San Antonio, Texas-based University Health faced several medication management challenges that could impact both efficiency and patient safety.
THE PROBLEM
As a large and continuously growing healthcare system – including a Level I trauma center, pharmacies and specialty pharmacies – it recognized the need to optimize the drug distribution process.
Nurses often spent an inordinate amount of time searching for medications in medicine cabinets, a task akin to playing “Where’s Waldo,” due to the disorganization and movement of items in the matrix drawers. With 150,000 transactions per month at the medicine cabinets, this wasted a significant amount of nurses’ time that could have been better spent on patient care.
In addition, the matrix drawers themselves caused problems. Medications may have moved around in drawers, leading to missing or expired medications and even cases where medications have been crushed or spilled, leading to contamination and waste.
These issues threatened the integrity and availability of medications and created additional workloads for staff in cleaning and handling discrepancies. The system simply wasn’t sustainable for a health care system of this size and the growing demand on care teams to balance, said Jennifer Hillman, executive director of pharmacy at University Health Inpatient Pharmacy. She holds a doctorate in pharmacy.
PROPOSAL
“The proposed solution from our chosen vendor addressed these challenges with several workflow and security features designed to streamline medication management and improve patient safety,” she explains. “We looked at a combination of hardware and software tools that promised to ultimately save our nurses time while making it easy to manage medications in our healthcare system.
“This amounted to improvements to the drug delivery cabinets, connected software to improve visibility and support remote workflows, and simplified workflow features,” she continued.
Key components included sealed metal bins with lids to replace the problematic matrix trays. These bins ensure that medications stay in place, preventing movement and subsequent problems such as missing or expired medications.
“By maintaining the integrity and organization of medications, this solution was expected to significantly reduce the time nurses spent in the cabinets and minimize medication waste and contamination,” Hillman noted.
“Another critical feature was the single-use controlled substance dispensers, tailored to accommodate various forms of medication, including tablets, capsules, syringes and vials,” she said. “These dispensers are designed to dispense only the exact amount of medication requested, reducing the chance of discrepancies and ensuring more accurate dosing.”
The promise of this technology caught Hillman’s attention, as University Health conducts more than 15,000 controlled substance transactions each month, creating many opportunities for risk or costly medication waste.
“When we look at nurses’ workflow, there is one feature that allows our nurses to queue their medications from their workstation rather than at the cabinet itself, reducing congestion and wait times at the medicine cabinets.” , she said.
“At the simplest level, these new cabinets also had special lighting features that would help our nurses find the location of the medication they needed,” she continued. “Although it sounds like the smallest feature, it was amazing to see the impact this had on the time nurses spent in the cabinet.”
These features collectively promised to improve operational efficiency, improve medication management and increase patient safety, she added.
MEETING THE CHALLENGE
As a healthcare system, University Health is focused on fully understanding how the technology it brings in works. Hillman often says that even though the healthcare system is the size of the Titanic, it must be as agile as a jet ski to ensure it can always deliver the right care to patients.
“This is especially important in medication management,” she noted. “When we first switched to Omnicell, we converted 207 medication cabinets across our healthcare system in just eight weeks. These cabinets are fully integrated into our IT systems, EHR and medication inventory systems, with one server providing connectivity across our healthcare system manages.
“This integration enables real-time updates and tracking of medication usage, further increasing our ability to effectively monitor and manage inventory,” she continued. “The combined functionality of Omnicell’s systems and our EHR ensure that our medication management processes are efficient, secure and aligned with our overarching goal of patient safety.”
The primary users of this technology are nurses and pharmacy technicians. Nurses, as promised, realized the benefits of the pick-to-light system, which indicates the exact location of the required medication, drastically reducing the time spent searching the cabinet. The Anywhere RN feature allows them to queue medications from their workstations, reducing cabinet overload during peak hours.
“Pharmacy technicians play a critical role in maintaining the system,” Hillman explains. “They are responsible for stocking the locked metal bins with lids, ensuring that each bin contains the correct medications and that they are stored safely. The single dose controlled substance dispensers are also managed by the technicians, who ensure that they are filled accurately and function correctly, delivering precise doses, minimizing discrepancies.”
RESULTS
One of the key results was a dramatic 50% reduction in nurse-related medicine cabinet discrepancies. This improvement was largely due to the controlled single-dose dispensers, which ensure that nurses receive the exact amount of medication needed, minimizing the chance of errors.
“While this is an important win from a safety perspective, it also demonstrates how we were able to reduce the manual burden on nurses to handle cabinet countdowns in the midst of an already hectic workday,” Hillman reported. “We have also been able to reduce the administrative burden on our pharmacy technicians as they had to investigate all these discrepancies, allowing them to focus on other critical tasks.
“Another key success metric was the 20% reduction in time nurses spend on the medicine cabinets,” she said. “The pick-to-light system played a key role in this achievement by streamlining the medication retrieval process.”
Nurses no longer have to wait in lines at cabinets or spend an inordinate amount of time searching for medications, which translates to more time available for higher-value patient care tasks. This increase in efficiency was critical, especially during busy medication transit times.
“In addition, the transition to closed metal bins with lids has increased our storage capacity on the floors by 30%,” said Hillman. “This increased capacity means we no longer need to regularly remove medicines to make room for new ones, simplifying inventory management and reducing the chance of missing or misplaced medicines.
“The overall integrity and organization of our medication storage system has improved significantly, helping to improve inventory management and reduce waste,” she said.
ADVICE FOR OTHERS
Technology-enabled medication management is no longer optional for hospitals – replacing manual workflows with automation for frontline teams not only improves efficiency but is also critical to patient safety, Hillman advised.
“The decision is not just about features and functionality, but also about the collaboration the vendor can offer,” she said. “Technology integration is critical for accurate, real-time tracking of medication use and inventory, which helps prevent errors and streamlines workflows. But I also recommend finding a vendor who is willing to work with you to resolve any issues that will inevitably arise during implementation.
“Another important consideration is staff involvement and training,” she continued. “The success of new technology depends heavily on how well its users, especially nurses and pharmacy technicians, understand and use the system.”
Investing in extensive training and fostering a culture of continuous improvement can significantly increase the technology’s effectiveness, she added. Involve staff early in the decision-making process and incorporate their feedback to tailor the system to the organization’s specific needs, she said.
“Finally, it is crucial to evaluate the scalability and adaptability of the technology,” she advised. “The healthcare environment is dynamic, with changing needs and growing patient populations. Choosing a system that can scale and adapt to these changes without requiring extensive overhauls will ensure long-term success and return on investment.
“Look for technology partners committed to continued innovation and support, as this partnership will be invaluable in addressing future challenges and opportunities,” she concluded.
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