Medication delivery aided by technology, automation

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In an effort to reduce medication errors while saving time and money, long-term care providers are looking more to technology to automate the medication delivery process.

"A growing number of facilities are starting to embrace technology that uses bar codes," said Scot Scurlock, vice president of group purchasing and shared services for the American Association of Homes and Services for the Aging. "I would expect it will be the norm within the next two years."

The skilled nursing population, in which individuals may average from nine to 12 medications a day, is in particular need of prescribing and dispensing clarity, experts point out.

"Patient safety is a huge issue right now," explains Carla Saxton, professional affairs manager for the American Society of Consultant Pharmacists. "As the accrediting organizations and payers focus more and more attention on it, there will certainly be pressure to adopt this type of technology." The Joint Commission on Accreditation of Healthcare Organizations is considering a proposal that says healthcare institutions should incorporate bar coding technology by Jan. 1, 2007. 

Loyalhanna Care Center is already ahead of the game. The 116-bed facility, in Latrobe, PA, recently began using a new medication management system available through Millennium Pharmacy Systems.

The process begins when a physician or nurse enters an order electronically, which is sent to the pharmacy in real time. Millennium's software alerts the facility of any allergy or interaction issues at the point of entry, so the order is clean by the time it reaches the pharmacy.

At Millennium's pharmacies, medications are dispensed from automated, bar-coded, bulk canisters into pillow packs, which are sent to facilities. Each pack contains up to three medications with individual bar codes that include information about the patient, the medication and the administration time.

Rolling laptops

The medication carts Millennium provides to facilities are equipped with laptop computers and hand-held scanners. When nurses go on a medication pass, they scan each bar code before tearing open the pillow pack. If a doctor has discontinued an order or the nurse accidentally picked up the wrong medication, a warning will pop up on the laptop screen.

"The system has reduced the amount of time it takes to do a medication pass, while increasing the accountability of our nurses," said Administrator Patti Benford. "It's very difficult to make a medication error now, unless you consciously bypass the bar code system."

Loyalhanna was able to afford the new system, Benford said, because it didn't require a large front-end investment. Millennium provides the training and equipment for a monthly maintenance fee, which Benford says can easily be recouped through savings in pharmacy costs.

"With the old system, we would receive 30 doses on a medication card, and if we only used two, the rest was wasted because state law says that the pharmacy can't take it back," Benford said. "Now, we only get two or three days' worth of drugs at a time, which has reduced our pharmacy costs tremendously."

Another bonus is that nurses no longer have to do drawer changes between medication passes because the packs take up less space.

Institutional prep

While bar coding technology on the facility side is still fairly new to long-term care, there are indications that it will soon be widely adopted. Institutional pharmacist PharMerica, which already uses bar coding in-house for dispensing purposes, is currently pilot testing a new product to improve customer connectivity.

"We've given facilities a handheld tool that has a built-in scanner and custom software application," explains Michael Rosenblum, the company's senior vice president of strategic planning, marketing and product development. "When nurses need to reorder a medication, for example, they simply scan the label and it goes right into our dispensing system."

PharMerica is also developing new applications for the device that will allow providers to use bar coding technology at the poi

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