Case StudyAt a GlanceOrganization Cookeville Regional Medical CenterCookeville Regional Medical CenterCookeville, TN Patient Safety Thrives in Rural Tennessee Hospital following Pharmacy Automation ConversionSolution Spotlight– Horizon Meds Manager™– PakPlus-Rx® Overview facility serves 14 counties in the Community growth fueled the rise of heart of the Upper Cumberland– ROBOT-Rx® region in middle Tennessee. The a small, country hospital into a– MedCarousel® regional medical center. When an hospital is a publicly owned facility. admittedly reluctant pharmacy The Board of Trustees is appointed turned to automation solutions, the by Cookeville city government.Critical Issues results were significant increases in– Reduce the risk of medication Cookeville Regional Medical Center patient safety, productivity, and cost errors scored in the top 25 percent of containment—an outcome that paid hospitals nationwide in patient– Position for bar-code point-of- back the investment in less than two satisfaction for 2005 and 2006 for care administration and years. both Inpatient Services and computerized physician order Emergency Services. entry systems Challenges– Reduce labor-intensive cart fill When Opless Walker was hired as The hospital continues to grow and first dose operations Cookeville General Hospital’s first today. The hospital is in the midst of pharmacist in 1971, the small, an $80 million expansion to– Improve efficiency in a tight country hospital had just 19 doctors accommodate a 10-15 percent labor market and less than 50 beds. For several annual patient census growth.– Contain increasing costs years afterward, he and one Furthermore, because Cookeville is technician performed all pharmacy consistently named one of Americas duties and were on 24-hour 10 most popular retirementResults emergency call every day. destinations, the hospitals patient– Improved medication dispensing acuity rate steadily trends higher. accuracy to 99.9% As the community grew, so did the– Avoided a projected 215 hospital, the pharmacy staff, and its Despite this advancement, however, potential ADEs annually, saving responsibilities. In just over a medication distribution hadn’t more than $1 million generation, Cookeville Regional changed much since Op Walker Medical Center became a modern, founded the hospital’s pharmacy– Cut missing medications by 37% thriving 247-bed regional referral practice. The pharmacy staff—nine– Reduced cart fill labor by 44% center with access to the most pharmacists, 12 full-time and 13 part-– Improved cabinet fill labor by advanced treatment options in the time pharmacy technicians— 82% world. continued to pick, pack, check, stock, and conduct medication inventory by– Accelerated medication picking Cookeville Regional provides hand. Scheduled medications were time by 60% inpatient, outpatient, rehabilitation distributed via a 24-hour cart fill. First– Trimmed medication inventory and emergency care in addition to a doses were dispensed by pharmacy or costs by 20% host of specialty services such as The retrieved by nurses from one of 17– Projected ROI of 136% percent Heart Center and The Cancer Center. unit-based medication cabinets. The over five years With more than 140 physicians average daily dispensing volume was providing care in 36 specialties, the 2,500 doses.
“Up until 2001, I was not sold on mirror. Patient safety is an issue automation,” explained Walker, facing you and your family every day. Cookeville Regional’s pharmacy If you or a loved one gets ill or director. “I believed a human being injured, they’re coming here. Don’t trained as a pharmacist or technician, you want them to have the best care and with the proper check systems in possible?’” place, could be expected to do a good job and put out a quality The board unanimously approved a product error free.” sweeping, three-phase modernization initiative impacting Yet, the system proved unproductive all areas of the medication-use and fraught with potential failure process. The first phase, launched in points. Pharmacists spent significant 2006, focused on central pharmacy time on repetitious order entry, and automation, and included:“I told the board, ‘Take a good dispensing, checking, and distributing medications. There was • Horizon Meds Manager™ (HMM)look in the mirror. Patient safety little time available for clinical pharmacy information system. Allis an issue facing you and your activities. Similarly, the nursing units pharmacy orders are processed also followed manual medication through this system. HMM alsofamily every day. If you or a dispensing processes. The integrates with Connect-Rx®, the management team believed its database and workflow platformloved one gets ill or injured, manual-based pharmacy processes that powers pharmacythey’re coming here. Don’t you were contributing to potential automation. medication errors due to misfills, aswant them to have the best care well as controlling medication • PakPlus-Rx® packaging service. inventory in the pharmacy and at The onsite packaging servicepossible?’” medication-dispensing cabinets. ensures a continuous supply of bar-coded medications is alwaysOpless