Automated Medication Dispensing Systems: The Cure for What Ails Hospitals?
The Global Automation Market Boom
Experts expect the global pharmacy automation market to grow at nearly 11 percent between 2018 and 2025 due to a number of factors. Hospitals are desperate for ways to curb the effects of rising labor costs, increasing demand for healthcare services, the decentralization of pharmacies, and the drive to reduce medication errors. An example of pharmacy automation is an automated medication dispensing system. With medication and dispensing errors being a major risk factor for hospitals, automated dispensing systems aim to remove the inherent human risk factor while providing an auditable trail.
Automated medication dispensing systems are only one element of the pharmacy automation market. Automation comes in many forms and increasingly more pharmacies are investing in the technology. Tabletop tablet counters, automated medication compounding systems, automated storage and retrieval systems, and automated packaging and labeling systems all fall under the global pharmacy automation market umbrella as well.
While automated medication dispensing systems are not the cure-all for what ails the hospitals, they do address many of the issues better driving medication management.
Related: Are Medication Management Systems the Answer to Error Prevention?
Rising Labor Costs
A Navigant analysis conducted by the Healthcare Financial Management Association found 78 percent of hospital executives believe their organization’s labor budgets will increase over the next 12 months and one in five believe it will surge to at least five percent. With operating margins dwindling and the demand for quality care increasing, hospitals must find ways to improve efficiencies.
This same study found that hospital executives ranked “productivity improvement and workflow redesign” as their main labor-management initiatives. Automated medication dispensing systems and other pharmacy automation tools offer promise.
Before automated medication dispensing systems were the norm, medication management was overwhelmingly manual. Pharmacy staff had to restock medication carts every day as they typically only hold a 24-hour supply of medications. The University Health Network found that while the medication carts were flexible, they were labor-intensive, could delay the delivery of the first dose, and had no way to prevent medication loss or “borrowing” of patients’ medications.
Related: Do Medication Carts Improve Patient Safety?
The study goes on to say that automated medication dispensing systems “save nurses time by eliminating the need for manual end-of-shift narcotic counts per patient care units” and they “reduce pharmacists’ dispensing time, as inventory management is driven by the pre-established minimum and maximum levels and is handled exclusively by pharmacy technicians.”
Clearly, automation saves time in multiple ways, giving the pharmacy and nursing staff the ability to do more in less time. With rising labor costs a top concern, automating as many tasks as possible enables hospitals to operate more efficiently with less staff.
Increasing Demand for Services
The U.S. Census Bureau projects that by 2030, all baby boomers will be older than 65 and will outnumber children for the first time in U.S. history. By 2035, the country will have 78 million people over the age of 65. Patients in this age range represent nearly 40 percent of hospitalized adults and can account for as much as half of all health care dollars spent on hospitalization. They are also hospitalized three times as often as those 45 to 64 years old.
According to Mercer, the United States would need to hire 2.3 million new health care workers by 2025 in order to properly care for the influx of its aging population. All health care positions will be in need, yet in the hospital setting, nursing may see the biggest deficit. Mercer states, “When there are fewer nurses available to handle a bigger volume of patients, it adversely affects patient outcomes because of nursing burnout.”
As demand for health care increases, hospitals will struggle to keep up given their labor shortages. They must find ways to make workflows more efficient and support nurses’ efforts. Pharmacy automation is the key. Pharmacy and nursing staff need the tools, enhanced with modern technology, to do their jobs faster without sacrificing patient safety or the quality of care. Fortunately, tools such as automated medication dispensing systems not only reduce workloads, but they add a higher level of security, tracking, and accountability. Patients are more likely to receive the right medications at the right time and nurses have more time to provide direct patient care.
The Decentralization of Pharmacies
Traditionally, hospitals function with a central pharmacy. All medication requests are managed from this central point. While this model has been the standard, poor communication between nursing staff and pharmacy frequently results in inefficient medication administration. One of the more prominent examples of such inefficiency is when nurses send medication requests to the pharmacy for missing or late medications. Pharmacists and their staff must stop filling incoming prescriptions in order to reconcile these requests. Then, there are the patients. They experience longer wait times to receive their medications, resulting in poorer patient experiences.
