Rice Memorial Hospital is a 136-bed rural facility located in Willmar, Minnesota, two hours west of the Twin Cities. Specialty services at the hospital include hemodialysis, hospice, and cardiac rehabilitation care; outpatient mental health; and outreach programs in radiology, endoscopy, and laboratory testing.
At Rice Memorial, our pharmacy is based on a centralized model, but our pharmacists also have decentralized duties. Remodeled two years ago, the pharmacy is centrally located on the medical/surgical floor. All of our pharmacists rotate through shifts that keep the pharmacy open 16 hours a day, seven days a week. There are nine pharmacists, six technicians, and a director of pharmacy. While we do not have a dedicated pharmacy information system specialist, two of our pharmacists serve in both a staff role and manage information technology.
Why SinglePointe
Prior to implementing SinglePointe, we stored patient-specific medications in the Omnicell automated dispensing cabinets (ADCs) but did not link these medications to the patient’s profile. The software we used allowed us to store medication in a secured location, but did not track the drug type or amount stored. We needed better safeguards for our patients and greater efficiency. SinglePointe software gave us the means to store and track patient-specific medications safely and efficiently.
Training Process
The training process involved a one-week session at an alpha site for two of our staff members followed by a four-week implementation and training program at our facility. Omnicell personnel were very helpful throughout the process. Post-implementation, we conducted competency training in small groups for the pharmacy and nursing departments to ensure each staff member was confident with their new tasks. In addition, a pharmacy representative attended all of the nursing staff meetings during this time to be sure all concerns were addressed and questions were answered.
Implementation
Before installing SinglePointe, the pharmacy was restocking ADCs once or twice a day and doing a cart fill manually everyday at 3:00 pm. With SinglePointe, we now do four autofills a day, wherein a patient-specific report is printed identifying what medications must be filled, how many, and for which bins. Keep in mind that for patients without medication changes, such as a discontinued drug or a dose change, there is no need to handle those specific bins. Assisted by the new software, pharmacy has taken over the responsibility of transferring medications when a patient is moved from one floor to another within the hospital, thereby making the transfered medications available more quickly.
There is also an automatic management of discontinued medications and discharged patient medications, as well as safe storage and control of patient’s home medications. Instances of missing medications have significantly decreased. The software also supports routine stock (non-patient-specific medications), which is the bulk of the nursing unit’s needs.
In the cart-fill system, medications were charged at the time the cart-fill report ran, thus returned medications had to be manually credited. With SinglePointe, the medication is charged at the ADC, so returned medications no longer need to be manually credited — a timesaver much appreciated by pharmacy.
Study Conclusions
We conducted a study to measure the impact of SinglePointe in our hospital. Results indicated that the nurses’ mean time pulling medications and pharmacists’ mean time checking medications was significantly less with the new system, although technicians required more time to stock the patient-specific bins.
Nursing reported improved satisfaction as the software ensured a consistent and secure location for all patient medications. This made the process of pulling and administering medications more efficient, while decreasing the risk of error. In addition, tracking patients’ own medications from home as well as multiuse medications, such as inhalers, was simplified. The automated removal of discontinued medications provided a further safety check. SinglePointe almost totally eliminates missing doses, which enhances the effectiveness of, and compliance with, drug therapy.
With SinglePointe, it is now easier and more efficient to find and administer patient-specific medications, which greatly reduces the risk of medication errors and increases staff efficiency. Pharmacy has a built-in tracking system whereby all medications are both accounted for and counted. Time-consuming manual processes are now automated and instances of missing medications have decreased significantly. Clinicians can now focus more on patient care rather than searching for missing medications.
By Kris Cervin, PharmD
Kris Cervin, PharmD, is a staff pharmacist at Rice Memorial Hospital in Willmar, Minnesota. She earned her degree from the University of Minnesota College of Pharmacy. Her areas of expertise include automated dispensing cabinet implementation and maintenance, ambulatory care with an emphasis in diabetes, anticoagulation and cardiovascular disease.
Reprinted with permission from Pharmacy Purchasing & Products, Vol. 5 #12. ©2008 Ridgewood Medical Media, LLC, Ho-Ho-Kus, NJ. All rights reserved.