Kodi Smith: Happy Tuesday, everyone. Thank you for joining us. We’re not quite to the top of the hour, so I’m going to give it another 60 seconds or so for everyone to filter in, and then we’ll get started.
I always feel like we need music here, something to cut the silence, right?
All right, so it is one o’clock. I’ll go ahead and get us started. Welcome to the Rural Health Executive Educational Series. Sorry, I’m losing my voice a little bit, so I apologize. I am Kodi Smith, the Partnership Manager with NRHA Service Corporation, and I will serve as your moderator today. Before we dive in, please note there’s a short survey at the end of the session.
If you could just take a moment to fill that out, I’d really appreciate it. Your feedback is invaluable in helping me to refine and tailor our series to best serve your needs. Okay, a few housekeeping items to touch on. All attendees are muted during the session. This does help to avoid background noise.
We do aim to wrap up the presentation in about 45 minutes to last time at the end for question and answers Um that being said if you have a question for our presenters Please go ahead and put it into the go to webinar control panel at any time And we’ll be sure we address it at the end Finally i’d like to remind you this event is being recorded and you will receive an email tomorrow with a link to the recording And we encourage you to share that with anyone who you think would benefit from the information 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.
But before we begin, I do want to extend our sincere thanks to our dedicated partner 3AM Technologies. We are so grateful for your continued support and industry expertise, which allows us to host conferences like the one we just got back from, educational events like this today, and other events dedicated to improving rural health care.
Your support is crucial to our mission of advancing rural health initiatives. So without further ado, I’ll be quiet and I’ll turn it over to Jeremy Garrett and Susan Ritter for our teacher presentation.

[00:02:26] Susan Ritter: Thank you so much. We are super excited to be here today and talk about the improving safety and cutting costs and automated dispensing kit systems.
And the first part is enhancing patient safety and reducing drug diversion. Jeremy, would you introduce yourself?
[00:02:40] Jeremy Garrett: Yes, I am Jeremy Garrett. I am the Director of Pharmacy Services at Weatherford Regional Hospital. It’s in Weatherford, Oklahoma. We are managed by SSM Health. We’re a 25 bed critical access hospital that has a busy ER, OB, med surg, and surgery, and we also have an infusion clinic with oncology services.
I manage the day to day hospital operations, and I oversee the 340B program along with our antibiotic stewardship program. And I oversaw the ADS integration into our hospital back in 2021.
[00:03:12] Susan Ritter: My name is Susan Ritter. I’m the owner and manager of Quality Rx Consulting. We are a rural hospital consulting service.
I do have my antimicrobial stewardship certification and we have developed a remote medication order processing systems and focus on rural hospitals. I’m a little different than Jeremy. I’m actually PIC at several facilities, but I am not on site. So our perspectives on the automated dispensing systems is a little different.
[00:03:45] Jeremy Garrett: Today’s webinar focus, we’re going to focus on improving patient safety. reducing drug diversion and enhancing hospital operations with today’s topics of being patient safety enhancements and drug diversion prevention.
[00:04:01] Susan Ritter: So just to give you a little background on understanding an automated dispensing system which are called ADS 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. Um, 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 seems. So just to kind of give you a picture of what this looks like in a facility, um, the medication order is entered by your provider. And then it goes to the pharmacy for your pharmacist to verify and approve your order.
From there, your electronic health record sends it to the automated dispensing cabinet. The nurse goes to the cabinet, picks the patient’s name, and it’s only allowed to access the medication that is ordered for that patient. So you’ve got a really good safety mechanism in that system. It updates the patient profile.
You’re allowed to see what’s been pulled and what was given, what was pulled out of that cabinet. There’s several different components in these automated dispensing 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.
[00:06:02] Jeremy Garrett: 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 BFF. 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 going to scan that medication and as Susan was talking about earlier, it’s going to pop open that drawer and they’re going to load that medication in the drawer in that specific place and they’re going to close it. It’s much more accurate as say you have the med cart where every, every patient has their own, uh, tray.
The technician in the pharmacy is going to 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.
But with the automated dispensing system, everything is going to be exactly where it’s supposed to be. You’re not going to have to worry about that. So when a nurse goes to need a medication, They’re just going to be easily, easily able to remove it. And so let’s talk about removing medications. There’s two ways to think about this.
