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● Workstations/Carts

Managing compliance when medication goes mobile

Tight regulation requires latest advances in tracking, storage and distribution. By Randy Gerwitz, R.Ph.


roper medication management is essential to providing high-quality care and maintaining patient safety in a hospital. Key elements of a medication management system are inventory control, storage, delivery, secu-

rity, integrity and safety. T e Joint Commission has consistently reported MM.03.01.01 (Medication Storage) as one the most challenging standards for healthcare organizations (http://www., “T e Joint Commission Perspectives,” April 2013). A critical evaluation of the systems employed by many organizations quickly identifi es vulnerabilities, shedding light on why so many need improvement. Medication is a very broad term, encompassing everything from traditional prescription drugs to I.V. solutions and contrast media used by radiologists. For many hospitals, the term medication covers hundreds of thousands to millions of transactions per year. Ensuring the integrity and security of so many products, which are completely woven into the fabric of patient care, taxes even the best systems. Several of the greatest vulnerabilities lie between the time of dispensing and administration to the patient. Over the past 13 years as a pharmacy director, the last eight serv- ing as the director of pharmaceutical services at Erie County Medi- cal Center (ECMC) in Buff alo, N.Y., I have witnessed signifi cant changes to medication distribution and administration processes. Approximately seven years ago, ECMC’s pharmacy moved to

what is referred to as a cartless dispensing model, which was cut- ting edge at the time. A cartless model allows for most medications required for patient care to be stored and secured in automated dispensing cabinets (ADCs) in patient-care areas. T is model greatly decreases the time from prescribing a medication to administration to the patient. It also minimizes the chance a medication will be missed, and increases accountability and reporting capabilities – all issues plaguing the traditional cart-fi ll model. T is type of system intrinsically secures the drugs up to the point

of removal from the ADC for administration, but does not address the next steps in the administration process. We needed a medica- tion management technology that would streamline and safeguard the transportation of medications from the ADC, or medication room, to the patient’s bedside. Earlier attempts at addressing this concern – employing mobile medication carts, commonly referred to as bedside medication verifi cation (BMV) carts – proved challenging. T e core function

20 November 2013

Randy Gerwitz, R.Ph., Director of Pharmacy, ECMC.

of BMV carts is to document the ac- curacy of medication administration by utilizing barcode technology to verify that the right medication (product and strength) is given to the right patient at the right time. When BMV carts fi rst appeared in patient care areas, security was a bit of an afterthought. Many models were little more than existing computers on wheels (COWs) with a drawer attached. Drawer locks were easy to break and generally opened with a key or universal code. T is meant that medications could at times be left unsecured in the cart, and that items placed in the cart by one professional could be removed from the cart by another without an audit trail. T is was particularly concerning when transporting a controlled substance. We are now utilizing a medication administration system that connects to a single medication database, creating a closed-loop process all the way to the bedside. T e system includes mobile medication workstations, designed with security in mind, that serve as an extension of the ADCs, ensuring drugs remain secure as they are transported to the patient. Our current carts continue to support the BMV mission but now provide capabilities, such as individually locking drawers that can be assigned to a specifi c patient, secure supply drawers and user-access audit trails. We can now answer the question: “Who was in that patient’s drawer last?" As previously stated, medication security was a key feature the organization evaluated in selecting the next-generation BMV cart. But several other factors – or shortcomings of the prior carts – were considered. We desired a platform that was fl exible, one that could be confi gured in several ways to meet the varying needs of diverse patient populations. For example, a nurse caring for behavioral health patients would need many smaller drawers; a medical surgical nurse may need fewer but larger drawers to hold IV infusions as well as oral meds. Flexible also means adjustable, since we have nurses less than fi ve feet tall and nurses more than six-and-a-half-feet tall. We also agreed that the cart needed to be easily serviceable. Out-

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of-service carts off er no value to the user. Ideally, the cart should be repaired or serviced on the nursing unit. Battery life was also a huge nursing concern; a cart should be able to go an entire shift without charging. Durability and mobility were also evaluated. How long is the projected serviceable life? What is the projected cost per year of service? Is it easily moved from room to room? Can the cart be easily cleaned? Does it meet infection control standards? All too often, organizations focus on addressing a known issue or vulnerability


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