Kodi Smith: Hello everyone. Thank you for joining us today. It’s not quite the top of the hour yet, so I’m gonna allow a little time for everyone to come in from the lobby and then we’ll get started.
It is one o’clock. I do still see some people coming in from the lobby, but we’ll go ahead and get started. Welcome to the Rural Health Executive Educational Series. I am Cody Smith, the Partnership Manager with NRHA Service Corporations. Before we begin today, I do want to just remind you or let you know there’s a short survey at the end of this session, and if you could take a minute to fill that out, I truly appreciate it.
We really do take that feedback and use it to refine and tailor these future series best to serve your needs. A few housekeeping items. All attendees are muted during the session to avoid background noise. We do aim to wrap up the presentation in about 45 minutes to allow for a Q& A at the end. If you have a question for the presenters, please at any time go ahead and put that into the GoToControl panel and we’ll be sure to address those.
I’d also like to remind you that this is being recorded and you’ll receive an email with a link to the recording, um, actually tomorrow, tomorrow afternoon. So today we have the privilege of hearing from Jeremy Garrett and Susan Ritter as they present the Improving Safety and Cutting Costs in Rural Hospital Automated Dispensing Systems Part 2.
So this is the Enhancing Financial Performance section. Before we begin, I would just first like to extend our sincere thanks to our dedicated partner 3AM Technologies. I am so grateful for your continued support and the industry expertise that you bring to us, which allows us to host conferences, educational webinars, and other events dedicated to improving rural health care.
Your support is crucial to our mission of advancing rural health initiatives. Okay, without further ado, I’m going to go ahead and turn it over to Jeremy and Susan for our feature presentation.
[00:02:24] Susan Ritter: Hello, thank you. My name is Susan Ritter, and I am a pharmacist and owner manager of QualityRx Consulting. We are a rural hospital consulting organization, um, where we manage drug rooms and hospital pharmacies for rural facilities that are a little smaller in size.
Uh, we also manage antimicrobial stewardship program, do the remote medication order processing, and, uh, remote monitoring offsite. And
[00:02:52] Jeremy Garrett: I’m Jerry McGarrett. I’m the director of pharmacy services at Weatherford Regional Hospital in Weatherford, Oklahoma. We are managed by SSM Health. We are a 25 bed critical access hospital that has a busy OB ORER in med-surg departments.
We also have an infusion uh, service with oncology services. I manage the day-to-Day hospital operations, and I oversee our three 40 B program and our antibiotic stewardship program, and I oversaw the integration of the automated dispensing system into our. into our hospital back in 2021.
[00:03:26] Susan Ritter: So last week’s webinar was over improving patient safety, reducing drug diversion, and it’s available on demand. If you’d like to watch it, you can request the link. And then today’s topics, we’re going to be talking about using an automated dispensing system for inventory control to help with your billing and to increase your overall efficiency in the hospital.
We all know that 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 and so we do not want to waste any of our resources on purchasing unnecessary medications that are just going to 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 and I can see what’s going on and it manages what’s available for the nurses on the floor.
With an automated dispensing cabinet, nurses can get in the habit of coming into a drug room and pharmacy after hours and they remove items that I may not know about. But with having an automated dispensing system, I know exactly what’s being removed and by who. So this alleviates things that are gone from the pharmacy without me being aware.
I’m able to really pack the cabinets out and so that helps me to have a lower inventory overall in my hospital pharmacy. And it allows me to keep a smaller inventory in the drug room and we have a better control overall. We reorder off of what a list that prints every day after we set our margins and set our reorder points and so that we can stock the cabinet and by having a majority of the items in the cabinet I have less inventory costs tied up sitting in my pharmacy.
You know, the most, um, we also have various cabinets and we’ve created kits so that we can load an RSI kit and pack it into the cabinet that can be pulled in case of an emergency. And this decreases the amount of meds that we keep on the crash cart that just have a tendency to expire where we can package them and keep them in the cabinets and keep them moving.
[00:05:36] Jeremy Garrett: 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 going to be expiring in the cabinets. So then they’re able to go pull those all over the hospital. So without, without an automated dispensing system, you’re going to 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. Also, what this does is cues them to look inside the, the, the main pharmacy for, for meds that might be expiring. We do bin checks manually anyway, but it’s very possible to miss something. An expiration sticker might, might fall off or something.
