Rapid (Rx) transit
Residents refused meds, tried to flee secure unit since talking to surveyor, nursing home charges
Time is a valuable and limited resource in long-term care. Caregivers often scramble to meet the varying needs of their residents and struggle to balance those duties against equally time-consuming regulatory requirements.
These challenges, coupled with a heightened focus on care quality and resident outcomes, are making more efficient and effective practices a must.
Medication management is one function that providers should consider overhauling — or at least moving to the top of their operational priority lists. Today's sicker and frailer residents need their medications sooner, and they count on caregivers to deliver medication swiftly, safely and seamlessly. Healthcare reform is also forcing operators to take a closer look at their existing policies and practices, and seek new ways to improve key functions, such as medication ordering and administration.
“With a focus on positive clinical outcomes, reducing admissions back to the hospital, and deinstitutionalizing care, the long-term care provider and pharmacy are faced with significant challenges to their existing operations,” says Troy Hilsenroth, vice president, vendor solutions for Omnicell.
Still, many facilities continue to rely on traditional, time-robbing (and often more error-prone) pen-and-paper medication management processes that involve manually filing, faxing, packing and sending of medication orders every shift.
“This takes time away from resident care on every shift and significantly increases the time it takes for medication fulfillment,” notes Ambrose Au, president of InfoMax Technologies Corp.
But some innovative solutions are coming to the rescue. From automated and remote dispensing units to digital data capture technologies and more, today's operators are tapping new ways to make medication management better, faster and more cost-effective.
“The more you can move away from manual processes, the better for the residents and the facility,” assures Maggie Falzone, director of nursing for Country House, a continuing care retirement community in Wilmington, DE.
Speed meets safety
In 2010, Country House moved from manual to electronic med passes to boost the efficiency of its medication management process. Laptop computers identify residents by name and photo, and display resident medications by administration time, which saves time and minimizes confusion and errors, Falzone says.
Because prompt, efficient medication delivery hinges on its availability, Country House has medications filled twice a week by the community's contracted pharmacy. Pillow packs are placed in drawers for each resident and time, and scanned into the system upon administration.
“If the right pack isn't scanned, the system [alerts you]. And if a doctor discontinues one of the medications after it's been put in the pack, the system will inform the caregiver not to administer it,” Falzone explains. “Prompt medication delivery is important, but safety and accuracy have to come first.”
It's a message that's echoing loudly throughout the long-term care pharmacy world. It's also the driving force behind the development and adoption of automated medication ordering and dispensing technologies that fully interface with pharmacy information systems.
After determining that its longstanding pharmacy model was no longer meeting the needs of its sicker and frailer long-term residents, Golden Living created a new one. Automated dispensing is at the heart of the operator's new pharmacy and clinical services company, AlixaRx. A dispensing unit houses roughly 200 of the most commonly prescribed oral solid medications, while a smaller, refrigerated companion machine holds approximately 150 additional items, such as first-dose medications, IV solutions, eye drops and patches. Combined, the units make about 95% of the most commonly needed medications in nursing homes available, around the clock. Once AlixaRx pharmacists review and clear a medication order, it's released electronically to be packaged and dispensed at the facility.
“No reordering is needed. The medication will continue to be dispensed until the order changes, which minimizes wait time,” says Robert Warnock, D.Ph., CGP, FASCP, of AlixaRx. “The process is faster and easier for the facility, and it allows our pharmacists to spend more time evaluating medications, doses, resident needs and records, and then work with physicians.”
Additional safeguards can further drive efficiencies in the medication management process. “Guiding lights on the cabinet quickly direct the user to the proper storage bin,” says Hilsenroth of Omnicell's units. An integrated medication label printer lets the caregiver print resident-specific labels at the cabinet to prevent mix-ups and meet Joint Commission requirements, he adds.
“When the system is interfaced to the pharmacy information system, the pharmacy can review orders prior to medications being released to caregivers. This helps prevent adverse drug events and meet increasingly stringent standards for handling controlled and narrow therapeutic index drugs.”
Sensors installed by the medication canisters in pharmacy company Talyst's remote dispensing units monitor each pill that drops, and another sensor by the packet ensures that one pill is received.
“If there's an error, we stamp that packet with an ‘X' and a note to destroy, and then we fill the next packet correctly,” says Dave Doane, R.Ph., Talyst's vice president of pharmacy services. If a new version of a drug comes in, such as a different generic, Talyst has a new canister that can be reconfigured at the pharmacy in just minutes. The average canister holds approximately 300 doses and can be filled in about the same time it takes to create a single 30-day blister pack.
Greater availability and speedier dispensing of generic drugs is another growing priority for pharmacy operators. Omnicare Inc., for example, has invested in a central distribution network that benefits the company's direct purchase of generics and makes the drugs more readily available.
“We also have our own repackaging facility. This allows Omnicare to convert generics faster,” notes Omnicare's CEO, John Workman.
More than ever, facilities with electronic health records in place are seeking integrated electronic medication ordering capabilities to avoid time-consuming duplicate data entry. For fast, effective pharmacy integration, the order-entry system should allow for clinically sound orders that fully consider the resident's condition, current medications and the pharmacy's formulary, reasons Rob Kerr, Remedi SeniorCare's senior VP of information systems.
“On the fulfillment side, long-term care providers want to know that the time from sending the order to its shipment is short. This requires using a pharmacy with substantial automation of the order packaging and dispensing process,” he says.
Capturing data electronically with a digital pen and paper is another way facilities can streamline their medication ordering, fulfillment and administration process. Providers can complete prescription orders, MAR sheets, admission forms and other documents by writing as they normally would and then docking the digital pen at the end of their shift.
“All paper forms and handwritten information are transmitted electronically,” explains Au of InfoMax. “Electronic copies are generated in our system without any scanning or data entry, and can be sent to various individuals, departments and systems within seconds.” Prescription orders are received by the pharmacy in a matter of seconds, instead of taking hours. What's more, issues such as busy fax lines, poor fax image quality, fax failures, order receiving delays, duplicate orders, no audit trails, and no absolute way to confirm that orders were received by the pharmacy are removed, he adds.
Pushing smarter practices
While automation and electronic ordering, documentation and med passes can shave valuable minutes off the medication ordering, fulfillment and administration process, that doesn't mean facilities that lack such solutions are out of luck.
In fact, sources say one of the best ways long-term care communities can hasten and enhance the medication delivery process is to improve communication and planning among discharge facilities and pharmacy providers.
“The number one, most vulnerable area [where medication is concerned] is transitions,” says Michael Yao, CMD, senior VP of clinical affairs and national medical director for Golden Living Centers. “There's often a fragmentation of care from physicians, which can result in more of a gap between the hospital and nursing home. When a patient is discharged, you may have people who need to be tapered off of medications because they're not appropriate for long-term use.”