By Julie Baumgart, PharmD

Columbus Community Hospital in Columbus, Nebraska, is a small 49-bed rural hospital. In the 1970s, two hospitals merged to form the present facility, which moved to a new building a little more than six years ago.

Pre-Automation Approach
Previously, the pharmacy’s cart fill system was strictly manual and divided so that one side was filled by a technician and one side by a pharmacist. A pharmacist would then check each cart to provide the final double-check. Nebraska law de­mands this double-check by a pharmacist, even when an automated bar code scanning system is in use.

Without automation, we had the problem of potential errors occurring when products were returned to the wrong bins. It was highly probable that any error would be detected before medication was dispensed, but the slight possibility existed that drugs would go from the wrong bin to the wrong patient. It was clear that we needed to find an automation solution to this challenge.

Shopping for a New System
We began to look at McKesson’s IntelliShelf-Rx program in late 2007 to address this system weakness, and at the beginning of 2008, we started the process of organizing our pharmacy information files to prepare for the transfer to the IntelliShelf-Rx system.

IntelliShelf’s software integrates with the pharmacy’s information system and unit-based cabinets to generate an electronic dispensing list that is completely paperless and read onscreen. The pharmacist still utilizes a paper printout, however, to perform the double check. The software communicates with an RFID–enabled guiding light technology to instruct the technician to choose the accurate medication and the correct dose. The RFID network consists of an antennae and reader and RFID tags for the medication bins. With IntelliShelf-Rx, cabinets may be filled by medication type rather than sequentially.

All products are bar-coded at the time of dispensing to ensure that the right medication, in the right dosage, and the right quantity is delivered. The patient bar codes on the bins correlate the right patient with the right medication, further ensuring safety. Patient medications are placed into a bin or envelope labeled with the patient name, and these are then delivered to the nursing units.

Benefits Reaped
One benefit of the system we really appreciate is that implementation does not require the rebuilding of our pharmacy’s basic equipment or the installation of any new shelving. IntelliShelf-Rx allows smaller pharmacies like ours to reap the benefits of automation without necessitating the installation of bulky equipment or the remodeling of the entire pharmacy department. While we are not doing inventory control at the moment, IntelliShelf-Rx is keeping track of medication expiration dates, and pulling expired medications has become a simple process for our staff. IntelliShelf-Rx has drastically reduced the errors of the wrong medication being returned to the wrong bin and then going to the wrong patient. It has also streamlined medication picking and restocking, resulting in substantially improved picking accuracy. Our first-dose, cart-fill, and cabinet-refill operations are now completed more quickly and easily. Our staff appreciates the use of IntelliShelf-Rx with first doses, and learning the system has been relatively easy.

When a patient comes into the hospital on multiple medications, the technician can pull those first doses, while the pharmacist only needs to check them. Our pharmacists spend less time dispensing medication and handling paperwork and spend more time addressing patient outcomes.In terms of patient quality and safety issues as well as financial return, IntelliShelf-Rx, optimizes first-dose cart fill and cabinet refill operations while minimizing medication errors and will soon manage our inventory control electronically. On the whole, it expedites a more efficient pharmacy workflow.
 

Julie Baumgart, PharmD, is director of pharmacy at Columbus Community Hospital in Columbus, Nebraska. She has worked at the hospital for 20 years and been director for the past four years.