Pharmacy Transfer Cart: Bringing the Pharmacy to the Floor

Medication Errors

Medications are an integral part of most hospital stays and can present some of the greatest risks to hospitals, patients, and staff. From medication dispensing errors to patients experiencing adverse drug events, more than 7 million patients are victims of preventable medication errors, costing health care companies $21 billion annually. The keyword here to focus on is preventable. The right tools, technology, people, and processes can eliminate these unfortunate events.

According to the World Health Organization, appropriate medicine use in the hospital setting is a multidisciplinary responsibility. The ASHP agrees, saying, “Medication errors can occur at any point of the medication-use system. Health-system pharmacists have the responsibility and expertise to lead and participate in the multidisciplinary committees to examine and improve systems currently in place.”

Physicians prescribe, pharmacists verify and dispense, technicians transfer, and nurses administer. With so many touches on potentially dangerous medications, it’s no wonder there is such a risk. It takes only one misread prescription, an improperly-dispensed medication, or a wrong medication administered to have catastrophic consequences. Even with the many involved stakeholders, all of whom are trained professionals, the pharmacy is ultimately responsible for controlling medication distribution. They lead the medication management direction and are the authority. The primary goal is patient safety, but there are plenty of other factors that come into play.

Medication Management

How a hospital approaches medication management is highly dependent on the hospital’s size, resources, and budget. There is not a one-size-fits-all solution. Rural hospitals, for instance, may have a limited staff, budget, and footprint. The pharmacy often manages medication from one central point and may require nurses to retrieve patient medications at the pharmacy. Larger hospitals, on the other hand, may have dozens of staff and enough budget to cover automated dispensing systems and pharmacy transfer carts. The pharmacy loads the transfer carts with unit doses and stocks the automated units or to point-of-use medication storage units at the patient’s room.

Medication distribution, therefore, may come in various forms. Hospitals of all sizes typically have bulk medications storage. This may be a separate room or part of the pharmacy itself. Larger hospitals may have bulk medication storage on every patient floor. A unit-dose system involves a pharmacy transfer cart that contains fully-stocked cassettes that hold pull-out bins containing medications for each patient for a specific period of time, usually 24 hours. The pharmacy removes the empty bins from a medication cart or cabinet and exchanges them with fully-stocked bins from the transfer cart.

The most common type of medication distribution is via an automated medication dispensing system. The University Health Network in Ontario, Canada defines these specialized machines as “decentralized medication distribution systems that provide computer-controlled storage, dispensing, and tracking of medications.” The majority of hospitals have this system because of the efficiency the automation brings, of course, but more importantly, its impact on patient safety. Automation greatly reduces risk and improves accuracy as well.

Pharmacy Transfer Carts Bring The Pharmacy to the Patient

The question of how to improve pharmacy efficiency without sacrificing patient safety is a common one for many hospitals large and small. Even the largest hospitals may struggle with headcount. Automation can relieve staff of many of the repetitive, manual tasks they must complete and reduce human error, but not all hospitals can afford such luxuries.

A relatively inexpensive way to ensure patients receive only the medication prescribed to them is with the use of pharmacy transfer carts. Instead of nurses having to retrieve medications for all of their patients at one time from the pharmacy room, the pharmacy loads pharmacy transfer carts with medications per patient by floor. Pharmacy technicians then transfer those medications to an automated dispensing cabinet.

Instead of a nurse having to retrieve the medications between each patient visit, a pharmacy technician rolls the cart to the patient floor. Pharmacy staff may load medications into automatic dispensing cabinets or nurses may retrieve them directly from a medication cart, a point-of-use cabinet at the patient’s room, or a unit-dose cabinet at the floor’s medication room.

Because pharmacy staff load the carts in the pharmacy, there is less risk to the patient for receiving another patient’s medication, the wrong dosage, or the wrong medication. With point-of-use cabinets, in particular, nurses don’t have to worry about anything other than properly administering the medications. Patients benefit when hospitals make their medications readily available, organized, and easily accessible.

Improving The Nurse Experience

Researchers continually document the high rate of nurse burnout. An RN Network study in 2017 found that nearly half of all nurses working in the United States have considered leaving the nursing field. Feeling “overworked” was the number one reason. Only 4 percent were ready to retire.

There are multiple causes for nurse burnout, however, having too much work during a shift is likely at the top of the list. Nurses often have long shifts and rarely have time to sit or decompress. Direct care for patients is only a fraction of how they spend their time. An interesting study found that nurses walk an average of 4-5 miles during a 12-hour shift. They are running from room to room, sometimes floor to floor, often to retrieve supplies and medications in order to do their job.

Hospitals can directly impact this inefficient workflow. When healthcare facilities store required patient supplies and medications closer to the patient rooms, nurses are able to spend less time running errands and more time caring for their patients. Medical pass-through cabinets provide the most efficiency. Hospitals install the cabinets in the wall between the patient room and the hallway and open on both sides. Staff and pharmacy technicians stock supplies and medications from the hallway so they are readily accessible to the nurse inside of the patient’s room. Simple steps like these help make the nurse workflow more efficient while improving the speed and quality of patient care.