More than likely, the same meds that are in the dispensing system are the same ones that came from the same box, essentially, in the pharmacy. So, that, that is definitely a big help. Also, on the control substances. So you have a obscure schedule to drug that’s not very used very often in the old system. If you have just a narcotic cabinet and say you miss that in a bin check.
You may be in trouble because you may actually get an order for that and you can’t use it. Schedule 2 medications do not come next day like most other medications. It’s usually a 2 5 day process. So you could really be put in a bind if you miss, if you miss something when it expires and then you don’t have it when you need it.
Basically with the automated dispensing system, we pull everything, we save it for a reverse distributor, which that, those base, what, those Those people do, they actually help legally with, with the forms, the 222 forms and the control substance invoices. They help send that back and that way it helps us.
Overall, the whole process is a lot easier. With the automated dispensing system, it’s definitely a more efficient process to find and waste medications, uh, than the old system. If you don’t have it, if you don’t have the drug cabinets, you have these narcotic slips that basically, uh, they’re, they’re Every time you go to give a narcotic medication, you have to fill that slip out.
The nurse does what it is, how much they gave, how much they wasted. Overall, it’s a lot longer, a lot longer process than the pharmacy’s got to keep track of that for five years. With the automated dispensing system, You don’t have to do that. Everything is readily retrievable. You don’t have to keep track of all that stuff and all.
If you ever need to look at that, you just run the report. Also, it’s easy to account for monthly control substance inventories. My technicians every month. We, we, we can, we do an inventory on every single system. I have seven systems in my, in my hospital along with our master in the pharmacy. It doesn’t take very long to count each one.
It is a great thing, and you always know exactly what you have. Another thing in this, you’re able to document and control substance waste, like I was saying. Uh, it’s just, it’s a lot easier. And then that says TN case. Basically what we’re doing with that, uh, TN case is a very expensive medication when, when that is pulled, they’re supposed to bring a sheet to the pharmacy to tell us that they’ve used it, but they don’t always do that.
These medications require manually to go into the HR and to waste a portion that wasn’t used. So say you have a 7, 000 medication. If you only use two thirds of it, you’re not going to get paid for the other third. So this basically tells us, Hey, we need to go when we run these reports, we need to go in and do this and, and, and, and do that, uh, uh, waste the same thing as for alteplase, it’s the same kind of drug.
They’re, they’re, they’re cloud busting drugs is 8, 000. It doesn’t take very long to get you in trouble. If, if you do, if you miss that waste, also you don’t want to be caught and somebody use that and then not reorder it. So these systems are very good for that.
[00:09:18] Susan Ritter: You know, to add just a little bit to what Jeremy said, since I’m not on site, it’s always in the back of my head that something’s going to get used.
I’m not going to know about it. And then there’s going to be an emergency and the drug’s not there. And by loading the TN case or the activase, I’m alerted immediately if one is used, you can get the report to print out or email to you and you know to reorder it, or I can reload it if we do keep two. But some of my facilities, like I said, they really don’t have a lot of funds.
And so we can just keep one in the building, we get alerted that it’s been used and then we know to go to divert for like a potential stroke patient, and we can order a new one and get it in. So that kind of helps me sleep better because I have systems in place with the automated dispensing cabinets to alert us when these meds are used.
And also to go along with this, I use the automated dispensing cabinets to alert us and to help capture meds and appropriate charges on these meds. Um, I have facilities who still use paper charge sheets and because like surgery or 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 dispensing cabinet shows that we use 20, But we only billed for 15, then I can detect that we have an issue in our processes and how we’re capturing these charges. The automated dispensing cabinets have also helped us identify missing charges when we just look at what was pulled in the ER.
So we’ve, when we’re comparing our charts to what was pulled from the cabinet, a lot of times we have some things that have been mischarted. They haven’t been charted given, or the nurse was so busy she didn’t write it down because we are on the paper charts. So when we can use that automated dispensing system report and make sure we’ve captured all of the charges Um, we also use it for supplies I know that sometimes you’ve seen nurses and they have stickers all over their scrubs or all over their charts because of things they’ve gotten from Central Supply or things that they’ve pulled and still have the charge tickets on there.