One is if you don’t have a computer EHR, and I’m sorry, some of you are on paper still, I know it stinks, but that’s just the nature of the business. Uh, at least if you have an automated dispensing system, you’re going to have a record of everything that’s pulled on that patient. So if there’s a question of something didn’t get written down on the MAR that was administered, you’re going to have at least a, you’re going to know what’s been pulled for that patient, and you’re going to know pretty much what’s been given.
Now, when you have a computerized EHR, much like what Susan was just saying, after, after it’s been verified, it goes to the cabinet through an interface, and the nurse is able to go to that patient and pull up a full another MAR inside, inside the system, and they’re going to say, see every medication that patient needs.
For the most part, everything they’re going to need is going to be in that cabinet. So say you have medications due at 0900, there are going to be places where you’re just going to tap the, tap the screen and the drawer is going to open. It’s much safer than the old way when you don’t have the ADS. Uh, you have two different MARs, so there’s less likely of anything being missed whatsoever.
Once the, once the nurse grabs the medication from the cabinet, they’re going to take it to the room, and then that’s where the bedside scanning comes in. Now in bedside scanning, my facility and probably most facilities have about a 95 percent scanning goal. We would love to have 100 percent scanning goal.
That’s probably just not going to happen. It’s just not possible. Some departments, like your emergency department, They may run 85 to 90%. That’s just because some things are emergent and things may just not get scanned. They may have to be administered in the computer later. Now, with that being said, If you have an automated dispensing system, you’re going to be much more comfortable and much less likely to make an error in that 15 percent gap because what you’re going to pull out of that cabinet is already going to be checked and it’s going to, you’re going to know that you’re given that.
So say you have, you’re, you’re wanting to give dopamine to a patient. Well, in the old way, if you don’t have a dispensing system, you’re going to be in the pharmacy. Someone’s going to run to the pharmacy to grab dopamine. Well, dobutamine is right next to it. They’re similar, but they’re not the same. With an ADS, that is not going to happen.
That look alike, sound alike drug, they’re going to be separated in the cabinet. So you’re going to get what you need, the patient’s going to get what they need, and there’s not going to be an error. There’s other instances, say there’s metoprolaltartrate. Hematoprolosuccinate, one’s short acting, one’s long acting, one’s twice a day, one’s once a day.
In the pharmacy, they’re more than likely going to be next to each other. But in this system, they’re not going to be in the same drawer. They’re not going to be even close to each other. You’re going to get what you’re supposed to have whenever that order is selected. You’re going to pop out what you need.
And then say you have a nurse that goes in the pharmacy after hours. They’re not used to being in that pharmacy. And it’s, like I said, there’s all these lookalike, soundalike drugs, and there’s been more times, and it’s probably been several years since we’ve had, since we’ve put in the cabinets, but I’ve got many times where calls were made to me from the pharmacy from nurses asking if they had the right thing, and actually, lots of times, they have the wrong thing, and I’m glad they called.
Next slide.
[00:10:35] Susan Ritter: You know, and just to add to kind of what Jeremy said, um, you know, I still have a rural hospital that uses the med carts and to reduce the medication errors. I mean, we’ve often had, well, not often, but we have had the tray has been pulled and given even to the wrong patient. And with the med cap, with the med cabinets, You’re preventing that from happening because they can only go into that patient’s medications and have a list of the meds that are due for that med or for that patient at that time.
Um, you know, one of my facilities, we don’t have an electronic health record in the ER and having the automated dispensing system there did help me to identify when we had a medication error. And Levaquin was supposed to be given and Keppra was pulled because I was able to go back and look at those reports.
You know, we could see exactly what happened and what was given to that patient. Um, another one of my facilities, we have the automated dispensing cabinets and we’ve implemented the barcode scanning to make sure that every medication that’s loaded in the drawer, like Jeremy was saying, is correct. So if we are going to load a Norvast 5, it has to be scanned and then it’s put in the drawer and then we know the correct med is there for the patient.
versus the nurse going in, pulling and trying to find their med and hopefully getting the right strength of medication. Uh, 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 room 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 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 that flags discrepancies and overrides. Those reports are printed. 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 called 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, I can see a detailed log that has every movement of that medication and who has been in the cabinet. And those are just some of the things that are super helpful for me since I’m not in the building and where I can kind of know, okay, this is what’s going on with my medications.
This is what’s happening with my patients. And I can also really see my nurse activity to see who’s in the cabinet, what they’re doing. And it just gives me a peace of mind for not being there. Okay. Staying on the
[00:13:11] Jeremy Garrett: traceability and error detection. Uh, we had an instance where, uh, we had a, an order for a vancomycin 1500 milligrams.