A recent study by the American Journal of Experimental and Clinical Research sought to better understand the impact of having a Decentralized Pharmacy Technician (DTC) on a select number of inpatient floors. The hypothesis was that by having a DTC closer to the nurses and patients instead of siloed in a central pharmacy, medication requests could be reconciled faster and medication administration would be accelerated. Instead of a pharmacy technician working in the central pharmacy, they spent their day on patient floors delivering medications to secure medication cabinets in patient rooms, restocking medications in automated medication dispensing systems on the floor, and acting as the liaison between the pharmacy and the medical staff.
Related: How to Optimize The Relationship between Nursing and Pharmacy
The study found the DTC model “significantly reduced nursing workflow interruptions and improved nursing satisfaction with pharmacy services and…holds promise in bridging the communication barrier between nursing and pharmacy staff as well as enhancing overall patient care.” Interestingly, the study did not find the DTC, in its current state, reduced the amount of work for the pharmacy. The study recommended a possible solution would be to provide the DTC with an electronic device in order to process medication requests from the nursing staff while on the floor.
These results highlight the need for hospitals to embrace not just one pharmacy automation tool, but multiple. By combining technologies, hospitals will likely experience a greater impact on their medication management effectiveness and get more out of the automation.
With nearly 450,000 million people dying every year because of preventable medical errors, the pressure to reduce those incidents is greater than ever. For every preventable death, hospitals may face community and industry backlash, reputational damage, and costly legal bills. Among the most common medication errors are:
- Failure to detect a disease state contraindication to the drug therapy
- Failure to detect a significant drug interaction
- Failure to detect a significant drug allergy
- Failure to prescribe the correct dose for a specific patient
The above issues are more closely related to the physician and pharmacy staff, however, nurses also introduce plenty of risks. One study found that 65 percent of nurses made medication errors. The wrong dosage and infusion rate were the most common types of mistakes. The causes for these errors were using abbreviations instead of full names of drugs and similar names of drugs. The study concluded, “Therefore, the most important cause of medication errors was lack of pharmacological knowledge” and “errors in oral administration were significantly related with number of patients.”
Nurses are not pharmacists. They handle medications all shift long, but they do not have the same knowledge of those drugs as the pharmacists and their staff. They are also often overworked, having far too many patients than they can adequately care for during a single shift. The risk of making mistakes and overlooking things increases dramatically when nurses feel rushed. As patient admissions promise to increase over the coming years and nurse shortages continue to plague hospitals, the stage is set for errors to rise.
Automated medication dispensing systems provide secure medication storage on patient care units. They contain mini-drawers that are stocked per patient by the pharmacy. Secure access ensures only authorized personnel can open the cabinet and only selected quantities of that medication can be accessed. Further, restrictions can be set for specified drugs and pharmacists receive reports whenever those medications are removed from the automated medication dispensing system. Pharmacists and physicians use these reports to track and monitor the appropriateness of that drug’s use. One study found this process reduced inappropriate drug use by 50 percent.
Evaluating Automated Solutions
As hospitals continue to search for solutions to the health care challenges, advances in technology may offer significant benefits. Hospitals will experience the greatest return on those investments when they combine technology and workflow optimization strategies, process improvements, and smart financial decisions. Hospitals are already dealing with shrinking margins and increasing costs, making it even more important to invest wisely in technology.
The most important element to consider is whether the technology being evaluated actually delivers the value it promises. Hospital staff must use the technology as intended, not taking shortcuts or workarounds that compromise security or patient safety. As with any investment, technology or otherwise, the results must be measured. Too many hospitals make investments without continually measuring results, wasting countless dollars on products that do little to benefit their intended user. Even worse, when metrics are not tied to those investments, hospitals may continue to purchase the same, ineffective products.
Hospitals must conduct proper due diligence, evaluating products based not on marketing content and sales pitches, but actual results that can be quantified. Not every solution is ideal for every hospital setting, either. Decision-makers must consider the various workflows before investing in any product. Inviting stakeholders to contribute their ideas and experiences, including nurse staff and pharmacists, will give executives visibility into they types of solutions that hold the most promise.