Well, a lot of those get trashed and so we miss those charges. By loading some of the more expensive things into your automated dispensing system, we can catch some of the more higher cost things that we want to make sure we capture for our charge reports. Jeremy, I think you have some examples of some things that maybe you have caught charge wise at your facility.
[00:11:48] Jeremy Garrett: Yes. So in our EHR, uh, we are charging on administration. So our bulk items like inhalers, insulin vials, tubes of cream, uh, they basically, you get, they get charged one time and you can go ahead and advance the next slide. Uh, but they get charged once, so they use that up. And then if they, if they need another one, it’s not going to get charged.
So when, with the dispensing system, when we run our dispensing reports, we’re going to see, Hey, this, they got another inhaler. They got another tube of cream and a 300 inhaler. It doesn’t take very many of those to really upset your CFO with if you’re wasting a lot of money. Uh, lots of times. Things can happen.
They can. They think they lose one. You see that it’s been dispensed. Well, before they even use that you can see that you can go down and find that they don’t open that inhaler and you save essentially save two or 300. Uh, when the nurse fails to administer in the Mar. Well, sometimes we’ll have 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 the 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 the automated dispensing system, you’re going to see that these are, these have been dispensed and so that way you can go back and charge for them.
Now, it talks about charging waste. The next thing we are actually already kind of talked about with that with the TN case and the alteplase, but ultimately, like I was talking, talking about before, you could potentially lose thousands of dollars by not charging that way. So, these systems really help you catch that waste and we’re able to go in and do that.
And as Susan was saying earlier, it’s her high cost drugs treated as a control drug. That just basically puts a lot more attention on it. So you’re not going to miss those charges. So next we’re going to talk about reducing hidden costs and a big hidden cost is drug diversion. We hit on this in webinar one.
Uh, we talked a lot more in detail on it. But essentially, drug, drug diversion, it can, it can cost you more than just the drugs you’re losing. It can also cost your reputation and goodwill, which is invaluable. Ultimately, a nurse that’s, that is not, uh, doing well, that is, that is abusing drugs, you’re going to get lower quality, lower quality patient care.
You’re going to have an increased incidence of medication errors. At the very least, it’s going to cost you negative HCAP scores. If that’s, that’s, if you’re lucky, then you could end up in the newspaper in the news. One time I had a pharmacy partner when I worked retail pharmacy, they’ve got arrested for, for stealing Xanax.
I saw that on the news. When I had to go to work the next morning, that got real interesting with patients and even your fellow employees. You don’t want to do that. Not to mention social media these days. Everybody, every little town has got a little, has a little Facebook group, a private Facebook group, where, you know, if Susie Q, that normally trashes the cheeseburger place or her kids school, well now you’re the focus if her family member was being taken care of by that nurse and there was something happened.
So then there’s personal and facility liability. You know, lawsuits, if there’s malpractice, but also the DEA and the State Board of Pharmacy, you can be fined. And then the pharmacists, they’re personally, they’re responsible. Every pharmacist that is a director of pharmacy has, is supposed to have a diversion plan.
And honestly, if you don’t catch it soon enough, you’re going to be held liable by the State Board. You’re going to be fined, and then your license can also be reprimanded. I’ll want to go back and talk just a little bit about an example that we did in the last webinar, because essentially the ADS is what helped us catch a nurse that was diverting.
She was stealing Dilaudid. She was doing an override and popping the drawer, but not taking anything under, under a patient. And we, it happens quite a few times to a point we thought that we might’ve had a software glitch. And then my CNO actually came to me and she was actually getting notifications on our EHR report since there’s an interface.
Well, the nurse came in one day to do some nursing education. She’s supposed to go to the training room that has computers. Well, she decided she was going to go to the medication room because there was a computer in there. Well, she’s a charge nurse. So people really just kind of let her do it. And sure enough, after she left, I ran a report.
There were, there were overrides. So me and my technician went down. And sure enough, we counted the vials. They were all there. But we realized that she had been taking vials of Dilaudid, taking them out of the room. taking the contents out, putting, putting saline back in and glue in the top back. Luckily she was so impaired.
The glue job was really, really sloppy. So we were able to see it. And luckily she put those in the back of the box. So I don’t think any patients ever got those can’t guarantee it, but I don’t think so because we were pulling from the front and she was putting the, uh, the, the old, the contaminated ones in the back, but without the dispensing system, we never would have caught her or it would have taken a long time.