And the, the vials are one gram that we have in our dispensing system. Well, the, we got a message in the pharmacy that, that cabinet needed, that, that drawer needed to be refilled. So my tech, my technician went to refill that drawer and she came back saying there’s something wrong because it’s still over half full.
Well, we got to look and we realized that a nurse was actually using one gram and not using that extra vial. And we were able to find, we were able to detect that medication error. It happened two different times on, on, on each one of her shifts and so on the third day is when we caught it, no harm was done to the patient, but we were able to catch it pretty quickly because of that.
Same thing happened to IV Bactrim, that’s sulfamethoxazole 800mg and trimethoprim 160. REHR doses that on the trimethoprim, the 160mg. Well, the nurse was dosing it off the 800 milligrams for some reason, and of course, she was using too few of vials. Same thing happens. We get a message, uh, saying that that drawer needs to be filled.
The technician goes to refill that drawer and it’s, it’s still pretty full. So again, we found that again, there was only a couple of doses that we, that, that were missed, that were messed up. We were able to fix that and no patient harm and we were able to educate that nurse and definitely that helps without the, without the ADS, we probably wouldn’t have caught that for a while.
Uh, and then it can actually go the opposite way. The nurse can call and say, Hey, I’ve got an empty drawer. You’re looking at your system and saying, well, it’s not even past the par level. Something’s wrong. You can see that maybe if there’s ever an error, somebody gave too much. Uh, we had another instance where our EHR had an update.
And we started seeing override, uh, messages, uh, from, from the system. And it was for ceftriaxone 2 grams, it’s an antibiotic. And we use an advantage system where it’s just, it’s a vial and a bag that snap together. And what happens when they updated the EHR, it messed up the order set, and it kicked back down to a regular vial and a regular small piggyback bag.
Uh, with these reports, we realized what happened, so we were able to turn that into our EHR team and get that updated. Now, sticking with traceability. In our system, we also put different things in there, uh, besides medications, we’ve put keys for other areas. We’re really not keys or prox cards is what we use here.
But I had several occasions, several instances in the last six months where I had the ER nursing manager come to me and was wondering where the, the key was to their, their main storage area, uh, materials management. It’s the after hours key. Well, I was able to run that report and see which nurse had that, you know, they were busy and she just dropped it in her jacket pocket and totally forgot about it.
And then I think hung the jacket up before she even went to work, so it actually stayed in the building. But we were able to find where that key was, who had it last, and the nurse manager was actually able to go back and see who had that key. So let’s talk about drug diversion now, another big part of these cabinets and what they can do for you.
Next slide. So AlphaSite, or BlueSite actually, did a study and released in 2024, that they said in 2022 and 2023, there were 16 million controlled substance wasting events in the hospitals. That is 16 million chances for drug diversion. At the same time, the CDC said that in, in 2017, that prescription opioid overdose was cost $78.5 billion.
Now, overall, they said that it was $1 trillion for that year. In 2020, they said that total was up to 1. 4 trillion. There’s no numbers released yet, but with the, with the fentanyl crisis, everything, it’s even more than that. Now, let’s talk about addiction rates. Trinkoff did a study with nursing back in 2022, and they found that 6.
6 percent of nurses had a substance use disorder. The same year, The Substance Abuse and Mental Health Services Administration did a survey and found that 17. 3 percent of people had a substance use disorder of Americans 12 years and older. Next slide. So, Trinkoff actually had more data, and actually when you, when they accounted for alcohol, it was 18 percent for nurses.
So, slightly higher, and it doesn’t make, it doesn’t surprise you because they actually have more, more access to medications. Next, next slide. So, drug diversion risk. So if you have an impaired nurse, They’re definitely going to put patients at risk for substandard care and infections. That’s just a matter of fact.
And they’re going to have a higher incidence of medication errors. You know, they may think they’re doing a good job, but a drunk driver also thinks they can drive down the road until they crash into somebody. There are going to be bad things that can happen from that. Then you’re going to have financial implications.
You’ve got the medication waste that I was talking about. Medication waste is usually the first step where an impaired nurse starts, Start taking medications from you before they do other things. That’s one good thing about these cabinets. You record the medication waste in these dispensing systems, so you don’t have to put it on paper.
