NRHA: Welcome to the Rural Health Executive Educational Series. I am Cody Smith, the partnership manager with NRHA Service Corporation, and I will serve as your moderator today. So today we have the privilege of hearing from Jeremy Garrett and Susan Ritter as they present improving safety and cutting costs in rural hospitals with automated dispensing systems.
Susan Ritter, DPh: So just to give you a little background on understanding and automated dispensing system, which are called a DS or an automated dispensing cabinet, you’ll see it two different ways in lots of different locations. Um, what an automated dispensing system does is it automates your medication storage, the dispensing, and the tracking of all of your medications in your facilities.
There’s a lot of benefits of it, but some of the key benefits are that it helps to reduce human error and medication errors. Um, it enhances medication traceability so you know where your medications are going, and it supports compliance with lots of safety protocols and recommendations. We do understand that there’s a lot of financial constraints in rural settings and money’s tight.
A lot of my hospitals don’t have money for this, but it’s not as out of reach as it often seen. In cabinets, they’re very customizable for your facility. A lot of my hospitals are super tiny, and so we don’t have a lot of room, but you can fit these cabinets in and you can customize to make it work for whatever area that you have available.
And again, you can kind of see the computer system and the screen that’s on the automated dispensing cabinets, the little drawers that hold the medications that will only pop open for that patient when it’s selected, when it’s already been approved in that closed medication order loop system.
Jeremy Garrett, DPh: So let’s talk about patient safety.
Everyone’s goal in healthcare is to provide great patient care while at the same time minimizing medication errors. So how do we do that? Well, number one, technology has been a big driver in this process, and one part of technology is barcode scanning. It’s almost become like a cornerstone of your risk mitigation strategy.
In hospitals. So here it says barcode scanning is everybody’s BF, F. Well, it’s kind of a joke, but it’s really not everyone from the C-suite down to the nurse. It’s a very effective tool. So when you go to load an automated dispensing system, say the technician goes, there’s a, goes to load it, there’s a barcode on the back of the medication, they’re gonna scan that medication and as Susan was talking about earlier, it’s gonna pop open that drawer and they’re gonna load that medication in the drawer in that specific place and they’re gonna close it.
It’s much more accurate as, say you have the med cart where every, every patient has their own, uh. Trey, the technician, and the pharmacy is gonna have to fill all those medications for that day. In the meantime, there’s lots of distractions. The phone can ring, someone can come up to the pharmacy. They may need them in another part of the hospital.
Well, those are all distractions and everyone knows distractions are definitely causes for mistakes and errors.
Susan Ritter, DPh: You know, the main thing for me, because I’m not on site at my facilities, um, I don’t have the luxury of getting to be there every day and see what’s going on. I depend heavily on my drug rooms.
Supervisor or my nurse that’s over the pharmacy, but I can use these reports with the automated dispensing systems and I can see what’s going on when I’m not on site. I also can have reports, um, that are scheduled and printed to where I can get them daily and I know what’s going on even though I’m not in the building.
So I have the system. It flags, discrepancies, and overrides. Those reports are. Printed every day and they’re looked at and if anything looks off my drug room supervisor, my nurse there that is on site knows to holler at me and I can log in and I can look and see, okay, what was pulled at what time, by who, under what patient, and know exactly what’s going on in the facility with those medications, even though I’m not there.
You know, so with the automated dispensing systems and the fact that I’m not on the site, they’re just, um, the reports are so important to me. I use them and I compare my facilities from site to site, and I can see the drug patterns on, um, how many opioids we’re getting in the giving in the ER compared to another facility.
I can use them to see, like, do I have one nurse that’s. Pulling more than the other nurses, kind of like, you know, similar-ish to Jeremy. I was able to run a report and see that I had one nurse who was pulling, um, way more Norco on a shift than another nurse. And you know, she actually did a drug test. She passed, but the next month, you know, I could see that hers worked.
Two times higher than all of my other nurses. We ended up figuring out, she was diverting unfortunately, and she was putting it in her pocket and taking it home to somebody else. So her drug test was clean. Um, but without being able to look at those monitoring patterns, you know, I don’t know if that would’ve ever been caught on paper, trying to see which nurse is giving more, which nurse is pulling more outta the cabinet because it was different strengths, but it just made it so much easier because I could.
