On our inpatient units, the AcuDose-Rx cabinets dispense orders that have been profiled by the pharmacy. With the exception of certain IVs and bulk items, nearly all of our patient medications are dispensed from the cabinets. Our outpatient unit cabinets stock a limited number of line items, including emergency medications and antibiotics.

The Challenge
In our intensive care, surgical, and transitional skilled nursing units, we have a limited amount of floor space and, as such, have only been able to install an eight-drawer main AcuDose-Rx cabinet and auxiliary tower. By eliminating cart fill and moving to a decentralized distribution model, pharmacy was required to restock the cabinets in those care areas on a daily basis, and often multiple times per day, in order to provide our nurses with 100% of the medications they need to care for our patients. To address this issue, we became a beta evaluation site for McKesson’s new high-capacity open matrix and detecting AcuDose-Rx drawers.

The Solution
The high-capacity open matrix drawers have almost doubled the line-item capacity of the AcuDose-Rx cabinets located on our ICU, surgical unit, and transitional skilled nursing unit. In addition, the high-capacity detecting drawers store items in pockets with unlocked, clear plastic lids. The cabinet informs the nurse of the medication location, and when an incorrect pocket is opened, an advisory screen alerts the nurse. The nurse must acknowledge the alert screen, causing him or her to stop and think for a moment. Nurses have commented that they appreciate these warnings, as they have helped prevent medication errors.

We use the detecting drawers for high-alert drugs, like heparin and Coumadin, that are not controlled, but certainly require additional caution upon dispensing. Likewise, the detecting drawers have been useful for dispensing look-alike, sound-alike drugs, such as hydroxyzine and hydralazine. For our controlled substances, we use high-capacity locked pockets.

After-Hours Dispensing
Our pharmacy is open from 7:30AM to 5:30PM, and we use a remote order entry pharmacy to process and profile our after-hours medication orders. Because they hold a higher number of line items, the high-capacity drawers reduce nursing’s need to locate medications on other units after pharmacy hours.

Conclusion
Our results have been positive. The new drawers have significantly increased our cabinets’ line-item capacity and reduced the pharmacy’s need to “rotate” medications. In addition, the increase in the number of medications available in the cabinets helps reduce the potential for late doses. Along with other medication safety initiatives like profiled dispensing and bar coded medication administration, the detecting drawers’ “incorrect pocket” notification can help to enhance patient safety with high-alert and look-alike, sound-alike medications.

For the past 12 years, Will Simpson, RPh, has served as the director of pharmacy for Clarion Hospital, where he has worked for 21 years. He is a graduate of Duquesne University.

WHERE TO FIND IT:

McKesson Corporation