And if she would have been sloppy with a glue job, it could have gone by yet. As we sign said, when we come in withida. So, and ADS definitely causes you to have quicker detection. And like when this, when we caught this lady, my state board was really impressed that we caught her so quickly. And I was too, because I would have been on the hook for it if we wouldn’t have caught her the next slide.
So, an automated dispensing system will definitely increase your efficiency. During nurse shift changes, you’re going to have a more fluid shift change when they go to give report. You’re not going to be counting a whole narcotic cabinet. Without the dispensing system, you can spend a lot of time counting narcotics, and that’s a waste of time that you could be using that on patient care.
While, while you got two nurses counting, you know, Miss Johnson that just had Lasix an hour ago, now it’s hitting, she’s hitting that call button. There may not be somebody to go down there right, right then, because you’re in report. With the automated dispensing system, you’re going to have less time managing your inventory.
The med waste process is faster and easier. I hit on this a little bit earlier, but essentially, you know, with the old system, Without the dispensing system, they’re going to fill out a narcotics slip. They’re going to fill out their name, how much they gave, how much they wasted. The witness, lots of times what they gave and what’s wasted is not that legible.
So you have to go back and try to decipher that. That’s kind of a problem. I know when I used to do my manual reports check and it was not easy with the dispensing system They check the med out and they can waste it right there with the other nurse. It’s right there in the reports It’s legible readily retrievable and it’s great It’s easy to keep for five years where the narcotics slips you had to keep for five years You had to have a file for each drug.
It’s kind of a nightmare to have to do that And then say you have like during shift change when you’re and you have you’re counting narcotics if you don’t have the dispensing system And you with the discrepancy You’ve got two people counting then you’ve got to pull that other nurse in that was has got signed on that Miss johnson still hadn’t got her got out of the bathroom and she’s hitting that call button It’s going to cause a problem and then like I said if she’s accused her niece and she’s in there You might see that on facebook, but essentially you got accuracy your increased Accuracy and you have less time tracking down errors
[00:19:15] Susan Ritter: 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 doing the manual count at shift change and how having the automated dispensing system freed up their time. So, you know, with the manual count, it required two nurses. They do a count of every single control drug.
in the facility in that area. So you have two nurses who are counting in ER. You have two nurses that are having to count in MedSurg. Sometimes it’s the same nurses. And so you have to, it just takes a lot of time for those nurses to be off the floor. It makes me a little nervous because I have a lot of time spent with the controlled drugs, which I’d really like to limit the access and limit the time that anybody has with the controlled drugs, limit opportunities to, um, have some sticky fingers.
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 surge, 10 drugs that are in the ER, um, 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 MedSurge or in the ER, you only have to count the medications that were accessed.
So the cabinet knows, hey, on this shift, we only removed morphine and Norco 10. So at that point, the nurses only have to count two of them instead of having to count every single control. In that department. So we kind of went through and we did some time, um, assessment on how much this. Like time did this really save?
And so if you say 40 minutes per shift at two shifts a day, because you counted each shift change, that is over 486 hours that you have had and that you’ve saved when you are doing the automated dispensing system instead of having to manually count all of the controlled drugs. Um, you know, another thing to consider is that, The shift change, if we’re going to detect a discrepancy, it’s so much easier at On the automated dispensing system when they’re counting at shift change They may not even know there is a discrepancy because they checked one out But they should have checked two out or there could have been a med error that was needed to be detected Um, so since i’m not in the building It takes me a long time sometimes to identify there’s a discrepancy if I did not have the automated dispensing system It takes a really long time to resolve if we do find a discrepancy because we don’t know who was in the cabinet necessarily.
We know who’s signed a drug out, but they had access to everything when they were in the cabinet. And maybe they didn’t sign in or, you know, they just opened the cabinet, but with an automated dispensing system, they have to have their fingerprint or their ID to be able to get into that cabinet. So, you know, exactly what happened and who has been in there.
They may have, we dissected this last week, uh, they actually use our automated dispensing report. We had a discrepancy and they couldn’t figure out what happened. Well, the nurse had only pulled 25 milligrams of Librium and they were supposed to have pulled 50. So because we had the discrepancy that was came up on the shift change, we were also able to identify a med error where we didn’t give the patient the right amount of medication that they needed.
