Henry County Medical Center (HCMC) in Paris, Tennessee, is a non-profit, 145-bed hospital with an average daily census of 60. We currently have automated dispensing cabinets (ADCs) throughout the hospital, including surgery, and are totally cartless, as we use the profiling feature of the ADCs with the scan stations on the floors and in the pharmacy department. We are in the process of implementing McKesson Paragon for our information system, and pharmacy is scheduled to start a new build in July and go-live in November 2009.

About three years ago we reviewed our information technology needs with the intention of transitioning to EMAR, BCMA, and CPOE. My directive was to prepare the pharmacy to provide these services while positively impacting the bottom line. Simultaneously we began looking at a new location in the hospital to expand our pharmacy, as we needed to develop the ability to provide employee prescriptions, while also meeting USP <797> guidelines. In addition, we had to prepare for the possibility of having to provide pharmacy
services for the nursing home and rehab center within HCMC, an additional 179-bed count.

New Pharmacy Build

Our plan was to expand from 1,100 square feet to 2,200 square feet to allow for hospital pharmacy operations, a retail pharmacy area, and a new cleanroom that meets USP <797> guidelines. As a new pharmacy build is a rare opportunity for a hospital pharmacy director, I wanted to ensure the new pharmacy would continue to meet our needs for the next seven to 10 years. I went on several site visits and talked with  directors about how they addressed similar challenges before deciding on a plan for our expansion.

For our inpatient practice, I needed to be able to provide bar coded medications to the floors for bedside verification and had to allow for the future possibility of providing medications by cart fill to the nursing home. At the time, we had a small unit dose packaging machine that did not perform bar coding, and with the new area, we wanted to maximize the efficiency of our space. I looked at medication carousels and high-speed unit dose packagers to help us on several fronts, including medication storage, maximizing inventory turns while decreasing inventory, and automating the dispensing process.

Implementing the Automation

We decided to use a robot-ready high-speed repackager, as well as a medication carousel. We now buy most of our medications in bulk and use our packager to package and bar code as many doses as possible. We use the high-speed packager as our primary choice for ADC refill and the carousel serves as the secondary choice. The packager fills about 65% of our medications and the technicians pull the rest from the carousel. The automation has allowed us reduce the refill process time. In the event that we do start performing cart fill for the nursing home, the high-speed packager will allow us to do so without the significant staffing challenges we would face if we were still using manual processes. We dispense 60,000 to 65,000 doses per month and with the addition of the nursing home, this number would likely double. Using our automated systems we can handle this growth in our current space with the addition of only 1.5 FTEs. We also are able to fill hospice and employee prescriptions with the repackager and unit dose package hospital patients’ home medications that are prescribed while in the hospital.

Results and Future Planning

During the planning stage, there was some concern as to how nursing would adapt to bedside medication verification. Would they continue to pull medications from the ADCs? Or would they want routine medications placed in med servers or carts? We designed our automation so that whatever the nurses decide, pharmacy will be prepared to handle it.

Automation adoption can be expensive, but projecting 10 years into the future, to where we will need to be as a department, the costs are clearly justified. Not only will we realize a decrease in inventory through the automation of par levels in the carousel, but we can also realize savings at our nursing home by providing bar coded unit dose medications at the bedside. In addition, the updated automation, along with new workflow processes, has increased patient safety and decreased errors within the department. 

Charles Dyer, RPh, is the director of pharmacy at Henry County Medical Center in Paris, Tennessee.