which turned out to be Synergy Medical. During a visit with Synergy Medical founder Jean Boutin at the company’s headquarters, Muzzy says, he and Matthews were immediately drawn to SynMed because of its capacity. “Before we discovered SynMed we visited sites in six states,” says Matthews. “These visits really helped us realize the potential of SynMed, and also let us see how the SynMed solution forces a consistent process.”
The SynMed system has 400 canisters, which do not have to be calibrated when a change is to be made, and the system requires a single operator who can fill up to eight cards during a single operation. “In reality, if you have a high-volume drug, you can assign several canisters,” Muzzy says. “The capacity was one of the obvious advantages for us.”
When Louis & Clark decided the SynMed system was the right way to go, Muzzy says he was impressed that Boutin made a personal visit to the Louis & Clark location. Boutin’s background was in the medical device business, and his wife was a pharmacist. Boutin’s knowledge and expertise in the pharmacy world made a difference when he came to advise Louis & Clark on how to best use the automation. Muzzy says that Boutin suggested that a structural engineer verify that the floor was strong enough to support the machine and a plate be installed to prevent the machine from rocking while working. “We wouldn’t have known that the rocking would affect the performance. He had the experience and history,” says Muzzy.
Matthews was at first concerned that it would take months to incorporate the system into the pharmacy. But he found the process SynMed uses minimized installation times, and everything went smoothly. Installation was done in about six hours. The machine was calibrated, and the following day the staff gathered for training. By the end of the day the staff was filling for the smaller facilities. “The entire installation,with training and processing live prescriptions, was complete in about eight days,” says Matthews.
Steps to Customizing
Muzzy visited their existing clients to explain the advantages of SynMed, specifically the amount of information each card contained for the facility staff and how it could be customized through the Synergy interface with the QS/1 RxCare Plus system. When the new card was presented to the facility, with its multiple quality control checks and the ability to customize the card, facility decision makers could see the advantages, Muzzy says.
The Dispill cards have larger bubbles, which could have been an issue for the facilities, but they hold a tremendous amount of information. The card is printed with a drug image, number of drugs, time of administration, and strength of the drugs that all correspond to each bubble. The card is perforated and color-coded for time of day. The perforations mean they are portable for ambulatory patients who wish to take a strip with them for the day. They are easy to use for an in-home caregiver.
“I talked to every facility, and I got a little pushback,” says Muzzy. “The biggest concern from the facilities were with staff resisting the change. I went over all the benefits of the cards, assured them that there would be no more changes, and asked them to try it. I even offered to go back to manual filling if they didn’t like the cards. They have all embraced it.”
One reason for the ease in transition, says Muzzy, was the willingness of SynMed and QS/1’s RxCare Plus programmers to modify the cards to meet specific facilities’ requests. For example, one facility likes to have the patient photo on the card. Another facility didn’t want this, andMuzzy has the option to put the Louis & Clark logo on the card rather than the patient photo.
“I was worried we were going to spend a lot of money and only have the system rejected by some of our largest facilities,” he says, “but our numbers have nearly doubled. The volume is manageable at this point, where it wouldn’t have been manageable before. We’re pressing for new business more aggressively.”
The Automation Advantage When Muzzy and Matthews went in search of automation, they wanted a production workhorse that wouldn’t get overwhelmed by the new facilities they hoped to bring on. With the manual system, techs would fill four cards at a time, and the QA pharmacists would have to stop to check the cards before techs could seal and prepare cards for delivery.
“The SynMed on-site visits really helped us realize the potential of SynMed, and also let us see how the solution forces a consistent process,” says Matthews.
One decision that made the Louis & Clark’s staff’s lives easier was the installation of a second workstation just for the SynMed. Although SynMed is up and running most of the day, the staff would need to take it offline when they needed to add drug records or to review files prior to sending them to the SynMed robot computer. The dedicated workstation allows the staff to make changes without stopping the workflow and creating a bottleneck.
Things to Consider
In evaluating the move to automation, Muzzy recommend exploring systems based on what suits a pharmacy’s current needs. He advises speaking with the manufacturer of the automated system for a recommendation from another customer using the same pharmacy management software. A site visit is the best way to make a decision; meet with pharmacy staff, ask questions about QA, and observe the techs and how they move in the workflow, says Muzzy. “We did as much advance work as we could, and we were pleasantly surprised. We have everything we want, and SynMed has been accommodating. It was a huge thing to bring the robot in here,” says Muzzy, “but what a difference it’s made.” CT