As health care dollars shrink and demand for services grows, we’re constantly challenged to refine our operations. And as a 182-bed acute care hospital in the highly competitive metropolitan New Orleans market, we continuously strive to improve care while increasing the efficiency of its delivery.
One way we do that at is through a hospital-wide program we call “Target Zero Initiative.” It’s based on the recognition that every process contains waste. And waste costs us precious time and resources. So our Target Zero Initiative challenge to employees is to identify waste and reduce it to zero wherever possible.
Using Health IT to Help Improve Operations and Care
In addition to the Target Zero Initiative, one of our larger improvement initiatives was implementation of an integrated enterprise healthcare IT system. In 2009, we selected the Paragon hospital information system (HIS), based on its ability to support all areas of our operations, from nursing documentation and CPOE to pharmacy, radiology, labs and the business office.
With an enterprise Microsoft platform, we knew that it could easily support future growth, and that Paragon would be a system that users could quickly learn and adopt. And it has been a valuable tool in our search for return on investment.
A pharmacy project that fit with our Target Zero initiative was of particular interest for me. Slidell has long taken a forward-leaning approach in pharmacy management, and as a former Director of Pharmacy, I’ve always been invested in medication safety.
With our HIS live and operational, we began asking improvement-focused questions. What if pharmacy automation could supplant manual distribution processes to reduce medication errors? Would the collateral benefits include time-savings? Using automation, could we reduce the number of pharmacy professionals required for distribution and redeploy them to enhance medication management and collaborate with nursing?
Due diligence gave us clear answers: pharmacy automation would help increase patient safety and enable our practitioners to work at the peak of their expertise. With automation, we could do more with less.
Serving as project champion, our pharmacy director and his team opted to purchase two key pieces of technology that work with the pharmacy management software in our HIS:
- A medication storage carousel – The carousel features rotating shelves, bar-code scanning, and software that guides technicians to medication storage locations. It helps us improve dispensing speed and accuracy, as well as inventory management.
- An automated medication dispensing robot – The robot receives electronic patient orders from our HIS, reads a patient bar-code label, accesses stocked manufacturer bar-coded medications, scans their bar codes to verify accurate dispensing, and delivers them either to a cassette or chute (depending on whether they are going to a cart for filling). All dispensing and restocking activity is fully automated and verified by multiple bar-code scans.
The combination of the carousel and robotic system helps to ensure that nearly all medications leaving our pharmacy have been verified as accurate via bar-code scanning, and that they will be readable by our Paragon system at the patient’s bedside.
But new technology was only half the solution. Process overhaul was the other. Partnering with Studiomaca, we mapped and analyzed current pharmacy and nursing workflows. Ultimately, we developed a hybrid medication distribution approach that enables individual areas to use the most effective model. In addition, our pharmacy systems work with our HIS application to support bar-code scanning of medications and patient wristbands at the bedside for a final safety check.
Technology Scores Benefits for Slidell
Just six months into our automation journey, we’ve seen significant benefits:
- Decrease in medication errors – Zero bedside medication errors since implementation of bedside medication bar-coded administration.
- Time savings – By simplifying distribution, automation increased time for pharmacists to devote to improving patient care.
- Waste reduction – Reduced oral solid packaging, labor costs and waste from outdated medications.
- Better inventory management – Inventory optimization via implementation of the carousel. Perpetual inventory management has allowed for an increase in inventory turns and reduced waste.
- Greater space efficiency – Reduced distribution footprint, with space reallocated to other important functions, such as clinical training programs.
- Improved inventory efficiency – The dollar inventory of medications in the automated dispensing cabinets has decreased by 34%, or a $60,000 reduction in carrying inventory.
- Compliance support – While pharmacy automation is typically eligible for a state’s pharmacy check waiver, it’s not currently available in Louisiana. We’re planning to work with the State Board of Pharmacy to get it approved.
Staying Ahead of the Competition
Without doubt, moving from manual to automated distribution presented a big change for Slidell Memorial. But we knew the return on our investment would be the ability to improve care and make better use of our skilled resources. It helped us to “work smarter” and to address the quality and cost drivers of health reform and declining reimbursement.
Slidell Memorial Hospital’s Pharmacy Increases Automated Dispensing
Since implementation, Slidell Memorial Hospital’s pharmacy automation has reduced the need for manual dispensing via medication cabinets. Less time spent on dispensing has freed pharmacy staff for medication management activities and collaboration with nursing.