A Matter of Medication Distribution Models

Richard Artymowicz
Director of Pharmacy Services, Cape Regional Medical Center

Getting the right medication to the right patient at the right time is at the very foundation of medication management. Many would be surprised by the behind-the-scenes logistics and considerations to moving those medications from the central pharmacy to the point of care.  

In this month's Future of Pharmacy Podcast, I was joined by Donna Yeaw, RPh, Director of Pharmacy, at St. Luke's University Hospital in eastern Pennsylvania. We discussed how we facilitated a deliberative and collaborative process to determine the best distribution approach for our respective health systems. We both came to different conclusions – but each centered on central pharmacy automation to ensure successful adoption of the distribution model.

Most central pharmacy operations operate on a centralized model (cart fill), decentralized model (cartless), or a hybrid of the two. With the cartless model, most patient medications are stored and dispensed from automated dispensing systems in patient care areas. With the cart fill distribution system, pharmacy processes deliver patient-specific medications directly to patient rooms, and minimal meds (usually PRN drugs) are stored in automated dispensing cabinets (ADCs) on patient floors. 

At my health system, Cape Regional Medical Center in Cape May County, New Jersey, we were running a 24-hour cart fill model. Several years ago, we switched from delivering patient medications to eMAR carts to nurse server boxes inside patient rooms to prevent issues with missing and incorrect medications.

When our central pharmacy robot reached retirement at Cape Regional, we used that as an opportunity to reevaluate and revamp the distribution model. After discussing multiple options with the nurses, we found recommitting to the cart fill model was the best option.

Employee satisfaction is one of Cape Regional's key initiatives. Our goal was to make life easier for nurses. Delivering to patient rooms was a key focus of the cart fill model, so our ultimate decision was rooted in improving staff satisfaction.

Cape Regional is now fully automated by an XR2 robot coupled with a carousel. The XR2 and carousel are managed by the same technician, while a floater assists with restocking. With a pharmacy check waiver requiring only a 5% random medication check, pharmacists are now able to optimize their time to focus on higher value activities.

Conversely, Donna talked about St. Luke’s journey in evaluating and switching their medication distribution model. For years, the hospital employed a cart fill model, supported by automated carousel and robot technology in the central pharmacy. Hospital patients received medications through delivery to server boxes outside their rooms. In addition, they had about 80 ADCs used for STAT, PRN, and controlled substance medications prescriptions.

Donna discussed the two significant challenges they faced: substantial medication delays by over 90 minutes, and packaging bulk medications into barcoded doses leading to an annual cost of $200,000.

Following a careful evaluation of existing processes led by Donna, a cartless model was piloted at St. Luke's. She stressed the importance of having the appropriate number of ADCs on hand to support nurses and patients. Typically, one ADC is assigned to 12 patients, depending on the type of care. 

The implementation of Omnicell's XR2 Automated Central Pharmacy System gave the health system more flexibility and the ability to drive better inventory optimization and cost savings. More importantly, nurses' waiting times for new medications were reduced significantly, which really pleased the nurses. And the increased automation in the central pharmacy is enabling pharmacists to focus on new clinical projects and explore new remote staffing models.

I encourage you to tune into  Omnicell's Future of Pharmacy Podcast to learn more about the changing landscape of medication distribution and hear about the approaches our health systems took to ensure the best model to help achieve our medication management goals.  

Disclaimer
The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer, or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.