A specialty pharmacy serving long-term care facilities has found benefits from bringing automated systems into its customer sites.

In May of 2009, Indianapolis-based Wellfount Pharmacy opted for the InSiteRx automated dispensing system of Bellevue, Wash.-based Talyst Inc. The dispensing units reside at the long-term term care facilities that Wellfount services, and through simplified user interfaces enable nurses to dispense patient-specific, multi-dose medication packets.

The benefits to this approach are manifold, says Paul Leamon, president and CEO at Wellfount. One of the most marked benefits is the reduced potential for error. Each dosage dispersed by the machine is printed with the patient's name, the name of the medication, and verifying bar codes which nurses check with a scanner. If there is a medication change, the previous prescription won't be dispensed by the machine again. The process is safer, Leamon says, because it is simpler.

"Traditionally in long-term care pharmacy, there are about 11 different hands that touch an order from the time a physician places an order until it reaches the patient," he says.  "It's a very inefficient process and there's a lot of potential for human error."

By dispensing at the point of care, the numbers of actors in the supply chain can be reduced to four: physician, pharmacist, nurse and patient. "In our minds it's become a supply chain management question," Leamon says. "To get to better patient care we have to manage the supply chain better. Following implementation, we found our error rate is at 1/100th  of a percent, when the industry average is between 3 to 5 percent. It's a huge change."

Leamon says the shorter fill cycles enabled by on-demand dosing also dovetail with broader trends in the long-term care industry, as patients with more acute illnesses are entering long-term care facilities. "The acute care settings are pushing patients out a lot faster now, and they are going into nursing homes," he says. "That population changes medications so often that the 30-day mentality of supplying doesn't work anymore." 

On-site dosing and real-time reporting also are helping to change the dynamics between pharmacy and facility by keeping pharmacists in the loop when it comes to patient care. For example, the pharmacist who used have to wait 30 days for usage reports now knows instantly how often "take as needed" drugs are taken. "Because it's an electronic system, the amount of knowledge we have at our fingertips is incredible," Leamon says. "The feedback loop is shortened and we know now in real-time what medications, for what patients, are being administered via the InsiteRx unit."

An ancillary benefit of having the unit on site, Leamon says, is a reduction in paperwork for nurses, who are also freed from performing time-consuming narcotics counts because all medications are already secured within the unit. "It about patient care," he says. "Nurses spend too much time doing administrative tasks."

Leamon says feedback from nurses in the facilities has been uniformly positive. "The technology is very easy to interface with. When we add a new facility, they are up and running within days."

There are other, broader arguments for on-site dosing. One is primarily financial. Since most unused medications can't be returned for credit, distributing medications on an as-needed basis saves money. Instead of billing patients, insurers or Medicaid up-front for 30-day doses that may go unused, Wellfount now only charges for drugs that are consumed. In December of 2009, the Congressional Budget Office estimated that medication waste in long-term care would cost Medicare $5.7 billion over the next 10 years.

There's also an environmental argument for excising wasted medicines.  A 2008 Associated Press investigation estimated that over 250 million pounds of pharmaceutical waste is generated annually by U.S. hospitals and long-term care facilities. The Environmental Protection Agency has said it would look into the issue, and in January New York State Attorney General Andrew Cuomo reached a settlement with two hospitals and three nursing homes that admitting to disposing of pharmaceuticals through toilets and sinks and into the state's watersheds.

-- Bill Kenealy


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