TWO YEARS AGO, MERCY HEALTH PARTNERS (MHP) STARTED MIGRATING toward point-of-care scanning to enhance patient safety, streamline workflow, improve data capture and analysis, and increase inventory and billing accuracy.

MHP encompasses seven acute care hospitals for a 20-county area in northwest Ohio and southeast Michigan. MHP is affiliated with Cincinnati-based Catholic Healthcare Partners, among the nation’s largest not-for-profit health systems.

For our point-of-care scanning system, we selected Horizon Admin-Rx, an integrated hardware/software solution from McKesson Corporation, which we have introduced in three of our Toledo-area hospitals: St. Vincent Mercy Medical Center, MHP’s regional referral center for critical care; St. Charles Mercy Hospital, a 390-bed Level III trauma center; and St. Anne Mercy Hospital, a 142-bed community hospital.

Regardless of best efforts and resources invested, no point-of-care scanning initiative can succeed without a reliable solution for bar coding medications. Having introduced McKesson’s ROBOT-Rx bar code-driven robotic dispensing system at St. Vincent in 2000, we had some experience with bar code packaging, but we needed to take it to a much higher level. We narrowed our options to the following:

• Repackage medications ourselves, with on-site equipment and packaging personnel at each hospital
• Establish a centralized packaging operation for multiple hospitals, requiring us to become an FDA-approved facility and provide fulltime pharmacist oversight
• Outsource all of our packaging

Frankly, we didn’t want to get into the packaging business; it wasn’t worth the compulsory expense, time, and oversight. We simply wanted to solve our packaging problem, and that’s why we selected the PakPlus-Rx service from McKesson.

PakPlus-Rx, a professionally managed, onsite packaging service, allows us to bar code virtually all our medication forms, including solids, liquid cups, vials, ampules, and syringes, as well as oddly sized items, both large and small. Using McKesson technology, supplies, and employees, the PakPlus service can be customized to suit varied hospital pharmacy environments or medication distribution methods.

Four Key Advantages
The advantages to using PakPlus are clear: professional proficiency, consistent quality, cost certainty, and easy integration with other medication-use systems. McKesson’s PakPlus-Rx employees report to work in our hospitals every day, just like our employees, but they focus solely on packaging medications. There’s no chance of them being redeployed to perform other duties, so our flow of packaged, bar coded medications is assured. Each month, they package approximately 25,000 doses for St. Anne, 40,000 doses for St. Charles, and 100,000 doses for St. Vincent.

We’ve been very pleased with the quality and consistency of our packaging, both of which are crucial to a successful bar coded bedside medication administration initiative. The font printed on the packages is large and easy to read, and because we know exactly what the service costs per month, we have no unbudgeted expenses for packaging.

The PakPlus-Rx software works on McKesson’s Connect-Rx software platform and integrates with our robot, our automated dispensing cabinets, and our bedside medication scanning system, allowing us to optimize our systems across the continuum of care.

Before You Begin: Three Considerations
Sooner or later, your institution will adopt bedside scanning and EMAR (electronic medication administration record) initiatives, requiring the pharmacy to package and bar code your medications. Following are some additional considerations to bear in mind as you develop your own packaging strategies:

• Accurately forecast medication volume. Project your unit dose daily volume as precisely as possible to help you determine your medication inventory needs. While establishing physical inventory is important, equally important is building your NDC bar code database. Both tasks will take about two months.
• Select the right space. Ideally, the right space in which to conduct packaging operations is contiguous with the central or a satellite pharmacy, where a pharmacist can provide oversight (required in Ohio), and allows easy access to essential utility hookups (i.e., compressor lines).
• Identify your startup costs. Whether you package medications yourself or outsource your packaging, you need to account for the costs of floor space, space modifications, utility hookups, personnel, and more. Think through each possible expense to avoid unhappy surprises.

Point-of-care bar code scanning solutions offer significant benefits to patients, clinicians, and hospitals, but they only work with bar coded medications. Utilizing a bar code packaging service can provide you with a reliable source of bar coded, unit dose medications, allowing your health system to realize the full benefit of a bedside medication scanning system.

Steven R. Meyer, MS, RPh, metro administrative director of pharmacy, Mercy Health Partners—Northern Region, is also an adjunct assistant professor of clinical pharmacy at the University of Toledo’s College of Pharmacy. The recipient of a BS in pharmacy and an MS in pharmaceutical sciences from the University of Toledo, he serves on the Pharmacy Technician Associate Degree Advisory Board
for Mercy College of Northwest Ohio.