You don’t have to have that waste slip on that narcotic and that you got to keep for five years. It’s all kept in this system. Next, you’ve got compliance issues. Your State Board of Pharmacy, your DEA in Oklahoma. We also have the Oklahoma Bureau of Narcotics. The State Board basically mandates that every pharmacy keeps a drug diversion policy that’s effective.
If you’re not effective and if you have a nurse stealing medications and it takes a long time for you to catch them, that’s on the pharmacist and they’re going to be disciplined for that. And then you’ve got your legal risks. Well, if that nurse makes errors, you’re obviously going to be probably having malpractice claims and then you’re going to have things in the paper.
You don’t want that. You possibly could have negative age cap scores, because you’re going to have bad surveys, and then, then you’re probably going to have to deal with Facebook, because you know the Facebook brigade that comes out to make comments on everything, especially in all little towns, they’re going to make comments on you too.
Now, I want to tell you about a time where we actually used our dispensing cabinets to actually catch a nurse that was diverting Dilaudid. A couple of years ago, we were getting reports, I was getting reports that we were running in the system of dispensers, but they weren’t taking anything, the drawer was popping open, but it was showing nothing was taken.
And it was starting to happen more and more over a few day period. And it was getting to the point where I would go and do an inventory and that they were there. And I was getting to the point that I thought that we might have some kind of glitch or something with our system. Then about that time, my CNO came to me and said, well, Hey, I’m getting, I’m getting notifications in my reports and our EHR.
Cause you know, they, you know, they have that interface. So, you know, again, I told her, I said, well, the count is there. So then that nurse came in, you know, Well, a day or two later to do training during the day, she worked nights and we have a training room, but she actually wanted to use the computer in the bedroom.
Nobody really said anything because she was a charge nurse. So they just thought, well, let’s just let her do that. Well, while she was in there, I ran a report after she left. Sure enough, she had accessed it again. Again, it was popping the drawer open, but nothing taken and closed in the back. And so I took my technician in and we did an inventory.
Sure enough, they were there, but I got to looking and there were, there were, uh, vials that actually had been glued shut in the back. They had been, she had been taking vials of dilaudid, popping the drawer, taking the vial, putting her purse and going out into the bathroom or who knows, well, who knows where else and taking the contents out and then putting saline back in the vial.
And since she was so impaired. She was sloppy, and she, you could see the glue on the vial. If she wouldn’t have been so, so sloppy, we might not have seen it. Since we caught it soon enough, I don’t think that any patients got that contaminated, dilaudid. And she was actually putting those in the back, and we were pulling for patients from the front of that box of 25.
But it scares the heck out of you to think about. What could have happened if a patient would have got that because, as I said, you know, the infection chance of infections there because she’s going to be sloppy. If she was sloppy glue in that, that, that bottle top, she was going to be sloppy putting that sailing back in and it wasn’t going to be clean.
Next slide.
[00:21:37] Susan Ritter: You know, so with the automated distancing systems and the fact that I’m not on the site, they are 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 are getting in the, getting in the ER compared to another facility.
Um, I can use them to see, like, do I have one nurse that’s pulling more than the other nurses? Um, kind of like, you know, Similar ish to Jeremy. I was able to run a report and see that I had one nurse. It was pulling, um, way more Norco on a shift than another nurse. And, you know, she actually did a drug test.
She passed. Um, but the next month, you know, I could see that hers were two times higher than all of my other nurses. Um, and we ended up figuring out she was diverting, unfortunately, and she was, um, 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 have ever been caught on paper, trying to see which nurse is giving more, which nurse is pulling more out of the cabinet, um, 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 in 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 some i’s and cross some t’s on watching the opioid use.
You know, just this last week, um, on the next slide, we were actually, I had a nurse that walked into one of the rooms and she found a Norco that was at bedside. And before the nurses even left the shift, we were able to run the automated dispensing system reports and we could review and see what nurse had been in that drawer for the Norco for that patient.
We could interview the nurse, see what happened, why she pulled the Norco and didn’t and left it bedside. And didn’t actually give it to the patient and we were able to educate and stop that very quickly. Um, I also perform random audits of all of my controlled drugs that are given. So I look at what was pulled from the cabinet.
We look in the EHR to see that it was documented giving, given, and it really helps to prevent any type of narcotic theft detection. Um, And we can see, you know, I had one nurse who was pulling and not documenting giving and they were handing it off to another nurse. So you’re able to really kind of close that gap to see what’s going on with my, with my narcotics, with the controlled drugs.
