Patient Safety on the Move in Hospital Pharmacies

Notes from the American Society of Health System Pharmacists’ (ASHP) 2011 meeting.

By Mitch Work, MPA, FHIMSS

Billed as the largest conference for hospital pharmacists in the world, the 46^th Annual ASHP Midyear Clinical Meeting and Exhibition was held Dec. 4-8 in New Orleans. Attendance was projected to be around 20,000 (no final figures had been released one week following the conference), though actual attendance may have been somewhat less and slightly down over last year. Still a good showing given the current economic conditions and a conference sandwiched between the holidays.

Who attends? According to ASHP the typical registrant provides “services for acute care patients and work in hospitals with 400 or more beds. Attendees practice most commonly in community (not for profit) hospitals, university hospitals and integrated health systems. The majority of attendees are female (65%). The mean registrant age is 49 with 25 years of practice experience.”

James Carville and Mary Matalin were among the keynote speakers and their topic, “All’s Fair: Love, War, and Politics” was particularly apropos as we head into “earlier than ever” primaries and caucuses.

I was a first-time attendee and visited the exhibition hall on Dec. 6 and 7. It was well attended. VIP Demos, sponsored by several of the larger companies and held prior to regular exhibit hours, provided an opportunity for “invitation only” prospects and clients to meet with companies to see the latest product introductions and enhancements. Many of these sessions were packed both days. The regular exhibit hours also saw a steady stream of attendee traffic.

There were more than 200 exhibitors from start ups and associations, to some of the largest healthcare device, supply and pharma companies, such as McKesson, Baxter, CareFusion, Omnicell, Cardinal Health, Amgen, Abbott, and Novo Nordisk to name but a few.

Patient safety, efficiency and cost savings were the overarching themes in the exhibition hall and were embraced by many new products focused on continuing to automate the hospital pharmacy and the healthcare enterprise. One example was CareFusion’s new Pyxis MedStation^™ ES System, an enterprise-wide medication management solution. Other products focused on new analytic software solutions like Omnicell’s Pandora product line.

There were also an amazing array of robots of varying sizes, performing mission-critical functions that continue to spread throughout the hospital pharmacy. They ranged from McKesson’s large robot units that dispense and deliver drugs to robots designed to fill I.V. compounds. This later area is one of the last bastions of largely manual-based processes in the hospital pharmacy, not unlike anesthesiology in the perioperative space where AIMS (anesthesiology information management systems), are beginning to eliminate largely paper-based systems.

I.V. compounding is a fairly new robotic application and goes a long way toward improving patient safety by reducing I.V. compounding-related errors. And these can be significant. For example, Baxa (recently purchased by Baxter) indicated that clients of their DoseEdge™ pharmacy workflow management system have documented the prevention of over 400,000 I.V. compounding errors of which 107,308 involved compounding the wrong drug.

One of the leading I.V. compounding robots is sold by an Italian company, Health Robotics, whose senior North American executive, Gaspar Viedma shared an interesting David and Goliath story with me. Gaspar is Spanish born, currently lives in Italy, and has worked in the North American Medical Technology industry for more than twenty years. He is charismatic, a consummate and convincing marketer, and an engineer by training, who helped develop their robots. Two years ago Health Robotics (David), looking to expand their installed base in the U.S., entered into a distributor relationship with McKesson (Goliath) who does not have a competing product but does have a large sales organization. It seemed like the ideal relationship. One problem: McKesson did not sell any of sell any of the I.V. robots. Health Robotics cancelled the agreement. McKesson sued. Suite was dismissed within three months by the courts citing there was no grounds for the lawsuit.

While I.V. compounding robots are just beginning to enter the main stream hospital pharmacy market, they appear to be a major improvement over the current largely manual processes. I.V. compounding requires precisely and repetitively measuring the correct drugs and concentration levels for I.Vs. – a natural application for robotic automation. If these new robots can deliver on promises of reduced pricing and increased speed while taking up minimal space in the hospital pharmacy, this market could take off in the near future.

Overall there seemed to be a sincere, shared consensus by all the exhibitors that we are headed in a common direction that will result in a truly automated hospital pharmacy environment and that the end result will be a reduction in errors and an improvement in operating efficiencies and clinical outcomes by eliminating paper and manual-based processes. While we are not there yet, it seems that the hospital pharmacy is headed in the right direction.

On a final note, ASHP should be congratulated for selecting New Orleans as their 2011 conference site. The city has made great strides in recovering from Katrina, though it still has a way to go and evidence of the storm can be seen in boarded buildings and renovations that are still underway. Taxi drivers, hotel managers and waiters expressed to me their appreciation for the ASHP coming to New Orleans. Thought I would pass those sentiments along to ASHP. New Orleans was a good choice.