San Antonio, Texas-based University Health faced several medication management challenges that could impact both efficiency and patient safety.

THE PROBLEM

As a large and continuously expanding health system – including a Level I trauma center, retail pharmacies and specialty pharmacy – it recognized the need to optimize its medication distribution process.

Nurses often spent excessive time searching for medications in medication dispensing cabinets, a task likened to playing "Where's Waldo," due to the disorganization and movement of items within the matrix drawers. With 150,000 transactions at the medication dispensing cabinets each month, this wasted a considerable amount of nurses' time, which could have been better spent on patient care.

Moreover, the matrix drawers themselves posed problems. Medications could have moved around within the drawers, leading to missing or expired medications and even instances where medications were crushed or spilled, resulting in contamination and waste.

These issues threatened to compromise the integrity and availability of medications and created additional work for the staff in terms of cleaning and managing discrepancies. The system was simply not sustainable for a health system of this size and the growing demands care teams were balancing, said Jennifer Hillman, executive director of pharmacy at University Health Inpatient Pharmacy. She holds a pharmacy doctorate.

PROPOSAL

"The proposed solution from our chosen vendor addressed these challenges with several workflow and security features designed to streamline medication management and enhance patient safety," she explained. "We were looking at a combination of hardware and software tools that promised to ultimately save our nurses time while making it easy to manage medications across our health system.

"This boiled down to enhancements to the medication dispensing cabinets, connected software to improve visibility and support remote workflows, and simplified workflow features," she continued.

The primary components included locked, lidded metal bins to replace the problematic matrix drawers. These bins ensure that medications remain in place, preventing movement and subsequent issues like missing or expired drugs.

"By maintaining the integrity and organization of the medications, this solution was expected to significantly reduce the time nurses spent at the cabinet and minimize medication waste and contamination," Hillman noted.

"Another crucial feature was the controlled substance single dose dispensers, tailored for various forms of medication, including tablets, capsules, syringes and vials," she said. "These dispensers are designed to release only the exact amount of medication requested, thereby reducing the chances of discrepancies and ensuring more accurate dispensing."

The promise of this technology caught Hillman's eye as University Health has more than 15,000 controlled substance transactions every month, which poses a lot of opportunity for risk or costly medication waste.

"Thinking about the nursing workflow, one feature promised to allow our nurses to queue up their medications from their workstations rather than at the cabinet itself, reducing congestion and wait times at the medication dispensing cabinets," she said.

"At the simplest level, these new cabinets also had special light-up features that would help direct our nurses to the location of the medication they needed," she continued. "While it sounds like the tiniest feature, it's been amazing to see what an impact this has made on nurse time spent at the cabinet."

These features collectively promised to enhance operational efficiency, improve medication management and bolster patient safety, she added.

MEETING THE CHALLENGE

As a health system, University Health is focused on fully understanding how the technology it brings in works. Hillman often says while the health system is as big as the Titanic, it needs to be as nimble as a jet ski to ensure it can always deliver the right care to patients.

"This is especially important in medication management," she noted. "When we first switched over to Omnicell, we converted 207 medication dispensing cabinets across our health system in just eight weeks. These cabinets are fully integrated into our IT systems, EHR and medication inventory systems, with one server managing connectivity across our health system.

"This integration allows for real-time updates and tracking of medication usage, further enhancing our ability to monitor and manage inventory effectively," she continued. "The combined functionality of Omnicell's systems and our EHR ensure our medication management processes are efficient, secure and aligned with our overarching goal of patient safety."

The primary users of this technology are nursing staff and pharmacy technicians. Nurses realized benefits as promised from the pick-to-light system, which highlights the exact location of the needed medication, drastically reducing time spent searching through the cabinet. The Anywhere RN feature allows them to queue up medications from their workstations, reducing cabinet congestion during peak times.

"Pharmacy technicians play a crucial role in maintaining the system," Hillman explained. "They are responsible for stocking the locked, lidded metal bins, ensuring each bin contains the correct medications and that they are securely stored. The controlled substance single dose dispensers are also managed by the technicians, who ensure these are filled accurately and function correctly to dispense precise doses, minimizing discrepancies."

RESULTS

One of the most significant results was a dramatic 50% reduction in nurse-created discrepancies at the medication cabinets. This improvement was largely due to the controlled substance single dose dispensers, which ensure nurses receive the exact amount of medication required, minimizing the potential for errors.

"While this is a significant win from a safety perspective, it also shows how we were able to reduce the manual burden on nurses to manage countbacks at the cabinet amid an already hectic workday," Hillman reported. "We've also been able to reduce the administrative burden on our pharmacy technicians having to investigate all these discrepancies, allowing them to focus on other critical tasks.

"Another key success metric was the 20% reduction in time nurses spend at the medication dispensing cabinets," she said. "The pick-to-light system played a significant role in this achievement by streamlining the medication retrieval process."

Nurses no longer must line up at the cabinets or spend excessive time searching for medications, which translates to more time available for higher value patient care tasks. This enhancement in efficiency was crucial, especially during busy medication pass times.

"Additionally, the transition to locked, lidded metal bins increased our storage capacity on the floors by 30%," Hillman reported. "This increased capacity means we no longer have to frequently remove medications to make space for new ones, simplifying inventory management and reducing the likelihood of missing or misplaced medications.

"The overall integrity and organization of our medication storage system has improved significantly, contributing to better inventory control and reduced waste," she said.

ADVICE FOR OTHERS

Technology-driven medication management is no longer optional for hospitals – replacing manual workflows with automation for frontline teams not only enhances efficiency but is key to the safety of patients, Hillman advised.

"The decision is not just about features and functionality, but also the partnership the vendor can provide," she said. "Technology integration is crucial for maintaining accurate and real-time tracking of medication usage and inventory, which helps prevent errors and streamline workflows. But I also recommend finding a vendor committed to partnering with you to navigate any hiccups that will inevitably rise during implementation.

"Another important consideration is the involvement and training of staff," she continued. "The success of new technology depends heavily on how well the users, particularly nurses and pharmacy technicians, understand and utilize the system."

Investing in comprehensive training and fostering a culture of continuous improvement can significantly enhance the effectiveness of the technology, she added. Engage the staff early in the decision-making process and incorporate their feedback to tailor the system to meet the specific needs of the organization, she said.

"Finally, it is crucial to evaluate the scalability and adaptability of the technology," she advised. "Healthcare environments are dynamic, with changing needs and growing patient populations. Choosing a system that can scale and adapt to these changes without requiring extensive overhauls will ensure long-term success and return on investment.

"Look for technology partners that are committed to continuous innovation and support, as this partnership will be invaluable in addressing future challenges and opportunities," she concluded.

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