The complexity of the operating room environment requires effective facilitation of the flow of patients, staff, equipment, and procedures. In particular, anesthesiologists need easy access to appropriate medications and patient data to promote the best possible clinical outcomes. As automated dispensing cabinets are adopted in more patient care areas, many hospitals are finding that the use of anesthesia medication distribution carts in ORs delivers advantages to patient care, while also benefitting workflow and the bottom line.
Peninsula Regional Medical Center (PRMC), a 288-bed tertiary care facility in Salisbury, Maryland, recently implemented Aesynt Anesthesia-Rx medication carts in its ORs to improve access to medications, automate documentation, and foster more accurate charge capture.
A Flawed Manual System
Following the successful implementation of ADCs on the nursing floors, PRMC decided to expand this strategy to address the challenges associated with manual anesthesiology processes. Prior to installing anesthesia carts in the ORs, anesthesiologists relied on a tray system that required regular stocking by pharmacy staff. Each tray included a paper list of medications and physicians were responsible for manually documenting all medications used. If a required medication was not on the tray, the anesthesiologist had to retrieve it from a dispensing cabinet elsewhere in the OR suite.
This system was inadequate for a number of reasons. First, accuracy was contingent on the physician correctly documenting medications and doses. Errors or omissions created issues downstream, when pharmacy staff manually compared the inventory documentation with the medications that were actually used. Quite often, documentation differed from actual counts, necessitating pharmacy follow up with the anesthesiologists to verify which medications and quantities were provided for individual patients. This approach relied heavily on mental recall and routinely resulted in inaccurate charge capture.
Following a thorough assessment of workflow needs and documentation challenges, we decided to deploy 20 Aesynt Anesthesia-Rx medication carts—one within PRMC’s endoscopy suite, two in the labor and delivery area, and the rest within all of the facility’s ORs.
Based on experience, the IT department at PRMC recognized the need to gain buy-in from providers early in the process. The first step was selecting a vendor; the organization hosted a fair for three vendors during which physicians, nurses, and other clinical staff had the opportunity to hear presentations and test each of the products for ease of use.
Once the vendor was chosen (based on staff reviews and pharmacy’s confidence that the vendor could provide service within a two hour window), PRMC deployed the new carts by identifying physician champions and engaging the anesthesiology department. Clinical staff provided input on the types of medications used most often, as well as the cart design that would best serve workflow needs. Finally, mock-up carts were designed and left in the anesthesia workroom for one month allowing anesthesiologists to become comfortable with the devices, while still employing the trays.
Following this step-by-step strategy to address buy-in, the actual implementation of the new cart system proved painless at go-live. Standardized carts were placed in each of the ORs allowing anesthesiologists to easily move from one OR to another, confident as to which medications were available and where they were located within the carts.
The chief of anesthesiology serves as the clearinghouse for any requests for changes to the carts. By assigning a point person for alteration requests, the pharmacy department no longer receives conflicting messages from multiple providers, ensuring everyone is on the same page.
PRMC has measured the success of this project through anesthesiologists’ feedback. With carts located in each OR, anesthesiologists are confident that the necessary medications will be standardized and readily available. Easy access is augmented by color-coded medication labels that dispense automatically from printers linked to the carts, further enhancing patient safety. Because a new interface links the carts to the hospital information system and the daily OR schedule, there is no need to scroll through every active patient record; rather, anesthesiologists can directly access a list of patients scheduled for surgery that day, facilitating the process of identifying the correct patient record.
Documentation is more accurate because touch-screen controls help automatically document medication retrieval. PRMC is currently engaged in a partnership with Aesynt to pilot a ‘no-count pocket’ within a cart in the main OR. Essentially, the drawer is designed to eliminate the need for a physician to count medications as each see-through pocket contains a single vial or ampule. A touch screen allows physicians to enter the number of medications being retrieved, and only the requested number of pockets open; the inventory is then automatically updated.
This automated process also streamlines restocking for the pharmacy. Instead of cumbersome manual inventory tracking, the anesthesia carts are polled twice every 24-hour period, enabling restocking via bar code-driven central pharmacy automation, thus ensuring that providers have what they need when they need it.
The ability to enter documentation at the point of service enhances charge capture by facilitating accurate patient billing—a key component in strengthening patient relationships. Overall, the system’s benefits are myriad; it ensures accountability and strengthens communication between pharmacy and the OR, while also enhancing patient safety.
Craig Scott, RPh, is the pharmacy automation manager at Peninsula Regional Medical Center in Salisbury, Maryland. Craig earned his BS in pharmacy from Ferris State University in 1978.