Pharmacists have been manually tracking and reconciling physical controlled drug inventory to a perpetual inventory log since 1971 at the institution of the DEA’s Title 21. The importance of tracking controlled substance inventory and dispensing history cannot be overstated, but has long been hampering the full potential of outpatient pharmacy operations. GSL Solutions Inc., a company well-known for the IntelliCab™ pharmacy will-call system found throughout military pharmacies and community pharmacies across the globe, has developed a new product, IntelliVault™. This unique product aims to replace the typical “gun safe” type open-faced and open-access controlled substance cabinet with a real-time discrete storage and tracking system based on Radio Frequency Identification (RFID). The IntelliVault™ system has successfully eliminated diversion and drug loss while optimizing pharmacy operations and reducing labor costs. It achieves this through shifting time consuming, yet non-clinical labor away from pharmacists to pharmacy technicians. It also eliminates time required to reconcile inaccuracies associated with manual logs via three steps:
1. Controlled Substance Stock Receiving
• Technician coupling of controlled substance stock bottles with a SmartBasket™ with entry of lot number and expiration date.
• Multiple technicians receiving and filing stock simultaneously.
• Automatic reconciling of received stock with distributor drug invoice or form 222.
2. Drug Retrieval + Filling
• Scanning the Rx label prompts a pharmacy technician to retrieve the controlled stock bottle with the Pick to Light™ System.
• Entry of lot number and expiration date at the receiving step allows for the oldest stock to be used first and allows for simplification of drug recalls.
• Returned to stock prescriptions will automatically be used on the next fills.
• Storing a given NDC in multiple SmartBaskets™ allows for multiple technicians to fill that same medication without the inventory worry of managing a "lead bottle."
3. Stock Bottle Back Count + Return to Stock
• Once the technician fills the Rx, a blind back count ensures accuracy, accountability, and chain-ofcustody. Any discrepancies are reviewed by a pharmacist, who can utilize GSL’s reports to review any potential issues with their associated users.
• Software uses Pick to Light™ Technology to prompt technicians to complete return to stock in a matter of seconds.
An Integrated-Delivery Network (IDN) hospital system in the United States conducted a time study in one of their several outpatient pharmacies to investigate the potential value and labor savings with a pharmacy workflow that utilizes IntelliVault™. The data collectors followed the lifecycle of a prescription from start to finish and recorded the amount of time to complete each respective workflow step. Average time to complete each workflow step was calculated and multiplied by the wage rate of each respective pharmacy employee type: “pharmacist (RPh)” or “pharmacy technician.” These labor costs were then summed to calculate the total cost to dispense a single controlled prescription in the Standard of Practice model. The total labor costs for the IntelliVault™ integrated model was calculated using the average time data from the old Standard of Practice model but adapted in the following way to conceive the IntelliVault™-integrated model: a) shifting workflow steps from RPh to technician, b) eliminating workflow steps no longer needed with the IntelliVault™-integrated model, and c) reducing average time to complete several workflow steps based on historical average time data of other pharmacies who have a proven IntelliVault™-integrated workflow. The IntelliVault™-integrated model costs of labor were then summed in the same fashion as previously described and compared to the costs of labor from the Standard of Practice model. Figures 1-4 describe the pharmacy volume, changes in workflow steps and average time to complete, labor savings per controlled Rx dispensed, and total yearly labor savings from workflow adaptations, respectively.
On average, there was a calculated labor savings of $2.62 per controlled Rx dispense in favor of an IntelliVault™-integrated system with total savings per year of approximately $23,000 based on the average monthly controlled Rx volume as shown in figure 1. A significant portion of the labor shifted from pharmacists to pharmacy technicians, as shown in figure 2, while still reducing total time to fill a prescription by 1.67 minutes.
From the data collection, we can see that the pharmacy has an opportunity for significant savings in labor.
This is largely due to the elimination of pharmacist entry and review of the manual perpetual inventory
log and shifting controlled drug retrieval, filling, and return-to-stock away from pharmacists to pharmacy
technicians. This allows for pharmacists to be more heavily integrated in clinical roles and counseling.
Additionally, this estimation in labor savings does not quantify nor qualify the time and risk required for
reconciliation of inaccurate manual logs. The use of a now automated perpetual inventory via IntelliVault™
tracks changes in controlled drug inventory in real time without the potential for human-driven accounting
errors and subsequent time spent counting and reconciling historical dispenses. Additionally, this estimation
of labor savings does not account for the improvement in controlled freight receiving processes, which are
automatically and electronically received and reconciled against distributor forms 222 and other controlled
drug receipts with GSL Solutions’ AutoLog™ features. Pharmacists no longer need to manually enter the
quantity of controlled inventory received into a manual perpetual log. Additionally, and not studied, a
system like IntelliVault™ would speed up quarterly physical inventory and allow for shifting this labor from
pharmacists to technicians. IntelliVault™ breaks the paradigm of spending overtime labor for this activity
before or after opening to regular technician hours during normal operations.
Pharmacies have been utilizing manual logs since it was first required by the DEA in 1971. Computers
and new robotics have digitized and evolved the world of pharmacy records and operations over the
last 30 years, but no technology has yet tackled the improvement in controlled drug inventory storage
and tracking. As the culture of pharmacy is rapidly advancing with clinical practice roles evolving at an
astounding rate, pharmacist time is valuable and often limited. The integration of IntelliVault™ appears to be
a natural progression to advance our archaic and outdated manual inventory log to a culture of automation.
It mandates improved accuracy and maintenance of chain of custody over the entire filling process. Utilizing
pharmacists as accountants for controlled inventory is clearly a disservice to the education and level of
expertise we hold in drug therapies. Integrating new technologies like IntelliVault™ allows pharmacists to
better apply their valuable clinical knowledge to the care team and facilitate improved patient outcomes