2026 Eastern States Conference

Authors





Lucas O’Brien, PharmD; John Hill, PharmD, MS; Eva Acks, CPhT; Lisa Hurowitz, PharmD; Stephen Wu, PharmD; Lauren Taylor, CPhT; Nick Paulson, PharmD, MBA; Richard Ewusie-Monney, PharmD, BCSCP; Samuel Culli, PharmD, MPH; Grace Pak, PharmD, MHA, BCPS; Amanda Stick, PharmD, MPH






Learning Objective





Describe the process of developing pharmacy standard operating procedures to maintain medication distribution during prolonged dispensing system downtimes 






Background/Objective





Critical cyberattacks on healthcare increased 179% from 2017 to 2023. Existing downtime procedures are often insufficient for prolonged outages. This project developed SOPs for an extended dispensing technology downtime at an academic medical center. 






Methods





A stakeholder group of pharmacists/pharmacy managers and pharmacy technician supervisors/information technology specialists was convened to address two downtime scenarios at The Johns Hopkins Hospital: outage of the carousel server or the automated dispensing cabinet (ADC) server of the hospital. For each scenario, the group conducted iterative gap analyses to identify vulnerabilities in dispensing, including order entry, verification, and distribution. Dispensing data was used to characterize unit-level medication volume and inform workflow decisions. Standard operating procedures were developed through a series of stakeholder meetings, with small-scale feasibility assessments of individual policies.






Results





Our gap analysis for carousel downtime identified key challenges. Transferring the carousel stock to manual shelving will require a plan to rapidly obtain an additional 14 shelving units. Without the carousel interface, cart fill and ADC restock labels will need to be manually generated as well as reports for medication purchasing. The gap analysis also revealed vital considerations for an ADC server outage. Inventory management will be complicated by an inability to process automated stockout and restock reports. Controlled substance documentation will also be compromised with cabinets placed into critical override, which must be navigated in consideration of their availability for emergent doses. 






Conclusions





SOP development for pharmacy technology downtime is an inherently creative process requiring diverse operational expertise, dedicated brainstorming time, and organized completion of follow-up tasks from the sessions. The key challenges for the carousel outage were mapping the inventory onto external shelving and planning generation of picklists and labels. An ADC interface outage will require interdepartmental coordination to ensure timely stocking, dispensing, and documentation of medications.






Self-Assessment Question





Which of the following is NOT part of the process for developing a downtime procedure?

• Gap analysis
• Predicting every downtime scenario
• Testing solutions
• Refining solutions