So having the, you know, The cabinet to be able to help us to detect things like that, you know, it’s just another benefit to be able to see when your discrepancy, you can be like, Oh, not only my monitoring, trying to keep somebody from taking my medications, but it also helps to make sure your nurses are administering them at the appropriate dose and in the right way.
I think Jeremy has also used the cabinet to protect keys in your building.
[00:23:14] Jeremy Garrett: Yeah, so who has the keys? You can look at this two different ways. First, what if a nurse takes the keys home? In the old system, if you don’t have an automated dispensing system, say you’ve had a discrepancy, the nurse wants to go home, it’s an hour after, by the time they finally figure it out, they’re out the door.
and they may take the keys with them. Most of these are rule settings. They’re not going to live right down the street. They may be 30 minutes, an hour away, and they realize Miss Johnson hitting that call button again. Now she wants her pain med. And the keys are an hour away. With the automated dispensing system, you don’t have to worry about that.
There are no keys. You, it’s not set up for that. It’s all automated. Like, like Susan was saying, your, your fingerprint, your ID. That’s all you need. We actually use the automated dispensing system a little differently also. We actually keep, Keys in it for different departments and it will be. We keep our epidural pump access keys.
Uh, we keep a farm, an extra pharmacy key in there for after hours access to the drug room materials management. We keep a key. And actually, it’s a, we keep, we use prox cards, but same, same difference. But we have the prox card. For materials management, if they need a big supply on them after hours, that’s not in their in their little supply room.
Are we use a sprinkler? So we have a sprinkler system key that that maintenance is put in there. It’s for the fire department. If they need that when they come and then we have an extra provider badges for like our providers when they come and they’re not normal. Normal employees. We have extra that so they can access areas of the hospital.
It’s really become very nice to have that. And then you have the accountability. If one goes missing, you know, who’s used that last and you can go to that, that nurse or whoever and find out where that’s at and return that. So,
[00:25:02] Susan Ritter: you know, overall, I really think the cabinets help us to become more efficient, especially since I’m not in the building, but once a week I can run an automated report. Anytime. Um, I can see, especially like with the fluid shortage that’s going on right now, I can log in and I can look and see how many fluids do I have on the floor, um, how many are we using and pulling out of the cabinet in a day.
You know, those reports really help me to be able to manage my inventory a lot better, even though I’m not in the building. Um, it increases efficiency of my time when I am, am in there. I can use the automated reports to look at billing opportunities and help us see where we’re missing some charges. It really helps with my inventory so that I’m not spending an excess amount of inventory on drugs that are not going to be used, that are going to expire or have to be returned and we’re not going to get full credit.
It uses the automated dispensing system to detect diversion and med errors. I also, it just definitely helps me on having a peace of mind on the. drugs we have in the building so that I know we’re not going to run out and have systems set up with the reporting to ensure that we keep the right meds in the facility that are needed.
And staffing, you know, really frees up your staff’s time, you know, shift change and even when they’re not at shift change going in and out of the drug room, the automated dispensing system just make you more efficient and help your nurses to get to be nurses instead of having to count drugs all the time.
[00:26:32] Jeremy Garrett: So let’s talk about benefits of a transition. There are two different ways. You have the old system with a cart fill system, or you have it with an automated dispensing system. So on the top is basically the way that kind of will go and flow when you have a cart fill. So first you would have a pharmacy manually selects the medications from the, from the stock shelves.
And then you’re going to put those medications and place them in the individual patient bins in the medication cart. Then each bin is labeled with the patient’s name and room number. Then the pharmacy staff double checks the cart against the medication orders. And then they deliver that cart to the nursing unit for administration.
Then once a patient needs, uh, whatever the, you know, the medication, It’s time for the nurse will access the patient med orders in the EHR, and then they’ll pull the from the patient band and administer the medication. That’s a whole lot of patient touches on that medication, or a whole lot of touches on that medication from nurses from pharmacy to nursing.
Then you can on the bottom, it is basically with a automated dispensing system. Here you see the pharmacy enters, verifies the medication orders in the EHR. And then those orders go automatically or populated into the ADS. And then from there, all the nurse has to do is they have to go and access the cabinet, and then they dispense the medication needed for each patient.
