Refining Lean medication management strategies
Ensure strategies are rooted in regulatory compliance and industry best practices while providing increasing nursing time with patients.
Across today’s performance-driven healthcare landscape, lean management principles are an increasingly important strategy for enhancing all elements of clinical care delivery. Ongoing process improvements that streamline operations, while also driving the highest quality care, demand initiatives that balance the needs of all stakeholders – patients, nurses, pharmacy, ancillary departments and the healthcare organization as a whole.
Pharmacy and nursing workflows within the bigger picture of medication management, including medication administration, are no exception. Hospitals across the nation leverage automation strategies for medication management processes, but identifying and implementing best practice workflows to optimize efficiencies, patient safety and ultimately, fiscal responsibility can be a challenging proposition.
As the industry faces increasing regulations and financial risk based on patient satisfaction and outcomes, it is imperative for executive leadership to understand how a hospital’s unique medication distribution workflow impacts pharmacy operations, nursing workflow and patient safety and satisfaction.
The ability to fully incorporate industry best practices around technology and workflow is critical to staying in the black when it comes to HCAHPS patient experience scores, outcomes metrics and quality, including readmissions, hospital acquired conditions and never events.
Leaner medication management: The balancing act
Hospitals face a double-edged sword when it comes to streamlining medication management workflows for both pharmacy and nursing. In today’s healthcare environment where maximizing productivity is essential, pharmacies are looking to establish a top-of-license approach to utilizing their resources which requires lean pharmacy operations. As such, many are leveraging automated dispensing cabinets (ADCs) that may help promote efficient pharmacy operations by making medications readily available on patient floors.
Non-value added time associated with retrieving medications is the result of nurses walking back and forth to the med room, waiting in lines to access the ADC and then retrieving medications. This all occurs during the “golden hour” of the morning, when nurses are charged with not only retrieving medications and prep supplies, but more importantly, determining the appropriateness of the medications. Additionally, the nurse is in a “race against the clock” to ensure medications are administered to all their assigned patients in a timely manner and in accordance with Centers for Medicare & Medicare Services (CMS) regulations.
With the average patient receiving nine medications, nurses can spend upwards of 30 minutes vending medications from the ADC—time that could be spent educating and engaging patients in their treatment plans. While it may be difficult to associate hard dollars with nursing time at the bedside, patient satisfaction and quality of care reimbursements are directly impacted by nursing time with patients. In fact, a hospital’s clinical process of care, outcomes and efficiency account for 70 percent of a hospital’s total performance score with patient experience accounting for 30 percent. This score is determined by the Hospital Value-based Purchasing program, which links a portion of a hospital’s CMS payments to performance based on a set of quality measures.
Due to the speed at which a nurse must administer the large numbers of medications to meet guidelines for timely medication administration, a “task-driven” nurse mentality, which diametrically opposes the needs of the patient during this “golden hour,” directly impacts patient satisfaction and requirements for medication education. This, in turn, can have an effect on reimbursement, which is why it is critically important for hospital leaders to ask the question: “How can pharmacy help nursing find more time at the bedside?”
Leveraging industry best practices
One solution to the goal of maximizing nursing time at the bedside is implementing a lean workflow. Eliminating, or drastically reducing, non-value added time provides the opportunity to not only increase nursing time with patients, but also to implement key initiatives—such as rounding, medication education or medication reconciliation—and improved throughput, all of which are proven to support quality and the patient experience.
Focusing purely on lean processes sometimes directly conflicts with best practice and regulatory requirements. Incorporating regulatory compliance and leveraging industry best practices as the foundation for lean medication management strategies ensures both safety and productivity needs are met. For example, while the vast majority of hospitals across the U.S. have invested in ADCs, many are still not optimizing or adhering to the industry best practices to produce optimal safety and performance results from their use.
These best practices include core processes developed by the Institute for Safe Medication Practices (ISMP), the nation’s voice for medication error prevention and safe medication use, in response to increased ADC use. Designed to maximize productivity and optimize patient safety, these guidelines aid in strategic decision making about ADCs and help healthcare organizations assess and manage their impact on both nursing and pharmacy workflows.
Additionally, the Joint Commission, American Society of Health-System Pharmacists, The Advisory Board and National Database Nursing Quality Indicators also provide best practice information that can be incorporated with lean workflows.
The following ISMP core processes for guidance on the interdisciplinary safe use of ADCs support the highest level of patient safety and provide best practice strategies for preventing dangerous work-arounds, increasing productivity and ensuring proper use of technologies for safe medication administration. Healthcare organizations can leverage these guidelines to lay the right foundation for the safe use of ADCs as they move toward maximizing nursing time at the patient bedside.
- Provide ideal environmental conditions for the use of ADCs
- Ensure ADC system security
- Use pharmacy-profiled ADCs
- Identify information that should appear on the ADC screen
- Select and maintain proper ADC inventory
- Select appropriate ADC configuration
- Define safe ADC restocking processes
- Develop procedures to ensure the accurate withdrawal of medications from the ADC
- Establish criteria for ADC system overrides
- Standardize processes for transporting medications from the ADC to the patient’s bedside
- Eliminate the process for returning medications directly to their original ADC location
- Provide staff education and competency validation
As hospital pharmacies focus on implementing the most efficient processes possible in order to improve their bottom lines in today’s value-based care environment, it’s important not only to leverage lean strategies, but to ensure these strategies are rooted in regulatory compliance and industry best practices while providing the desired impact of increasing nursing time with patients.
By incorporating these practices as a foundation, organizations can make the most of lean medication management for enhanced clinical quality, productivity and financial performance overall.
Debra Jarratt, RPh, is an executive pharmacist consultant at Aesynt. Carole Farmerie, RN, BSN, is a senior executive nurse consultant at Aesynt.
