1. Deschaine, Michael R. PHARMD, MBA

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When Lawnwood Regional Medical Center-a 341-bed, acute care facility in Fort Pierce, Fla.-decided to move to electronic medication administration records (eMAR) and bar-code technology for medication administration, it was essential for administrators to evaluate other technologies that would impact the efficiency of the system, especially medication packaging and dispensing systems.


Prior to implementation, our pharmacy team identified three critical elements that needed to be addressed: an inefficient order processing system, a lack of adequate physical space for proper drug storage in the pharmacy, and no bar-coding capabilities. (Without an accurate bar-code system, there's no way to verify the "five rights" of safe medication administration-right patient, right medication, right dose, right time, and right route.)


By taking a closer look at pharmacy operations, our management team was able to develop an effective strategy along with achievable goals that included plans for:


* preparing for eMAR implementation


* decreasing calls to the pharmacy


* improving unit-based cabinet stocking/auditing


* reducing inventory.



The plan included installing two vertical, rotating medication storage and dispensing systems, also known as carousels, and a high-speed packager-the key component to facilitating eMAR. Lawnwood was already using unit-based cabinets for dispensing medications in nursing units, so the implementation of this additional technology would streamline efficiencies even more.


Due to space issues in the pharmacy, the facility had to undergo remodeling. This entailed physical demolition and construction of areas designated for the carousels and packager. Before implementation of eMAR, managers made sure that firm policies and procedures were in place. Once the new technology was installed, staff assigned medications to the containers in the high-speed packager and, at the same time, "cleaned up" the drug formulary. These steps launched the bar-coding process at Lawnwood, building the foundation for patient and medication safety.


System design

Our high-speed unit-dose bar-code packaging system is a 450-canister unit with specific medications assigned to each container. Each medication type is weighed on a scale to calculate the number of tablets being loaded into the system-eliminating the need for manual counting. The high-speed packager runs virtually unattended and standardizes the packaging of all bar-coded medications, streamlining processes and eliminating errors.


Medications are dispensed in strips of individually wrapped packets; the Lawnwood system runs 75 packages a minute. When technicians are packaging several different medications at once, empty packets run between the different medications so they can easily identify the breaks. There's no need for pharmacy staff to double check the batches of medications once they're dispensed because each medication was verified when the canister was filled.


All of the automation solutions at Lawnwood are integrated, which improves the unit-based cabinet restocking process and provides auditing efficiencies. The cabinets send alerts to the carousels when inventory is low. At the same time, the carousels notify the high-speed packager when minimum par levels are reached. The packager then runs the appropriate quantities to replenish the inventory. Recently, pharmacy personnel converted to stocking the unit-based cabinets directly from the high-speed packager.


In addition, Lawnwood personnel have been able to reduce inventory and decrease costs. Constant, accurate inventory counts enable order placement before stock-out situations arise. Personnel can purchase medications for the high-speed packager in bulk, resulting in substantial cost savings-$15,000 in 2006.


At Lawnwood, high-speed unit-dose bar-code packaging systems are proven to eliminate medication errors, streamline processes, and decrease costs. No matter what your hospital's current process is, it's important to find a reliable, accurate packaging solution that integrates seamlessly with your current systems.