And even though I’m not in the building, the automated dispensing systems allow me to see exactly what’s happening with them.
[00:24:31] Jeremy Garrett: So let’s talk about affordability. I know a lot of small facilities thinks that. think that they probably can’t afford this and there’s no sense in even thinking about it. But at the same time, there’s a lot of state boards of pharmacy that are really advocating for these drug systems because it helps combat diversion.
And also, as I was saying before, it helps decrease medication errors. Now, some ways to, to, to get funding for this, there are grants out there that, that you can get for small facilities in rural settings. You just got to find them. In my instance, in my hospital, we actually use sales tax. We actually had a sales tax vote.
That was shared between the hospital, the, uh, local schools, the, this, the, uh, college, and then the city. And it’s an ongoing tax that we were lucky to have voted. So that’s how I was able to buy my, my system. I want to use COVID funds at the time, but my administration was really afraid that the auditors were going to come back and say that we were going to have to repay that money.
You know, hindsight actually. That wasn’t the case and there’s all actually a lot of hospitals that actually use the coven money to to buy these systems back then Basically an ads is way more critical than many hospital administrators believe it’s It’s almost really you it’s almost you can’t almost not do it.
And as far as More more things to think about this is a depreciable item on your medicare cost report There’s also a lot of different companies out there that that that that make these cabinets and you may think that They’re way more expensive than they really are and you may not even need a huge system You may just need a small system a relatively decent sized system for like one area hospital state er there I know some hospitals So emergency rural health and emergency rural hospitals that are just have one system in er and then they have the small med surge You And they can get everything they need out of that system.
Or they can have one system in ER, then a smaller system, just a single tower, and like, in your med surge. So, it’s way more affordable than you really think it is. And, you know, our next webinar, we’re gonna go more into detail on that, and how, and show you ways that maybe you, you really can afford that.
Next slide. So, some of the key takeaways today. We’ve talked about how the ADS improves patient safety by reducing errors and enhancing traceability. We’ve talked about how these systems play a crucial role in detecting and preventing drug diversion. And then we’ve given you real world examples between myself and Susan on our two different perspectives and the tangible benefits in both rural hospital settings.
And like I said, next week, we will talk about financial implications. And with that, I’m going to turn this back over to Cody for questions.
[00:27:11] Kodi Smith: Thank you so much, everyone, and thank you for joining us today. Jeremy, Susan, great information. I do want to thank everyone again for joining us. Go ahead and put your questions in that control panel.
Let’s go ahead and to jump into some of the questions we’ve received so far. Uh, Jeremy, Susan, how do automated dispensing systems help reduce medication errors, particularly in rural hospitals where staffing and resources are limited?
[00:27:35] Jeremy Garrett: You want me to take that?
[00:27:37] Susan Ritter: Well, we both can. I mean, I can tell you just in a tiny hospital.
Um, you know, we have a hard time with staffing in general, and I think everybody does at this point in time. It’s hard to get nurses and it’s hard to maintain your nursing staff. Um, but with the automated dispensing system, you know, it allows you to free some of the nurses that are up in my drug rooms.
Like I have some of them that may have two or three nurses in the drug rooms because they are bigger hospitals, even though they’re rural hospitals, they’re really busy. Uh, but with an automated dispensing system, we’re able to put those nurses on the floor instead of having them in the drug room filling a cart when you.
have so much knowledge they don’t need to be in there filling a cart and they could be out on the floor and then pulling those medications, um, from the automated dispensing system. Um, and of course, kind of like what Jeremy said, filling a cart creates a lot of opportunities for errors, um, and just a lot of time that’s spent when you have to pull every med for every patient where you can just go to the cabinet and pull it one at a time very quickly that pops up for that patient exactly what’s due at that time instead of the hunting and pecking.
[00:28:44] Jeremy Garrett: Yeah, yeah, and I’d say it’s pretty much the same here and as far as short staffing, you know, I’m, I’m a small hospital and not all small hospitals have pharmacists, but you know, we do here. My main technician is actually an LPN. So, lots of times we’re able to shift out, like, if somebody needs help starting an IV and surgery or on the floor.
And, and you know, in CAT scan they’re having trouble starting an iv. They don’t have to pull a nurse from the floor or er, I can send my nurse and she’s really good at what she does, really good at dropping NG tubes down in er, on the floor too. And then say we have a code in er, we both can shift over.
