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Volume 2012 Number 1

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Automated Dispensing Machines - Surprised by the Numbers

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Mark Neuenschwander articles by this author...

Mark Neuenschwander has earned his reputation as one of the nations' leading authorities on dispensing and point of administration automation. Whether writing, lecturing or problem solving with a client, Mark communicates in terms and concepts that are easy to grasp and apply. His fresh perspective and keen insight stem from having invested thousands of hours in research and in-depth consulting with clients.

I’ve been thinking about automated dispensing machines, traffic cameras, Michelangelo, and Atlanta in May.
On a recent NPR program, experts discussed how installing cameras at intersections increases citations while decreasing violations. Initially, revenue from tickets exceeds the costs of the technology and personnel required to manage it. Within a few years, however, traffic cameras modify behavior so effectively that eventually there are barely enough violators to cover the cost of the electronic law-enforcement systems. Mission accomplished.

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To make narcotics diversion more difficult, most hospitals have installed automated dispensing machines (ADMs). On Showtime’s third episode of the premiere season of Nurse Jackie, the ever-irascible RN of All Saints appeals to Dr. Cooper: “Vote ‘no’ on the Pyxis.” When asked why, she snips, “That machine is not only an insult to nurses, it is squeezing Eddie out of a job.” Turns out, Eddie is the pharmacist who helps Jackie divert narcotics to sustain a habit that makes Vicodin-popping House look like a rookie.

Stay tuned. Though All Saints will probably go ahead with Pyxis (or some other ADM), nurse Jackie will find other creative ways to score narcotics. ADMs make diversions harder but hardly impossible.

Hospitals wishing to use ADMs to their potential must use them skillfully. Artists need brushes, but even more so, brushes need artists. One of my hospital clients is dead serious about mastering the art of using their technology to rid narcotic intersections of violations. First, they sprang for expensive state-of-the-art surveillance software, which perpetually gathers then parses data from all ADM activity and issues daily reports of irregular or suspicious activity. Second, they assigned a compliance specialist to comb through the reports and confront offenders. This person (a skilled RN, who also happens to be a trained attorney) devotes an average of two hours a day to the task. Over the past six months, the diversion team has caught and dealt with six violators.

To some, these higher-than-normal numbers will be shocking. Veterans of drug wars will view them as closer-to-actual. Hospitals tackling the problem head-on find many more diversions than they ever imagined were occurring in their halls. True, with artful surveillance, citations increase, but violations decrease. And along the way, the most skilled of violators are found and put out.

Upon learning about my client’s six violators in six months, their state hospital board immediately sent out an inspector who concluded the hospital should be penalized for their higher-than normal diversion rates. Turns out the inspector had never seen an ADM nor had the slightest clue how one works. Using similar logic, I suppose the inspector would recommend shutting down intersections with cameras, arguing that the surveillance activity creates more violators.

Something similar occurs after hospitals implement bar-code point-of-care (BPOC) systems. While the number of medication errors reaching patients drops significantly, the number of errors identified throughout the medication-use process goes up dramatically.

Like traffic cams and ADMs, BPOC systems are mitigators—reducing violations, eliminating errors. They are also messengers—announcing problems that have been disguised and denied for years. Sure what’s revealed is alarming. It is also remedial, enabling hospitals to better see and finally address reality. Why would anyone shoot these messengers? We should let their numbers motivate us to master the art of using technologies to achieve the good purposes for which they were created.

Not bothering to whisper, a tourist looking up at Michelangelo’s brush strokes on the ceiling of the Sistine complained, “That’s not so great,” to which a nearby tour guide barked, “Sir, the viewer is on trial, not the painting.” Don’t be distracted by unstudied bystanders who misinterpret the valuable information ADM and BPOC systems produce.

Oh, yeah, Atlanta. Join us in the hub of the South as we continue “Mastering the Art of Barcoding” at The unSUMMIT for Bedside Barcoding. On its fifth anniversary, The unSUMMIT will be held at the Newell/Rubbermaid World Headquarters in Atlanta—May 5-7. Come to collect and contribute BPOC information that will result in meaningfully using this meaningful technology.

What do you think?

Mark Neuenschwander

mark@hospitalrx.com

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