Recently, Becker’s Hospital Review published an excellent piece entitled, “It’s time to bridge clinical and operational excellence – Here’s how to get there.” The article points out that hospital pharmacies sit at the intersection of the supply chain and clinical care and are thus an often-overlooked opportunity for improvement. Michael Brown, vice president of managed services at Cardinal Health, explained, “Traditionally, the pharmacy has been relegated to the basement of the hospital and viewed as a utility. The pharmacy department now must be viewed as a strategic asset. It needs to be represented on the care team and the executive committee.”
One way for pharmacy directors and teams to contribute to operational excellence is to champion a new way of thinking about the pharmacy workflow process. Small changes in how medications are delivered to patients can have a significant impact on the quality of care, cost, and patient satisfaction.
The Process Gap
Today, most hospitals use centralized medication distribution rooms for each floor or unit. Pharmacy team members stock automated dispensing cabinets with the required minimum levels of medications. The cabinets are opened with a key or code. Each time a nurse needs to administer medication to a patient, he walks to the medication room to retrieve the drug. Many such dispensing cabinets have a software component that records what drug was allotted. Once the medication has been dispensed, the pharmacy has no control over what happens between the medication room and the patient’s bedside.
This “last 50 feet” is the danger zone.
While everyone wants to deliver excellent patient care, mistakes happen, and corners get cut. Because walking to the medication room, and potentially waiting in line, each time a patient needs meds is inefficient and does not add value; many nurses grab medications for more than one patient to save time. While logical, this approach introduces the opportunity for error. The Patient Safety Network reported, “In a review of 91 direct observation studies, investigators estimated median error rates of 8%–25%, depending on the measurement strategy.” The last 50 feet does not account for all medication administration errors, but it is undoubtedly responsible for some of them.
Modern Healthcare wrote, “In the first six months of 2018 alone, healthcare organizations lost more than 18.7 million pills from employee misuse and theft. That diversion costs public and private medical insurers $72.5 billion each year.” In other words, drug diversion is a huge problem. The time between when a medication is dispensed and when it reaches the bedside is an opportune time for drug theft.
Bedside RX: A Better Pharmacy Workflow Process
The lack of control between the time a medication leaves the dispensing cabinet, and when it reaches the patient is something that pharmacy and nursing teams can work to address by utilizing modern medical carts and cabinets.
Secure, automated point-of-use or pass-through cabinets can be installed in patient rooms. Using a transfer cart, pharmacy technicians can deliver the medication that each patient needs right to their room. Nurses dispense medications at the point of care, eliminating the opportunity to mix up patient meds and significantly decreasing the amount of time the drug is subject to diversion.
The approach is simple, yet an essential step on the path to achieving both clinical and operational excellence.
We’ve already addressed how the new pharmacy workflow process reduces the opportunities for clinical error and drug diversion, but the advantages don’t stop there. Moving the pharmacy to the bedside also helps:
Improve Health Outcomes
According to a study by BMC Health Research, the amount of time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Nurses spend as much as 45 minutes a day on tasks related to procuring medications. Point-of-use and pass-through cabinets give that time back.
Increase Customer Satisfaction
Research published in the New England Journal of Medicine found, “When analyzing all the factors influencing overall patient-experience scores in hospital settings, aspects of nursing care and communication were more predictive than interactions with physicians.” Anything that can improve the nurse/patient relationship is good news for consumer satisfaction results.
Strengthen the Relationship Between Nursing and Pharmacy
Streamlining the distribution of medications removes much of the friction that often hinders trust in the nurse/pharmacy relationship. Giving the pharmacy control over the last 50 feet, and allowing nurses to focus on patients, rather than medication delivery is a win for all involved.
Reduce the Risk of Hospital-Acquired Infections
Pass-through-cabinets allow medications to be delivered to patient rooms without a pharmacy tech actually entering the room. This decreases interruptions and distractions as well as reduces the risk of transferring pathogens to the patient. They are also ideal for maintaining isolation protocol when patients suffer from infectious illness.
Although Medication errors and drug diversion are costly and reason enough alone to reinvent the pharmacy workflow, the current approach results in other waste as well. Nurses walking to and from centralized dispensing areas and sometimes waiting in line is not a wise use of one of the hospital’s most valuable resources. Nor is it a smart financial move to have pharmacy directors clearing up communication issues or worried about dispensing protocols when their attention could be focused on more strategic work.
Of course, cost isn’t everything. As Mr. Brown told Becker’s, “If you’re only focused on cost-cutting, you may be doing more harm than good. We try to reframe the conversation and explore how pharmacy teams can drive innovation in their health systems. Given mounting financial pressures, innovation is the key to expanding services and improving care.”
Sometimes people think that operational excellence is achieved through big, bold, game-changing actions, and sometimes it is. But more often, the path to excellence consists of many incremental changes that solve pressing problems, reduce risk, and improve customer satisfaction. A shift in how medications are delivered in hospitals is a perfect example of the potential for such positive change.