The Brookdale University Hospital and Medical Center in Brooklyn, New York is a voluntary, nonprofit teaching facility with a Level 1 trauma center, an acute-care hospital, and two long-term care facilities offering over 900 inpatient beds. In order to support such a large and dynamic environment, we rely on information interfaced between our pharmacy information system and our patient care areas to create a seamless medication distribution loop. In the central pharmacy, we employ an automated unit dose medication packager and software coupled with automated dispensing cabinet (ADC) technology to track controlled substances stored both in our central vault and at various distribution points throughout the hospital. In the patient care areas we use cartless medication distribution in concert with our ADCs.
As we progressed from a hybrid system to the current cartless model, we chose to implement Omnicell’s Savvy mobile medication system—to provide a safe and secure method by which to transport medications from our ADCs to individual patients. As part of our initial investment in the Savvy system, we deployed it on a 32-bed medical/surgical nursing unit so as to closely observe the resultant effects.
Bridging the Gap Between ADCs and the Bedside
As effective use of this new process requires both nursing and pharmacy staff to be on the same page, when we went live with Savvy, we put forth extra effort to ensure these two departments supported each other during the implementation and training phases. Omnicell representatives came onsite for the initial product introduction and offered support throughout the implementation process by training and troubleshooting for pharmacy clinicians and nurses alike. As a general rule of thumb, pharmacies implementing new automation systems should make sure that vendor representatives are closely involved throughout the process for all hospital shifts.
As with many technological implementations, the impetus behind adopting a cartless system was in part to divert our pharmacists’ time toward more clinical roles on the floor—interacting with nurses, physicians, and other clinical staff rather than remaining in the pharmacy acting as drug distributors and handling cart fills. As a result of this clinical collaboration, our pharmacists are now more involved with patient care. The secondary driver was to find a better, more accurate, and more accountable way to deliver medications from ADCs to patients. Before implementing Savvy, our nurses were frustrated by the process of having to return to the ADC for each patient dose, yet were well aware of the dangers associated with pulling multiple medications at a time without some form of secure, segregated, and identifiable transport accountability. The Savvy system addresses this issue through the use of patient-specific, locking drawers that are filled from the ADC. As the nurse makes medication rounds, he or she enters the patient information at the bedside and the appropriate medication drawer will unlock and illuminate, clearly indicating the medication to be administered. Nursing can also remotely access our ADCs from the Savvy units to prepare several patients’ medications ahead of time. This enables the nurse to make just one visit to the ADC per med pass—a workflow that also results in additional time made available for nurses to spend with patients. For example, prior to Savvy, each nursing unit had four separate Omnicell ADCs—four points of access, with each cabinet storing identical inventories. Now, the Savvy units direct nurses to a specific cabinet location to retrieve medications, allowing for slow moving items to be consolidated to a location in a single cabinet. This makes for a more efficient inventory management process.
Expanding on a Successful Implementation
Due to the success of the Savvy system in our med/surg unit, we are working closely with our hospital administrative team to expand the system throughout the hospital. Additionally, Brookdale plans to implement an electronic medication administration record (eMAR) and bar code medication administration (BCMA) system in the fourth quarter of 2011 to further ensure safe and secure medication administration. The benefits of Savvy will be enhanced once eMAR and BCMA are implemented because nurses will have extensive data on patient records and medication administration right at the patient bedside.
Although pharmacy drove the acquisition of the Savvy system, our nursing staff is the most directly affected as the end users of the actual units. Therefore, we were pleased to receive positive feedback from nursing about the improved workflow benefits and the added level of safety in delivering medication to their patients. Nursing has now taken ownership of the system and throughout this process we have all benefited from the improved relationship between our two departments.
Qazi Halim, MS, RPh, is the director of pharmacy at Brookdale University Hospital and Medical Center, and is a clinical associate professor of pharmacy practice at Long Island University.
Leonard Gerschitz, RPh, MBA, is associate director of pharmacy at Brookdale University Hospital and Medical Center and is a clinical assistant professor of pharmacy practice at Long Island University.
Johnny Ha, PharmD, is the pharmacy coordinator at Brookdale University Hospital and Medical Center and also is a clinical assistant professor of pharmacy practice at Long Island University.
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