The ADS tracks and logs each medication pull and reports discrepancies or overrides. You can see right here, it’s a lot simpler process and really a lot safer process. The less touches equals less medication errors, because with, with each touch, there could be distractions and all kinds of things, but with the automated dispensing system, it is much safer.
[00:28:11] Susan Ritter: So, you know, to add to that, the hospital that we added the cabinet to about a year ago, we saw a drastic decrease in after hours entries. I always look at how many nurses are coming into my drug room or pharmacies after hours and having to remove meds so they didn’t get to. fill the cart because they had a new admit.
And so they had to go in there and try to find whatever drugs for that new admit. So, you know, I count how many times are signed, which they don’t always have. They’re probably not always signing, but on average, how many times are coming in and having to get medication out of the hospital pharmacy. Well, before we had the automated dispensing cabinet, they were in there at least four times a day after hours from having my drug room nurse be in the drug room.
So, that really takes your nurse off the floor, off from working their shift, and doing patient care, and they have to come into the hospital pharmacy. Some of my hospitals, we require two to go in, um, just for, to prevent diversion of patients. Your non controlled prescription items. And so you’re really removing them from patient care, and they’re having to go into the drug room, hunt around, try to find the drugs that the patient takes, and get through the night until the drug room nurse is there the next morning.
After we added the The automated dispensing system, we have an average of less than one entry per day. So you’re averaging or I think it’s around like 0. 86 to 0. 9 is about where our entries are right now. So if you think about that, that gives the nurse so much more time to be on the floor doing patient care.
instead of in the drug room or the hospital pharmacy looking for drugs. And it also decreases the potential for other medications to walk away because when you have a nurse that’s in there, sometimes it’s easy to say, Oh, my kid’s sick. I’m just going to snag a Zytravax or I’m going to take some Zofran because they have a stomach bug.
And, you know, those are still diversion opportunities that you want to try to diminish as the hospital pharmacist and to save money for your facility and to make sure that everybody’s following the rules appropriately. Um, so having the automated dispensing system, that really keeps people out of the drug room and they can just go to the cabinet for the new patient and pull their drugs out and not have to go in after hours.
[00:30:24] Jeremy Garrett: So let’s talk about the affordability of an automated dispensing system. I know a lot of CEOs and CFOs think that it’s just way too expensive and they don’t even want to mess with it. So But really, they ought to look at it because there are a lot of options that they can use that will decrease that cost.
But first and foremost, your state boards of pharmacy really are advocating for ADS because it helps combat diversion and decreases medication errors. Those intangibles alone are definitely worth looking at. There’s also ways to afford it. There’s a grant, there’s, uh, especially for the smaller hospitals, you just have to, to know where to look and how to write the grant.
My hospital, we use sales tax. Uh, there was a sales tax that was split between I think the, the hospital, the city, the, the, uh, schools and then the college that we have in town. And it’s kind of an ongoing tax, but it keeps on getting, getting approved and we’re very lucky with that ’cause that’s how I was able to afford mine.
In reality, an ADS is way more critical than any hospital administrators believe. And like I said, it would save you more money than you think, uh, just for medication errors. If you get lawsuits or whatever else, it’s going to save you with that. Another thing to look at is the number of systems. Like I said, I have seven systems.
Most hospitals aren’t gonna need that. A lot of small hospitals and especially I’ve seen some rural emergency hospitals or just small hospitals that don’t have a lot of people in med surg and they have a busy er, they have a big system in ER and either no system in med surg or a small system, especially if they’re close, they can, they can both access, you know, the area pretty well.
One small system is not that expensive, especially if you look around at some of, at all the companies that have these. Not everyone’s as expensive as you think they are, and it’s also depreciable on your Medicare cost report. That’s one thing to definitely think about. Uh, it’s just, it is really a great, great tool to have, and it’s definitely worth the money, and you really can’t afford, and excuse the double negative, but you can’t afford not to have it, and once you do get it, you’ll see just how valuable it really was.
[00:32:27] Susan Ritter: You know, and just to add to that, um, the facility that recently put mine in a year ago, we had four or five full time drug room employees because it’s a super busy critical access hospital. And with the automated dispensing system getting to put in, we were able to cut our employees in the drug room and let those nurses go back on the floor.
And everybody needs nurses right now. So, you know, that was just an additional benefit affordability. It may be high, but you’re paying those salaries either in the drug room or pharmacy. or you could have them on the floor and being able to put some of those nurses on the floor is a huge benefit. Um, so some key takeaways is just that an automated dispensing system improves your inventory control, which is going to save you money.