And basically since we’re doing, since the, the, the meds are in the cabinets, that’s decreasing some of that work and gives it frees up us time so we can do some of this other stuff.
[00:29:34] Susan Ritter: Yeah, I had a hospital that we put the automated dispensing system in just about a year, a year ago, maybe a year and a half now.
And I think at the time we were running four employees in the drug room. And when we added the cabinet, we were able to give back, you know, at least one nurse to the floor and, um, another one has gone part time. And so, you know, but it’s so nice to be able to free up some of those nursing staff to go actually work on the floor instead of being in the drug room because of the automated dispensing system.
[00:30:06] Kodi Smith: Great. Thank you so much. Another question that just came in. What issues, if any, have you seen in integrating with the various EMRs?
[00:30:13] Jeremy Garrett: Well, I can, I can tell you on ours. We initially had MedHost, and we chose not to integrate with them at the time. We could have very easily, but we were going to be switching to, Epic, and there was no sense for us to pay twice.
So, but when we integrated with Epic, it’s been, it’s been pretty smooth, couple of bumps at first, but you know, all in all the systems work really well. And Epic is, you know, it’s the main system. A lot of people can’t afford Epic, but I know that, that this system that we’re using. Can work with med host and a lot of the other ones, uh, but but you know, epic is so complex And it actually works really well with it And I have seven systems in this hospital in different areas and they’re all integrated and they work well
[00:30:59] Susan Ritter: yeah, jeremy jeremy has um He has a little more money and a little bigger hospital than what i’m used to and in my facilities, you know We run cpsi meditech Um, I have another one.
That’s I think Um I don’t even think of the name of it, but you know, we’ve integrated these systems without any problem. It’s a lot less pain, painful than I thought. I kind of had the deer in the headlights look when you’re thinking about trying to get these to work and talk. And you know, it was so smooth, um, to be able to integrate and be able to pull from it.
I do have one facility that it actually not integrated in their EHR, but it’s just, we have all of the controls in the automated dispensing system. And so even though, um, they didn’t at the time, they couldn’t afford the integration, but they are able to put all of our controls in there. So for MedSurg and for the ER, kind of like what Jeremy talked about earlier, uh, it’s so nice because the nurses can just go pull all of the controls from that automated dispensing system.
Um, but the integration with the other, with my other EHRs has, Was not bad at all. It was super easy.
[00:32:05] Kodi Smith: Great. Thank you. And that kind of leads into our next question. At the beginning there, Susan, you mentioned something about small budgets, given the tight budgets of rural hospitals. How did you help your facility justify the investment in ADS?
Are there any specific financial benefits or cost saving measures?
[00:32:21] Susan Ritter: You know, Jeremy, I know he probably has a little bit more to add to this when I’m finished, but it frees up your employees. So you’re able to cut down on your employee costs because you have the automated dispensing system. And it is something that you can write off and that, um, you know, is able to go off on your cost report.
Um, you know, and it. It also helps with inventory control and some things like that, which I know we’re going to talk about at the next webinar, but because we’re able to keep less inventory, our costs are dropped. You know, there’s just a lot of ways that I think it’s kind of a balancing system. It does cost an initial upfront, um, but you are able to deduct that off, but it also saves a lot of money and saves a lot of employee time.
So those employees are out on the floor and you’re not using them all in the system. You can actually use them on the floor, taking care of patients and doing actual patient care.
[00:33:12] Jeremy Garrett: And I’ll, I’ll add to that, uh, when I first came here five years ago, my budget for every two weeks was 80 hours of pharmacists and 80 hours of technician.
My budget still is 80 hours of pharmacists and 80 hours of technician. But at the same time, we’ve, we’ve added all kinds of stuff at infusion clinic, chemotherapy. We’ve added all kinds of clinical services. I’m ACLS certified. I do all kinds of things in the hospital. We still have pretty much the same labor budget as we did when I got here five years ago, but we didn’t do nearly as much as what we’re doing now.
[00:33:46] Kodi Smith: I love that. Thank you. Um, can either of you discuss for both of you how ADS can help rural hospitals meet regulatory requirements, such as those set by the State Board of Pharmacy, especially with limited oversight?
[00:33:58] Jeremy Garrett: Well, one thing with, with the state boards, they really, really want tight controls on your control substances.
