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The pharmaceutical benefits and limitations of ADCs and BCMA

The effective use of ADCs and a BCMA can considerably impact a pharmacy's operations for the better, but both can have their limitations.
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These devices can introduce to medication errors if not implemented and/or managed appropriately. Just like every other technology, device, correct use and
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control,or very cautious use, follow the standard procedure is also necessary. These devices, if we use incorrectly could retrieve an incorrect medication because of open access to all drugs in a drawer. And there are several types of automated dispensing device in our market, so you may want to pick up or want to select the one that with one drug in one drawer. In this way, we could avoid the open access problem. And also, it could be a carelessness or lack of verification of drug label due to a false belief that the system is computerized and not as susceptible to errors. People sometimes,or some of them will have the false belief that it’s already computerized so everything is fine, everything is correct.
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But, they forget that the drug is start by a pharmacy, they could make mistake. Somebody could pick up the drugs and return the drugs to the wrong drawer. These are the possible errors. And lastly, drugs stocked in the wrong pocket either because one or more doses inadvertently fell into the wrong slot or due to a pharmacy restocking error. So, these are the possible sources of errors.
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So, for pharmacy restocking, we recommend that every time when the pharmacy, either the pharmacy or technician restock the medication, they need to use bar code to verify the medication in the pocket are the correct one. The second available technology is Automation in Centralized Dispensing. In the past, the pharmacy need to use the select bar coded unit dose medications for scheduled medication cart filling. And today, we could have machine. We could use these machines to automate first dose dispensing and to replenish low stock medications in decentralized automated dispensing devices, which is introduced before. And all doses dispensed by the robot are bar coded, thus providing a foundation for the implementation of bar code medication administration systems. And today,
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because we have all these technology, the disadvantage is the increase in labor needed to repackage the medications.
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And also the advantage is: we could reduce pharmacy labor costs, eliminate routine and repetitive tasks associated with dispensing, and improve medication dispensing accuracy. And also in the centralized pharmacy, we could have carousel dispensing technology. These are the dispensing device that consists of a medication storage cabinet with rotating shelves and comprehensive software that manages inventory and prioritizes workflow. The third technology we want to introduce is the Bar Code Medication Administration. The BCMA technology incorporates the use of bar code scanning functionality into medication administration phase of medication use. In the system, there is a three-way check of the nurse, medication, and patient at the bedside.
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So, when the nursing staff performing the Bar Code Medication Administration, firstly, they need to scanned barcode on the nurse identification badges. Secondly, they will scan the bar code on the unite dose package of medication. And lastly, they will scan the patient’s identification on the wristband. So, after performing these process, the nurse, administrator identification, the dose of medication, the time of medication and patients’ name are all recorded on the medical. Other benefits from BCMA system are the first one, the system could verify the drug against the patient’s electronic medication administration record, and also the system could document the time and details of administration. The system could generate a charge for the drug to the billing.
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If the whole hospital want to have the Bar Code Medication Administration system, the pharmacy has to repackage and bar code every single medication package, and because bar coded packages are not available from manufacturers. I believe every country, some of the products, commercial products, already has bar code on the packages, but not all of them. So, the pharmacy needs to prepare these bar coded unit dose packages. So the unit dose packaging machines with bar coding capabilities are available for purchase or lease. And these, even though you rent it, or maybe some hospitals want to purchase these machines, it will have pretty substantial cost on the budget. If we wait to against the benefits in patient safety and added efficiency,
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there could be a benefit. So, every hospital needs to do the cost and benefit evaluation. We have to introduce some of the available technology, and in all these technology; actually, we need to face how to select them, how to implement them, and how to maintain these devices. So, the roles of Pharmacists are very obvious. The pharmacists are probably the best person involve when Key decisions are made in these phases, for example, planning, selection, implementation, maintenance of electronic patient information system. And the value achieved within organizations depends on three factors. The first one is the efficiency of the system. The second is the level of detail applied to managing and making the most of the system.
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The third one: the cooperation between departments. In the selecting automation part, I think, probably is the most important because you have planning, and the most difficult and important ones is how to select an appropriate device for your own institution.
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So, you need to consider or ask following questions: Can the vendor provide you with established policies and procedures for integrating the systems into the pharmacy’s daily workflow, clearly defining pharmacist and technician responsibilities, and clearly defining system downtime procedures? Cost benefit analysis need to be done. And through the analysis, we could tell this system will reduce supply and labor expense offset the cost of the automation? And what is the potential increased the revenue as a result of the automation? Does the system produce useful statistical and managerial reports, and do they provide a report writing and analysis tool? How does the system utilize barcode technology to improve accuracy of transactions?
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And how long has the company been in business and how many units do they have in operation? And how much spaces will the automation required, and its remodel required?

Here, we will discuss the possible drawbacks of Automated Dispensing Cabinets (ADCs). Whilst barcodes can be integrated into the machines to increase accuracy, if not managed appropriately these devices can give rise to medication errors. However, there are distinct advantages to applying Barcode Medication Administration (BCMA), as outlined below.

Possible sources of errors when using ADCs:

  • Open access to all drugs in the drawer
  • Lack of verification
  • Errors arise when staff restock the machines

One should not assume that computerised systems will never make mistakes, as there are still human factors at play.

Automating the centralised dispensing process:

  • Centralised dispensing can be automated to achieve first dose dispensing and replenish low stock medications in decentralised automated dispensing devices, where all the medication dispensed by robots is barcoded. This reduces pharmacy labour costs, eliminates routine and repetitive tasks associated with dispensing, and improves medication dispensing accuracy.
  • Carousel dispensing technology can also be applied, such as dispensing devices that consist of a medication storage cabinet with rotating shelves, and comprehensive software that manages inventory and prioritises workflows.
  • BCMA technology incorporates barcode scanning into the medication administration phase. In the system, there is a three-way check of the nurse, medication, and patient at the bedside.

The benefits of applying BCMA:

  • Increased accuracy and efficiency of verification of data
  • Document time and details of administration
  • Autogenerates billing details

However, repackage and barcoding every medication package may mean extra work, and purchasing the necessary equipment is a substantial cost investment.

Pharmacists’ role in automation:

  • Planning
  • Selection
  • Implementation
  • Maintenance of electronic patient information system

The value achieved within organisations depends on three factors:

  • Efficiency of the system
  • Level of detail in management
  • Cooperation between departments

Factors to consider when selecting automation:

  • Compatibility with current hospital system
  • Investment-return ratio
  • Statistical and managerial reports of the system supplier credibility
  • Space/equipment requirements
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Good Pharmacy Practice: Pharmaceutical Services

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