Somerset Hospital is a 120-bed facility treating 4,500 inpatient and more than 147,000 outpatient visits, annually. The pharmacy employs 18 FTEs—eight pharmacists and ten technicians. Prior to purchasing and implementing the PROmanager-Rx dispensing system, Somerset had a strategic information technology plan in place that included implementation of CPOE and BCMA in 2011. As this left the distribution portion unattended to, we ultimately decided to bring in PROmanager-Rx to complement these implementations.

Just in Time Delivery
The impetus behind the strategic information technology plan was to create a closed medication loop. Accordingly, we felt that CPOE would close the prescribing phase and BCMA the administration phase. Once those elements were attended to, we needed to address distribution by acquiring an automated medication dispensing system, and found that PROmanager-Rx and Connect-Rx—a software platform that integrates pharmacy and nursing automation solutions on a single system with one interface to the PIS—would close the distribution phase, and therefore the entire medication loop.

Scheduled medications (ie, those medications not dispensed from ADCs) for patients in the med/surg and telemetry units are delivered daily to nurse server cabinets within each patient room. Likewise, scheduled medications for CCU patients are delivered daily to medication drawers stored in the CCU medication room.

Prior to the purchase of this automated dispensing system, the med/surg, telemetry, and CCU medication batches had to be run 24 hours in advance of delivery. The batches were filled and checked by a pharmacist, but then had to be kept up to date until the next delivery—a period of up to 24 hours. Clearly, it would be ideal to run the batches just prior to delivery, but without automation, that level of activity was impossible to achieve. PROmanager-Rx offered to provide the efficiency necessary for technicians to fill the batches—with Connect-Rx providing a bar-code solution for pharmacists to check the batches—just prior to delivery.

At Somerset, we have always dispensed only the dose that is to be administered. If the dose requires multiple tablets or capsules, those are combined by the pharmacy. If a dose only requires a half-tablet, only the half-tablet is dispensed from pharmacy. We were happy to be able to continue this patient safety practice while still taking advantage of the accuracy of automated dispensing by PROmanager-Rx. 

Operational Benefits
The PROmanager-Rx has enabled considerable improvement in the restocking of returned unit-doses. Previously, this was a manual task and we experienced some errors as a result of medications being returned to the wrong bins. Now, returned unit-dose medications are processed by the system and those errors have been eliminated. Currently, we charge on dispense, but we plan to charge on administration after BCMA implementation. At that point, returned medications will not have to be credited and the process will become even more efficient.

We use PROmanager-Rx to dispense as many oral solids as possible, as most unit-dose packages are compatible with the system. As of now, we have only about five unit-dose drug packages that are incompatible (eg, paper or irregular sized packages). Otherwise, we only repackage drugs if they are not available in unit dose and we generate bar-coded labels using McKesson software to facilitate this process, in house. Of note, the third party repacking vendor products we have encountered are compatible with PROmanager-Rx. It is a great benefit to not have to repackage medications before loading them into the machine; the majority of drugs are system-ready upon delivery from the wholesaler. 

Results of Improved Efficiency
Though our staff members’ efficiency was improved, as a small department with the need to cover weekends and nights while still offering staff a reasonable schedule, we did not feel that staff reductions were appropriate. Instead we directed newly available resources to other projects. As a result, we were able to implement a unit-based pharmacist service and expand the employee prescription benefit. We have reaped savings and improved quality through better medication management, increased employee satisfaction with and reduced the cost of the prescription benefit program, improved nursing and medical staff satisfaction with pharmacy services, as well as overall job satisfaction by providing pharmacists with clinical opportunities. 

Conclusion
PROmanager-Rx has made a big difference in how we manage expiration dates as it dispenses the drug with the earliest expiration. In addition, identifying and removing soon-to-expire medications from stock is much improved. While we did consider other solutions, including McKesson’s PACMED, we felt that PROmanager-Rx was the right product for our pharmacy. It has improved efficiency and accuracy, rendering medication distribution safer, and allowed us to expand the services we provide to patients and our employees.

Michele Russic, RPh, has been the director of pharmacy at Somerset Hospital in Somerset, Pennsylvania, for the past 24 years. She received her BS in pharmacy from Duquesne University.

 

PROmanager-Rx Statistics at Somerset Hospital

• 408 unique medication line items assigned to the system
• Can assign low-volume, infrequently used medications, which present potential for error when dispensed manually
• Approximately 6,700 doses stored with 5,300 free spaces available
• Employs dynamic optimization where max and par levels adjust for usage—currently in use for 97% of stocked medications 
• Dynamic optimization settings: 
  - Long-term interval of 31 days; short-term interval of five days
  - Acceleration threshold 1.5—helps identify usage spikes over 150% of our long-term average usage within the short-term interval
  - Dynamic optimization days max = five; par = three, which helps reduce inventory over time