As nurses are able to spend more time with patients, patients experience better health outcomes. Nurses are less likely to burn out due to feeling overworked. Of course, more goes into helping nurses with their workflows. Workloads should be reasonable and that may include reducing unnecessary errands. The faster a nurse can do his or her job, the more time they have to provide quality patient care.

Improving The Patient Experience

Ultimately, the patient experience through positive outcomes is the number one priority of all healthcare facilities. Without patients, the hospital ceases to exist. Patients may have a choice of where they receive their medical care. A poor hospital experience is like everything else: patients will tell others and the hospital reputation suffers.

The U.S. News & World Report released their Best Hospitals rankings every year. According to their own study, the rankings are “designed to assist patients and their doctors in making informed decisions about where to receive care.” Not surprisingly, their methodology is based on measures such as patient experience, patient safety, and quality of nursing. To be named on the list is a high honor for hospitals but also an indication of what makes a hospital successful.

It is clear that patient safety is at the forefront of healthcare. There are various initiatives hospitals can take to ensure patient safety while also improving the quality of nursing care and the patient experience. They are all inextricably linked. It will require hospitals to leverage modern advances in health care to enable such a mission.

Researchers and industry experts determine optimal hospital workflows, broken down by role and hospital size, through countless studies. Similarly, studies reveal the most useful building, floor, and even room configurations to optimize efficiencies and patient care. Well-documented studies also reveal the most effective systems, equipment, supplies, technologies, and processes. Experts have found many of the best hospitals in the country implement these elements into their environments. These hospitals offer insight into what works. Smart hospitals looking to continually improve their services should take note.

Using Technology to Minimize Drug Diversion Risk

Automated dispensing machines are among the most innovative technologies available to hospitals today to modernize their medication management systems. They provide secure medication storage on patient care units, bringing the pharmacy closer to the patient. Even moreso, their security features protect the hospital, patients, staff, and even the community from medications getting into the wrong hands.

The machines are equipped with digitized locking mechanisms and electronic tracking software. Both reduce the risk for medication diversion and ensure only the right people are accessing the right medications for the right purposes. Medication diversion is the illegal removal of prescription drugs from health care facilities. Medication diversion is not only illegal, it costs organizations more than $300 million every year in lost medications, law suits, and fines. Reputational damage that leads to fewer patients choosing that hospital is harder to quantify.

The 2017 Annual Drug Diversion Digest reports the most drug diversion incidents occur in hospitals and medical centers and 41 percent of publicly-disclosed diversion incidents involve nurses. Sadly, 10 percent of nurses are addicted to prescription drugs. Some say their jobs are not only their source for their drugs but the culprit. Psychology Today reported on an interesting trend it found in one of its studies. “As physicians have become pressured by the need to increase the volume of patients they treat, nurses have also been burdened with more tasks traditionally performed by doctors, resulting in higher stress. In addition, rotating shifts and long hours coupled with easy access to addictive medications set up a perfect storm for nurses to turn to mood altering substances.”

Giving Nurses What They Need to Succeed

Nurses need help. Hospitals cannot expect nurses to do serve the patient’s best interest when unrelated tasks, manual administrative duties, and senseless errands burden them. Adding more nurses sounds like the easiest fix, but it is not always possible. The next best thing is streamlining and error-proofing as much of their workflow as possible, giving them the right resources to succeed, and limiting their workload to only what is reasonable.

Medication administration may only be a small part of a nurse’s job, but all that goes into that task adds up and takes time. By automating as many of the frontend processes, hospitals give nurses more time on the backend working with patients. It seems as though automated dispensing machines not only benefit the pharmacy but the nurses, patients, hospitals as a whole.

Improving The Entire Hospital System

The Canadian Journal of Hospital Pharmacy released an article years ago questioning the benefits of automated dispensing machines. Their goal was to help pharmacists find effective strategies and technologies to improve patient safety in the hospital setting. The 2009 article concluded that they provide a “good balance among security, accessibility, and inventory control of medications…and prevent potential drug diversion.”

Automated dispensing systems are not the only solution to patient safety, yet by combining them with pharmacy transfer carts and other effective tools, efficient and reasonable nurse workflows, and optimized processes, hospitals are able to do more than protect patients. A complete medication management system can empower nurses to do more of what they came to the profession to do and less of the tasks that drive them to quit or worse, drive them to drug addiction. It can save hospitals significant costs across the board and improve the patient experience while delivering the best care.

As technologies advance, hospitals must determine which innovations make sense for their environment. While they achieve efficiencies and cost savings by implementing the latest technologies, they can cost the organization plenty if they are not properly utilized. Hospital executives need visibility into the benefits of these technologies in their own setting to ensure they are bringing measurable ROI.

With medication management systems, measuring medication error rates is relatively simple compared with understanding nurse and pharmacy workloads and how that impacts patient care and safety. Those who do, however, stand to gain a competitive advantage and just may find themselves on the list of the nation’s best hospitals.