With these cabinets, you get that you get any entry, anything that’s done in these cabinets of, like I said, if a drawer opens, like when we caught that one nurse, if a drawer opens, even if they don’t take anything, it shows that that drawer opens. So you’re going to know entry anytime that drawer is popped and it’s going to keep a great, great count of, of your narcotics.
And I mean, that’s just, you know, That’s great. It absolutely just keeps a control of everything and anything that that makes the state board happy is going to make you happy. It’s going to make your administration happy. It’s going to make you less likely to be fined because ultimately most state boards when they come in, they’re, they’re really looking at your controls more than anything.
And then, then, as we’ve talked about how it can help reduce medication errors, because it’s much more accurate because you’re scanning those medications when you’re loading them. And then when you’re going to give the patient, you’ve already scanned it once, you already know you have the right medication.
So. And then if you add barcode scanning to that, that’s just an extra layer. So, you basically, I’m not going to call it a fail safe, but it’s much more safe than what it would be without.
[00:35:07] Susan Ritter: You know, and to add, because I’m not in my facilities, you know, the DEA and the, of course, I’m in Oklahoma, so we also have Oklahoma Board of Narcotic Drug Diversion to deal with, and the state board.
You know, they want to see a closed loop system for your controlled drugs. And so, also, you know, the ISMP recommends using automated dispensing cabinets, but when you are trying to make a closed loop system of purchases to checking into the hospital to administer into patients are wasting the automated dispensing cabinet records that information.
So, For me, of course, it makes a lot easier for the pharmacist, um, because I can go and run reports. I can see when, where my drugs moved when they were loaded, um, what day, who loaded them, who refilled how many, what patient they got pulled out on, how the waste, you know, occurred, who witnessed the waste, and I just have a great closed loop.
When you’re trying to do that all paper, you really leave yourself more susceptible for diversion, for errors. It takes a lot of time when you’re trying to audit and make sure, okay, that drug got checked into the floor on this date and you have to flip their ton of papers to see who did it. Nobody signed off on it.
I mean, it’s just, you’ve got Such a mess, honestly, where the automated dispensing system just creates such a great loop that’s closed to help prevent diversion and which meets your regulatory requirements, and it makes them a lot happier that they can see you’re reviewing those reports versus, um, trying to shuffle through paper, uh, to, to meet a requirement that’s sometimes very difficult to meet.
[00:36:44] Jeremy Garrett: And, and piggybacking on top of that, you know, with, when you’re on paper, you have to keep all records at least five years for controlled substances. You’ve got narcotic administration slips. You’ve got to keep track of all those. You’ve got to separate those. You’ve got to separate all your inventory stuff.
It’s, it’s a lot of stuff to keep up with. The key word here is readily retrievable. The state board, the DEA wants ready, readily retrievable reports. Well, it’s easy to do with, with an automated dispensing system. It’s, it takes 10 seconds to run a report. It might take you 20 minutes to find all this information otherwise.
So it is, it is really great. My file cabinets are a lot, a lot cleaner and a lot lighter than they used to be. Cause as we’ve had this system almost five years, so we’re almost to the point where all of our old records are shredded. We we’ve got a lot more space, a lot more room, and I don’t have to worry about keeping up with all that paper.
[00:37:36] Susan Ritter: And it helps with HIPAA compliance. You’ve got your HIPAA compliance safety in that factor too. It’s a lot easier. I’ve had a facility that had all of their records that were stored and it was broken to. And then they had a fee and a fine. And when you have it all, you know, on, usually it’s safer online than they’re uploaded.
And your electronic records is a lot easier.
[00:37:58] Kodi Smith: Great. Thank you. Um, go ahead and we have more time. So if you have questions, more questions, please go ahead and put them in. I’ve got my last question right here. Um, how have you integrated your ADS into reporting and processes to help combat drug diversion?
[00:38:14] Jeremy Garrett: Well, as I kind of talked about before, I run reports every day on cabinet activities, uh, waste review, uh, overrides, uh, any kind, any, anything like that. I run all these reports daily so I can see all cabinet activity on all controlled substances. And that, that basically is part, overall part of my drug diversion policy with the state board.
You know what, it
[00:38:37] Susan Ritter: also helps. I mean, not only just to control drug diversion. Um, I know it’s helped in my facilities. We have, have less entries into the drug room after hours. And so anytime you have somebody coming into the drug room or your pharmacy after hours, um, we end up with Zithromax, you know, is missing.