It improves your billing accuracy, which is going to make you money. And then it helps reduce your hidden costs by allowing those nurses to have their time spent doing nursing duties versus hunting and looking for drugs. Uh, the benefits apply to a full time pharmacist. Like Jeremy and also, you know, to me where I’m working remotely and I consult and I’m only in the facility once or twice a week, and they didn’t hopefully we’ve demonstrated some significant financial operational benefits of having an automated dispensing system.
If you guys have. Any questions for us? You know, we’d be happy to answer them and see if we can help kind of guide you in the right directions or clear up anything that’s not very clear.
[00:33:56] Kodi Smith: Great. Thank you, Susan and Jeremy. Um, if you have questions, please go ahead and put those in the control panel now and we’ll be sure to get to them.
I’ll get us started here. How do automated dispensing systems help with inventory control in hospitals with limited budgets?
Well, I mean, basically, you don’t have to keep as much
[00:34:17] Jeremy Garrett: inventory. That is a, that is a big thing with this is that you always know how much you’re going to have and it’s, you can keep more stringent controls of, especially with the reports. And like with Susan, she’s not on, on, on station all the time. It’s, it’s a lot better.
We, uh, in my hospital, we did cut our inventory. I just did inventory, uh, last month. I know one of my first inventories I did probably almost five years ago. My inventory was around 170, 000. We’ve gotten bigger. We’ve gotten, we’ve gotten a lot more complex and we got the dispensing systems and we’re still running about the same inventory.
I think that last was around 180, 000 and inflation has increased the amount of drugs way more than that. So it has really saved us a lot of money. If you want to think of it like that.
[00:35:04] Susan Ritter: Yeah, and you know, my goal at my rural facilities is if you see all the drugs behind Jeremy, like we can get most of them in the cabinet, and then we don’t keep another box of 100 on the shelf, we let it notify us when we need to reorder, and then.
We can reorder at that point. So it really helps us to cut, um, my stock that’s at the drug room a lot by having the cabinets. We’re able to put it out on the floor, keep it moving, and keep our inventory circulating that way.
[00:35:35] Kodi Smith: Okay, great. Thank you. Uh, another question. Can you provide examples of how ADS has helped identify and recover missed billing opportunities?
[00:35:47] Susan Ritter: You know, I can say we’ve used it a lot in my rural hospitals, uh, especially the ones that may not have an electronic health record in the ER, um, and their paper charting, but some of them do have the electronic health record. And we’re still just, we miss billing opportunities because we bill upon administration.
They may not go in the morgue and document it. And so we can, you know, print the report, see what’s pulled, print the report, see what’s billed and see where we’re missing out some issues with our systems and be able to recoup those. Those drugs that haven’t been billed for
[00:36:19] Jeremy Garrett: and then we’ve had plenty of times where we’ve gone in and ran dispensing reports like on a weekend.
It could be crazy. They’ve had a code. They’ve used TN case and I didn’t get the code sheet that I was supposed to get. So, I didn’t even really know, and we have, we have backup TN cases, so, you know, they may, the technician may have taken it, and it may have reordered it, but not, I’m not told that, you know, we’ve used it.
Well, I’m able to go in and run those reports and see that we’ve used it, and the patient may have only used a portion of the bottle, like two thirds of the bottle, like I was saying earlier, and we would have lost out on thousands of dollars. If I wouldn’t have seen that. So I, in my EHR, I think I have 48 hours after they’re discharged to go back and, and, and build manually.
And then I, it’s a little bit more complicated after that can still be done, but it is definitely helped with that drastically. Those high dollar meds, it is really saved a lot of money, uh, that way.
[00:37:23] Kodi Smith: Okay, thank you. Um, do you know what funding options or grants are available for rural hospitals looking to implement an automated dispensing dispensing system? And how can hospitals, I can’t talk today, you guys, I’m sorry. How can hospitals justify the initial investment? I
[00:37:40] Jeremy Garrett: don’t know of specific ones because I haven’t looked.
I just know that there’s stuff out there, grants for rural hospitals, uh, for multiple, multiple reasons. Uh, and this would fall into that. 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, a big complex system like I do.
