Hospital pharmacy makes successful transition
Change took about three years in all
When Shore Memorial Hospital of Somers Point, NJ, completed its three-year transition to adopting new electronic technologies, including a bar-code point-of-care system, there were numerous positive outcomes.
There are safety benefits, as well as process efficiencies, says Barbara Giacomelli, PharmD, MBA, director of pharmacy for Shore Memorial Hospital.
The main benefits to switching to the automated bar-code system include improvements in inventory management and pharmacy, improved revenue capture, and savings in nursing time with regard to handling and documenting controlled substances, Giacomelli says.
An independent study conducted by consultants found that the capital outlay paid for itself within 4.4 years, Giacomelli says.
About four-fifths of health care organizations still have not switched to bar-code point-of-care technology, but the technology's use should increase as health systems invest more resources into improving patient safety, she notes.
Shore Memorial has had the bar-code system in place for a little more than a year, and the hospital has seen anecdotal evidence of a decrease in medication events since it was implemented, Giacomelli says.
"At this point it's the best option that's out there to ensure you have a safe environment for your patients," Giacomelli says.
"We track medication events, and we're seeing a shifting in some of the events," she adds.
While the bar-code point-of-care system might not save time overall for nurses, it does improve quality and moves the charting process to real time, Giacomelli says.
"In the traditional system, the nurses do something and chart later," she explains. "In the bar-code system, they chart at the same time they're doing the activities."
At Shore Memorial Hospital, the bar-code process works by having bar codes assigned to individual nurses, patients, and to medications, Giacomelli says.
When a nurse administers medication, she scans herself to identify who is administering the medication. Then she scans the patient to ensure the correct patient is being given the medication, and finally she scans the drug to match the drug to the patient and to make sure that the correct dose and form of drug is being administered, she says.
The electronic system integrates the data with the hospital's computerized data so that a pharmacist could review the patient's medication list and see exactly what was given and by whom, she adds.
If there's an error, the bar-code scanner gives the nurse a beep and places a message on the screen to which the nurse must respond, Giacomelli says.
There are some challenges to changing to a bar-code system, and these mostly involve staff training and technology maintenance.
For instance, the reason the bar-code system doesn't reduce nursing time altogether is because there are times when nurses will have to take a little longer to use the system, Giacomelli notes.
"It could be the hand-held scanner needs a new battery," Giacomelli says. "It's like a computer, and sometimes it gets stuck, and you have to reboot it."
Also, the documentation is more detailed than in the manual system, she adds.
"The computer forces you to provide information on why you got that alert signal, and what you're going to do about it," Giacomelli says.
The hospital's nurses had to take eight hours of training on the bar-code system, as well as four hours on using automated dispensing cabinets, which were also added as part of the three-year change, she says.
The hospital's pharmacists attended the nursing training sessions so they could understand how the nurses' role worked with the system.
"If questions come up with the bar-code scanners, the nurses will call the pharmacy and ask for help," Giacomelli says. "So they have to understand how the nurses' piece works."
Then the pharmacists have to attend eight hours of their own training, and they take an annual competency test on the knowledge, she says.
Since the software will have changes each year, including upgrades, there is some measure of ongoing training needed.
To obtain staff buy-in, the hospital held a variety of meetings in which staff were included in discussions about vender selection, the hospital's three-year plan, the automated pharmacy component, and the bar-code point-of-care system, Giacomelli says.
"We had a lot of displays, and a multidisciplinary committee met to lay-out the three-year plan," she adds. "We had meetings with representatives from each area, and then we met with the staff so everyone is clear about why it's important and how it's going to benefit patients."
The training and buy-in process appeared to work since there's been no pharmacist staff turnover in 4.5 years, Giacomelli says.
"We haven't had turnover, which is unique in a competitive market," she says. "When we get feedback and complaints, we try to address those."
Maintaining the system is another major challenge.
The hospital hired an informatics pharmacist to handle the bar-code point-of-care system and the enhancements needed to ensure the system is working better for the end users, Giacomelli says.
One of the benefits to the system is an improved revenue capture with regard to floor stock medications, Giacomelli says.
"We were not always charging for floor stock in the manual process, and through automation it's clearly identified which patients received which drugs," she explains. "So it's improved the whole billing process."
The bar-code system also has resulted in the hospital implementing a stronger formulary management process, Giacomelli says.
"We have extensive IV to PO conversion and also renal dosing protocol management," she says. "We do prospective antibiotic monitoring, and we have redeployed a pharmacist who used to check charts to the emergency department [ED]."
The pharmacist helps the ED with medication reconciliation on admission and helps to improve the whole medication turn-around process, Giacomelli says.
"We've identified several potential medication events that were avoided because of our having a pharmacist in the ED," she adds. "This is where we could shift resources to improve quality and have stronger control over the drugs we're using."
Also, prior to automation and the bar-code point-of-care system, the hospital's medication inventory turns were 9.6 times in a 12-month period, Giacomelli says.
"Now we're at 17.1 times per year," she says. "When you're holding less inventory in your department, you have less risk of having expired drugs or obsolete items."
The new inventory process is fully automated, so pharmacists can easily check the computer to see how many items are available and how much of each type has been used.
With the fully automated inventory management, the hospital saved $250,000 in inventory savings during the year following the transition, Giacomelli says.
"Another advantage with the inventory management is that we have less stock-outs and less chance of running out of a drug because we always know what the inventory is at any place in the hospital," she says.
Giacomelli is convinced that bar-code point-of-care systems will be implemented in increasing numbers of hospitals nationally because of both the safety benefits and the efficiency benefits.
"Everyone recognizes that medications are high-risk, and they want to offer the most efficient, safest environment for pharmacy," Giacomelli says. "They want to make their offices run better and improve retention and operate as cost-efficient as possible."
When Shore Memorial Hospital of Somers Point, NJ, completed its three-year transition to adopting new electronic technologies, including a bar-code point-of-care system, there were numerous positive outcomes.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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