feature Short-Cycle Case Study
Ahead of the Curve
by John Becker
Well ahead of a federal mandate, a Pennsylvania long-term care facility uses a shorter dispense cycle and pouch packaging to reduce medication waste and increase nurse productivity.
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director Linda Imm says, 30-day supplies also made her staff less productive.
HarmarVillage Care Center (HVCC), a 130-bed facility located in Cheswick, Pa., is part of the Grane Healthcare family of skilled-nursing facilities. Grane, with offices 10 miles away in Pittsburgh, also provides pharmacy services to those facilities.
“We spent a lot of time documenting the return of drugs to the pharmacy for proper disposal,” Imm says. “Also, if a resident was moved temporarily to the hospital, we’d have to document what cards we had on hand and how many, so that when the paLinda Imm tient returned, the pharmacy wouldn’t ship us those meds all over again. It was very time-consuming.”
anuary 2013 is the current Centers for Medicare and Medicaid Services (CMS) deadline for long-term care pharmacies to dispense brand-name oral solids in supplies of 14 days or less. One such facility has already made the move, with surprisingly positive results.
Seeking the Best Solution HVCC’s chief administrator, Greg Hall, says they started considering the change — along with a move to automated tablet packaging — almost three years ago. According to Hall, the problem with 30day supplies is that orders change or are discontinued, or residents are discharged Greg Hall from the facility entirely, often well before a month’s supply of medication is exhausted. Unused drugs were returned to the pharmacy and disposed of. “We felt by going to a seven-day supply, or even better, a four/three-day supply twice weekly, we could significantly reduce waste,” Hall says. In addition to the cost of the wasted drug, Hall’s nursing 12
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Other equally important issues that Hall and Imm sought to address were the drawbacks and inefficiencies inherent in the use of bingo cards. The cards are bulky, and the nurses’ medication carts had become cluttered and disorganized. “With 20 residents per cart, and many on four or more meds, the drawers quickly became so full you couldn’t fit another card in,” Imm says. “If the cards got out of sequence, it took time to hunt down the resident’s medication. Sometimes pills would simply pop out of their plastic cells and fall to the bottom of the cart. Cleaning the carts and keeping them organized became a real issue. With pouch packaging we knew we’d be much more organized and efficient in distributing meds.” Over the next few months, pharmacy and nursing home staff met regularly to thoroughly review the pluses and