You know, like I said, I have seven systems. I have a huge system in MedSurg. A big system in ER that’s, that’s, I mean, it’s, it’s, it’s, I would, I would consider it monster. It’s, it’s three big towers and then the fridge. And then I have some smaller ones in other areas of the hospital. And so you’re really not going to need that much, even if you’re just looking for controlled substance management, it’s not going to take nearly as much money as you think it is.
Just control substance management alone, if that’s where you want to start. That’s going to decrease your liability and the State Board of Pharmacy is going to definitely be more appreciative when they come to do your surveys.
[00:38:44] Susan Ritter: You know, in addition, I have a facility that I consult with that before I came, they had some trouble with diversion and the hospital is fine.
30, 000, which was a lot for a small hospital, and that’s very limited resources. So, you know, it’s definitely worth getting the automated fencing cabinet in there just for the controls, and they now have one that just does the controls because they can’t afford to have him in two different areas. But having that one cabinet for the controls to decrease your risk of fines and These and diversion is cost effective.
Also, one of my facilities I went through and added up all of the costs that we had an employee cost and by having somebody in there seven days a week for 12 hour shifts in the pharmacy or drug room. And when you compare that to the cost of the automated dispensing system, you know, it was cheaper to put your automated dispensing system in and cut down on that employee time.
And some of those employees, we got to relocate in other areas. And so nobody lost their job, but we just had more coverage in other areas. So it was definitely a beneficial cost wise in that, if you look at your cost of what you’ve got in there right now.
[00:39:56] Kodi Smith: Thank you. Another question. How has ADS improved nursing efficiency and how does that translate to cost savings? I know we talked a little bit about that, but let you guys kind of hit that one more time.
Uh, well, I mean, essentially, it has, you know, as
[00:40:14] Jeremy Garrett: Susan was saying, it’s cut down on what you’re having to spend.
That’s, that’s, that’s a big portion of that.
[00:40:24] Susan Ritter: Yeah, I mean, we just, my nurses are, they’re free to go on the floor instead of, and take care of their patients instead of having to go and hunt meds all the time. So, you know, I don’t know, I mean, cost wise, of course, what we talked about prior, but I just think giving the nurses some time back to be nurses instead of having to be frustrated when they go in and try to find a med and call and call me or call somebody else and want to know where it’s at.
And sometimes it wasn’t there because somebody took it and we didn’t get to reorder it. It’s just. All of those little things that you may not even think about that it’s so beneficial to have your automated dispensing system because it removes those problems for your nurses and helps you to take care of your patients better.
[00:41:03] Jeremy Garrett: Yeah, and the nurses are going to be happier and they’re going to be able to do more things and they’re going to help Miss Johnson get the bathroom.
[00:41:13] Kodi Smith: Yeah, absolutely. I think that’s one of the biggest takeaways that I’ve listened to you guys on both of these sessions is the nursing efficiency, right?
It’s so important when our nurses are at the bedside and who they’re taking care of, you know, um, I don’t have any other questions at this time. So, I will say, don’t hesitate. If you have a moment, you have a question you want Susan or Jeremy to ask, go ahead and put it in. We’ll be sure that you have the contact information.
While we wait to see if there’s any other questions, Susan, Jeremy, I’ll turn it back over to you for any closing remarks.
[00:41:42] Susan Ritter: You know, I don’t have any more closing remarks. Just if you guys have a question and want to reach out and visit with me, my email is right there. Feel free to holler, Jeremy.
[00:41:51] Jeremy Garrett: Yeah, same here.
We really appreciate your time. Uh, I’ve been doing this a while. Uh, I, 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 whatever, uh, even like getting policies and procedures after you get it, anything that you would need, I can help you with.
[00:42:19] Kodi Smith: Great, wonderful. Well, thank you so much everyone for your time today. Thank you 3MA Technologies for the information today and bringing us together. Don’t forget to take down that information if you have questions or you want to reach out, please feel free to do so. And of course, you know how to get ahold of me.
A link to the recording will be sent tomorrow afternoon. And when we sign off today, if you could just take a moment to fill out that survey, I would really appreciate it. I do review that information and take that into consideration when tailoring our future series. Jeremy, Susan, thank you again so much for all the information.
And joining us today.
[00:42:51] Susan Ritter: Hey, thank you guys. Thank you