Zofrango is missing. I mean, there’s all these things that are not maybe controlled drugs that are locked up that are still prescription medications that tend to walk off. And by having the automated dispensing cabinet, it keeps everything more secure. And nobody’s accessing my pharmacies after hours are very, very rarely are they going in there, which helps decrease any type of diversion in non controlled drugs as well as the controlled drugs.
And I do look at reports. Um, I haven’t. Just on a daily, daily look at to review my overrides, my waste log to make sure everything was wasted. Um, so, I think that’s just another aspect that’s not controlled drug, but it’s still diversion.
[00:39:39] Jeremy Garrett: Yeah, and I had the nurse that we caught, uh, Stealing the Dilaudid.
She, we, we think that she was also the one that was coming in taking Zofran after hours. And with the ADS, I mean, yes, we had Zofran in that, but our overstock is still in the pharmacy. She was finding reasons to come in here. Basically, the ADS helped get rid of a bad employee and someone that was stealing narcotics.
And the fact that she was a charge nurse, and I didn’t go over this one ago, is that she had the keys to the narcotic, to the narcotic, uh, cabinet. So without the ADS, if If she just had, she could have actually gone in there anytime she wanted taking those vials, we never would have known unless she got, you know, more sloppy with the glue.
So, in all the ADS can can basically help manage and it’s a deterrent too, because once we caught that person and they were fired. And then some charges were filed. Nurses were real, were real scared to say, I mean, I don’t want to scare someone, but they were real leery. They didn’t want to screw up. I mean, it’s having an ADS is definitely a deterrent because nurses know that someone’s watching them.
[00:40:44] Susan Ritter: Oh yeah, we do, we do a lot of nurse education from our ADS reports, from what’s pulled, um, if they handed it off for somebody else to give, we educate and say you can’t do that. Um, you know, there’s just so many. Reports that I look at that I love, um, but you know, what’s interesting is when you were talking about your diversion story, I had a neighboring facility and they caught diversion in the same way.
It was actually a PCA cartridges. They were pulling out the medication from and the pharmacist was looking at reports and noticed that why is this drawer opening and being accessed and nothing is coming out. Yeah, but the inventory is staying the same, and that’s exactly how they detected the same type of diversion.
They were pulling from the P. C. A. cartridge and replacing with water. Um, and so, you know, if you didn’t have the report, I don’t know how you would detect that because you’re opening a cabinet because I’m always thinking, Oh, how am I going to stop this at my facilities when I hear about diversion? And if you didn’t have the cabinet with the cabinets easy, I added a report that runs.
like accessed and not removed, I can look at it and see. But if you don’t have the cabinet, it’s very difficult to, unless you just happen to go in there and you catch it and you see something that looks off, like something glued on, but you don’t have a trigger to know to look. So the cabinets are super helpful to be able to know anything
[00:42:02] Kodi Smith: that’s being accessed.
Sorry, I
couldn’t get my mute to come off. Thank you so much for the information. I don’t have any more questions at this time, but we do have plenty of time. So if you have questions, go ahead and put those in. We’ll be sure to address them. Susan, Jeremy, I’ll turn it back over to you just in case we don’t have anything else come in.
[00:42:24] Susan Ritter: All right, I think, you know, I just really want to thank you guys for listening. I hope that some of the information was helpful. Our email addresses are on here. If you’d like to email us a question, there’s David with 3AM Technologies. He could also answer any questions about an automated dispensing system.
Um, and feel free to holler at me. I think Jeremy probably feels the same way, but we’d love to talk to you guys and just kind of tell you how it’s helped us, or if you have another question you didn’t want to ask, just shoot me an email and we can get back to you.
[00:42:55] Kodi Smith: Great. Love it. Thank you so much. Thank you everybody for joining us today.
Please take down this information. I know, I know this group very well and I know that they’ll reach out or answer your questions if you reach out to them. They have a plethora of information and happy to share it. So I’ll give a couple minutes for you guys to take this information off the screen. Don’t forget we have a follow up session next.
It’s next Tuesday, right? I’m not losing my mind. Yes. So happy to see y’all there. Um, if you have questions that come up in the meantime, or other questions you want me to ask at that webinar, go ahead and send them my way. Um, and I’ll add that to the next session. So, I guess until next time, I’ll give you all some time back in the day.
Have a wonderful day. And thank you, Jeremy, Susan, and David with 3AM Technologies. We’ll talk to you guys next time.