Pull it by nurse activity report. Um, so, you know, I use these as a diversion solution, the reports that come off of the automated dispensing cabinets, and then I use them for opioids for, um. For my opioid stewardship programs and my small hospitals to make sure we aren’t giving too much or to see how many my providers are writing for and to be able to make sure that our hospital can dot mize and cross some t’s on watching the opioid use.
Inventory control is a part of hospital pharmacies and especially with the rural facilities. You know, I have to watch and monitor on site and we don’t have a lot of money. Um, but so we do not wanna waste any of our resources on purchasing unnecessary medications that are just gonna go out of date with an automated dispensing system.
It allows me to remotely control our inventory and to be able to see what we have in the building, even though I’m not on site. I appreciate them because I can run reports. Um, I. See what’s going on, and it manages what’s available for the nurses on the floor.
Jeremy Garrett, DPh: So an automated dispensing system definitely helps simplify your expired med management process and really your overall med management process.
Every month, my technicians run a report on meds that are gonna be expiring in the cabinets, so then they’re able to go pull those all over the hospital. So without, without an an automated dispensing system, you’re gonna be in lots of different areas, lots of different cabinets, trying to pull those meds.
It takes a lot of time. This is very fast and they know exactly where to go.
Susan Ritter, DPh: And also to go along with this, I use the automated dispensing cabinets to alert us to help capture meds and appropriate charges on these meds. I have facilities who still use paper charge sheets and because like surgery or our er, they may not be on an electronic record.
Well, we can run the report with the automated dispensing system and we see how many of an items used during a time period. And then we can compare it to the charges that we build out in our EHR. So if my automated fencing cabinet shows that we use 20, but we only bill for 15, then I can detect that we have an issue in our processes and how we’re capturing these charges.
Jeremy Garrett, DPh: Like, well, in the old system, before we had the cabinets, a nurse may come in after hours to the pharmacy, they may grab what they need, another inhaler, another tube of cream like I was saying. And they’re supposed to put it on your night log. Well, that doesn’t always happen. In a perfect world it does, but we know that that just doesn’t always happen.
And so when you’re running these reports in the in, in the automated dispensing system, you’re gonna see that these are, these have been dispensed. And so that way you can go back and charge for ’em,
Susan Ritter, DPh: you know? So about a year ago, one of my larger critical access hospitals that I consult with. They implemented the automated dispensing systems, and I do think that, you know, as a team, we were most surprised by the amount of time that the nurses were spending and doing the manual count at shift change and how having the automated dispensing system freed up their time and so manually, you know, it takes around.
20 minutes in each department, and that’s probably a pretty conservative because you’re counting 20 drugs that are in the med surg. 10 drugs that are in the er, 10 drugs that are in the PACU or in surgery or whatever. But with the automated dispensing system, it does require two nurses, but it only takes about two minutes because instead of having to count every single control that’s on med surg.
Or in the er, you only have to count the medications that were accessed,
Jeremy Garrett, DPh: the initial investment. Like I was saying earlier, it may not be as high as you think it is. It could easily be less than $50,000. Easily, especially if you don’t have a full co, a big complex system like I do, you’re really not gonna need that much.
Even if you’re just looking for controlled substance management, it’s not gonna take nearly as much money as you think it is just controlled substance management alone. If that’s where you want to start, that’s gonna decrease your liability. And the State Board of Pharmacy is gonna definitely be more appreciative when they come to, to, uh, do your surveys.
Susan Ritter, DPh: And in addition, I have a facility that I consult with that before I came they had some trouble with diversion and the hospital was fined $30,000, uh, which was a lot for a small hospital. And that’s very limited resources. So, you know, it’s definitely worth getting the automated sping cabinet and they’re just for the controls.
If you guys have a question and wanna reach out and visit with me, my email’s right there, feel free to holler. Jeremy,
Jeremy Garrett, DPh: same here. We really appreciate your time. Been doing this a while. Like I said, I, I really, if you have any questions whatsoever, I’d be more than happy to answer anything. I’ve helped a lot of different facilities when they’ve had questions and whether to do it or not to do it or, or, or, or whatever.
Uh, even like getting policies and procedures after you get it. Anything that you would need, I, I can help you with.
NRHA: Great. Wonderful. Well, thank you so much everyone for your time today. Thank you three of my technologies for the information today and bringing us together. Don’t forget to take down that information.
If you have questions or you wanna reach out, please feel free to do so.