Walker, Pharm.D. For instance, pharmacist checks of available. Also, because all overnight cart fill picks revealed as medications are bar coded, itDirector of Pharmacy many as 35 picking errors each shift. provides an inherent double While uncovered errors were check, helping to prevent corrected prior to leaving the dispensing errors from occurring pharmacy, it underscored larger before they ever have a chance to challenges within the hospital’s happen. medication-use cycle. • ROBOT-Rx® system. The robot Answers automates medication storage, First-hand research about pharmacy dispensing, returning, restocking, automation changed Walker’s mind. and crediting functions for about “I’ve totally turned around,” he said. 450 of the hospital’s most “I’m sold on automation because it commonly used medications. potentially eliminates virtually all Technicians operate the robot and human error factors.” pharmacists perform a 10 percent random check. The system While Walker recognized the value dispenses about 2,200 doses as of bar-code automation technology part of the cart fill. Medications with regards to medication safety, are dispensed into patient-specific, workforce productivity, and cost bar-coded envelopes. The robot containment, he needed to convince also dispenses most first doses. the administration and the board of Overall, ROBOT-Rx accounts for the city-owned hospital. approximately 92 percent of all medications dispensed by the Walker presented his research pharmacy. findings—including a detailed workflow study, cost-benefit analysis, • MedCarousel® system. Technicians and site visit results. “My priority is use MedCarousel to pick patient care,” said Walker. “I told medications for cabinet filling and the board, ‘Take a good look in the for some first doses. The rotating
shelves, bar-coding, and pick-to- Financial Performance light technology improve picking “The pharmacy automation pays for accuracy and speed. The high- itself in several key ways: reduced powered inventory management inventory, reduced potential software improves inventory turns litigation, and reduced patient and reduces medication costs. stays,” Walker said. “After all is said and done, our net income is veryNurses retrieve some first doses, as good.” The hospital is on pace towell as PRN and floorstock realize a payback period of 1.8 years,medications from 17 previously and a return on investment of 136.5installed unit-based cabinets. The percent over five years. Other resultscabinets also interface with a include:controlled substances software fornarcotics. Said Walker, “We’re • Trimmed medication inventorygetting a lot less calls from nursing. costs by 20 percent. “One of these days, I’m going toNurses are reporting far fewer • Projected savings of $18,000 permissing or incorrect medications.” retire. When I walk out of this year by buying medications in bulk form. institution, I want to be able toResults • Experienced a first-year costDespite continued patient census avoidance of $11,200 from look back and know that I left itgrowth, central pharmacy reduced expired medications. a safer place. With pharmacyautomation has dramaticallyimproved medication safety, Additionally, Cookeville Regional has automation, I have that peace ofproductivity, and cost containment, established the foundation for theaccording to Walker. next two phases of its closed-loop mind.” solution: bar-code point-of-careMedication Safety administration and computerized Opless Walker, Pharm.D.“We’ve gone from 35 nightly cart fill physician order entry systems.picking errors to zero,” Walker said. Director of Pharmacy“We also increased our clinical Conclusionpharmacy practice. The result is While the tangible outcomes areprevention of approximately 215 significant, Walker believes that theadverse drug events (ADEs) per year, hospital also is benefiting from asaving our hospital a projected fundamental shift in public$1,010,500, based on FDA estimates perception with regards tofor ADEs.” Other results include: medication safety. As a taxpayer- funded facility, the hospitals• Improved medication dispensing pharmacy automation project via ROBOT-Rx to 99.9 percent required public approval. It was a accuracy. highly visible issue that generated• Cut medication picking and much publicity and anticipation. restocking errors by 80 percent through MedCarousel. “Patients, physicians, staff,• Reduced the number of missing administration, and board members medications by 37 percent. all have seen the highly visible, fundamental changes weWorkforce productivity accomplished through pharmacyPharmacy automation led to automation,” said Walker. “Thedramatic productivity increases, medical staff and nurses now seeWalker said, including: pharmacists making a difference in the patient care areas, and the• Reduced cart fill time by 44 pharmacists feel more a part of the percent. healthcare delivery team.” For• Improved cabinet fill time by 82 instance, clinical pharmacists carry percent. PDAs with them during rounds and• Speeded the medication picking use them to access pharmacological process by 60 percent. references when consulting with physicians.