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Automation - it's a word that has become synonymous with the ability of a healthcare organization to foster an environment that most efficiently uses resources to best serve patient care. It has gained momentum in recent years as a solid strategy for merging cost containment needs with the advancement of HIT, ultimately taking the effectiveness of healthcare delivery to the next level.
Although somewhat new to the spectrum of automation tools covering the healthcare space, wireless medication tracking systems are turning heads across the industry for their proven ability to deliver administrative and clinical ROI. By providing real-time tracking of patient medications from preparation in the pharmacy to final delivery in the nursing unit, these solutions impact productivity, costs and patient satisfaction.
 How are these gains achieved? Consider this: When real-time medication tracking is available across an enterprise, the pharmacy is no longer the go-to department for status updates. Real-time monitoring also eliminates waste associated with duplicate orders and obsolete inventory. Nurses have instant access to the status of a medication, and patients receive needed pharmaceuticals in a more timely fashion, improving clinical relationships and patient satisfaction.
Healthcare organizations can expect the ROI from automated medication tracking to be greater than 3:1, which helps to build the business case to implement these systems. Because this kind of automation has the potential to improve timeliness of medication delivery and patient satisfaction, these systems complement an organization's efforts to improve performance measures and scorecards.
A Day in the Life
It's not unreasonable to expect that a typical pharmacy in a large hospital system will field well over 10,000 calls in a month. In fact, a 700-bed healthcare system recently tracked calls to the pharmacy over a 4-week period and found that roughly 18,000 were made for a variety of needs, ranging from follow-ups on medication orders to lost inventory.
Most pharmacies are not staffed in a way that allows for individual follow-up on all potential errors or medications that may have gotten "lost in the system" between the pharmacy and the clinical floor. Therefore, in an effort to satisfy clinical needs and the demands of nursing staff across a facility, most pharmacists will simply re-send the medication or fill the order again.
This process can result in a significant monetary loss related to duplicate medications or inventory that gets returned to the pharmacy. Plus, continuous distractions that take pharmacists away from their primary focus of accurately filling medication orders can potentially lead to greater risk of medication error.
In 2009, the pharmacy department at Riverside Methodist Hospital (RMH), a 1,058-bed tertiary care hospital member of OhioHealth, conducted research to track calls made to the pharmacy in relation to nursing follow-ups. The calls tracked covered those seeking information on where medications were in the distribution process and when they would be delivered.
The pharmacy estimated that they received about 400 calls per day, taxing resources and hindering productivity. The end result was a vicious cycle of longer response times and continuous follow-up from frustrated nursing staff.
Research conducted at the facility also revealed that there were approximately 150-175 missing medication requests per day. Further, the department's obsolete inventory had reached $250,000 annually due to normal shelf-life expiration and duplicate doses generating waste.
Automated Medication Tracking Delivers
It's no secret that hospitals across the U.S. are trying to bring down pharmaceutical costs. Automated medication tracking should be considered as a component of this strategy.
Once automated medication tracking was deployed at RMH in 2009, the facility realized a 32 percent reduction in wasted medication costs, reducing missing medication requests down to 90 per day for a savings of nearly $100,000.
Staff were able to track medication statuses in real time via a status board displayed on two 42-inch plasma TV screens in the pharmacy or through any hospital computer available to authorized nurses. This eliminated the need for follow-up and minimized confusion associated with medication orders, increasing productivity for nursing and pharmacists alike. Over 6 months, this resulted in productivity gains valued at $12,000 in medication-safety pharmacist time and $50,000 for the hospital staff overall.
Automation of medication tracking also has the potential to open opportunities for strategic review of workflow in the pharmacy, allowing managers to create more efficient processes and targets. For instance, if an organization is targeting a 25 minute turn-around time for a particular medication delivery but finds that the actual time equates to 60 minutes, tracking systems can pinpoint where the breakdown occurs.
At RMH, a review of workflow helped the organization make the decision to change its medication distribution process for inpatients. Rather than deliver to medication storage areas on each unit, the pharmacy now delivers medications directly to patient rooms, helping nurses save steps and improve work flow.
Pharmacy managers can easily determine when peak times occur and how to staff accordingly to meet targets, especially as more time is freed up from staff fielding the barrage of daily calls from the floor. Through automated medication tracking, the opportunities for setting realistic targets and trending can be enhanced to a new level in the pharmacy setting.
While efficiencies and improved patient care make the case for automation, advantages achieved through the development of a more cohesive relationship between nursing and pharmaceutical staff ranks just as high. Historically, a shaky relational balance has existed between the two departments due to time constraints in the pharmacy and the need for quick response to patient needs. Automated tracking provides an avenue for improving this balance, furthering the overriding goals of information sharing to best meets the needs of patients.
Best Practices for Implementation
Hospitals that have deployed barcode technology will find that automated solutions are an easy fit within their networks, as most require only a barcode, either 2D or linear with an HL7 interface for interoperability. Thus, the primary question to consider is the flexibility of the solution. Can it grow to meet the future needs of the organization?
Specifically, this consideration is important because many hospitals will begin with a few scan points and then add more over time. RMH began with 12,000 doses a month, focusing on high-priority and high-cost medications, and has increased gradually over time.
Another question to ask is whether the vendor charges by the dose or offers the solution as a flat fee. Charges by the dose can add up quickly, whereas a flat rate provides a predictable cost alongside an unlimited opportunity for ROI.
Start-up costs are moderate, and ROI is typically three times the initial cost and often realized within months of deployment.
Considering that there are minimal barriers to entry and deployment for automated medication tracking, these solutions should be factored into HIT budget equations going forward. The benefits achieved through cost efficiencies and productivity are far-reaching across pharmaceutical and nursing departments, and hospital executives can rest easy in the knowledge that ROI typically outmatches the initial investment by 3:1.
These solutions will continue to become an integral part of the automation evolution as hospitals recognize the potential for improving patient care, workflow and minimizing waste.
Bernadette Edseth is an operational pharmacy product manager for Pharmacy OneSource, part of Wolters Kluwer Health.
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