Case Study

increasing labor shortages andhigher labor costs, Blanchard soughtto streamline processes throughautomation. But he also wanted tobalance automation with the desireto continue using nurse servers.

AnswersAfter an extensive review of variousmedication distribution models,Evergreen chose to automate existingprocesses. "We already weresuccessful in terms of delivering unit-dose medications to the bedside,"explained Blanchard. "It became amatter of streamlining pharmacyoperations so that our staffing ismost efficient. The ROBOT-Rx®system is the obvious solution." TheROBOT-Rx system automatesmedication storage, dispensing,returning, restocking, and crediting.

Evergreen began by packagingmedications in bar-coded, unit-doseform using McKesson equipment."Because the packaging looks similar,we wanted to get nurses accustomedto using it—to be able to distinguishwhat a Protonix dose looks likeversus a digoxin, for instance. It wasa smooth transition." After buildingits bar-coded medication stock,Evergreen went live with ROBOT-Rxin March 2004. "At first, weconducted a short trial with ourpharmacists checking every dose therobot dispensed," explainedBlanchard. "Now we do a daily 10percent random check, with approvalof the state Board of Pharmacy."

Evergreen Hospital Medical Center Nursing, Pharmacy Benefit from ROBOT-RxMedication Dispensing Solution

OverviewOfficials at Evergreen HospitalMedical Center sought to prepare forbar code medication administrationand improve efficiency of medicationdelivery to nurse servers. Byimplementing the ROBOT-Rx®system, the hospital increaseddispensing accuracy to 99.9 percent;cut cart fill labor by 72 percent; andrealized nearly $2 million in annualsavings via 24,000 pharmacist-patientinterventions.

Challenges Located on the outskirts of Seattle,the 250-bed Evergreen Hospital is acommunity-based facility serving agrowing population of more than400,000 people. For more than 15years, nurses at Evergreen HospitalMedical Center were accustomed toretrieving unit-dose medicationsfrom nurse server units. To fill thenurse servers with unit-dosemedications, the pharmacyperformed a daily manual cart fill.Selecting and checking the 1,125daily doses took nearly 15 hours fortechnicians and pharmacists.

"The nurses liked the convenience ofhaving scheduled and common PRNmedications as close as possible tothe bedside, as opposed to walkingto the medication room down thehall," explained Bob Blanchard,director of pharmacy. "It's good fornursing workflow and safer, but thecart fill was a very labor-intensiveprocess for pharmacy." Faced with

At a Glance

Organization

Evergreen Hospital Medical CenterKirkland, WA

Solution Spotlight

– ROBOT-Rx®

– AcuDose-Rx®

– Packaging Solutions

– MedDirect™

Critical Issues

– Reduce the risk of medicationerrors

– Position for bar code medicationadministration

– Support existing nurse servermodel

– Reduce laborious cart fill andfirst dose operations

– Improve efficiency in a tightlabor market

Results

– Improved medication dispensingaccuracy to 99.9%

– Conducted nearly 24,000 clinicalinterventions annually, savingapproximately $1.9 million

– Cut first dose fill labor by 78%

– Reduced cart fill labor by 72%

– Decreased crediting labor by50%

– Strengthened narcoticsmanagement

Copyright© 2007 McKesson Corporation and/or one of its subsidiaries. All rights reserved. All product orcompany names mentioned may be trademarks, service marks or registered trademarks of their respectivecompanies. AUTO 144_8/07

The hospital uses ROBOT-Rx for 24-hour cart fill, automaticallydispensing to envelopes imprintedwith the patient's name and barcode. The patient-specific envelopesare then transported via carts to thenurse servers. The robot also fills firstdoses, transported either bypneumatic tube or via messenger.

To further address medication safetyand tracking in patient care areas,Evergreen installed 24 AcuDose-Rx®medication dispensing cabinets. TheAcuDose-Rx cabinets store narcotics,floorstock, and PRN medications.Previously, narcotics were secured inthe medication room and requiredextensive manual documentation."The narcotic counts were donethree times daily, at each shiftchange," said Blanchard. "Now, withthe AcuDose-Rx cabinets trackingusage, nurses do it once per week."Also, because all medications in theAcuDose-Rx cabinets are bar coded,dispensing, monitoring, restocking,and charge capture are greatlyenhanced, Blanchard noted.

Results Today, the ROBOT-Rx accounts for 95percent of all unit dose medicationsdispensed by Evergreen's pharmacy.This has dramatically impactedmedication safety, productivity, andcost containment. At the same time,Evergreen Healthcare hasexperienced significant growth: a 29 percent increase in average dailycensus, and a 53 percent increase indoses dispensed per day.

According to Blanchard, theautomation systems easily haveabsorbed all of the workloadincrease. In fact, since implementingROBOT-Rx, the pharmacy requires 58 percent fewer technician FTEs and61 percent fewer pharmacist FTEs formedication dispensing and checkingduties. Those FTEs have beenredirected to other activities. Thenumber of hours dedicated to clinicalpharmacy has doubled. ExplainedBlanchard, "We now havepharmacists assigned to conductingclinical activities on every floor."Pharmacist interventions from May

2006 to May 2007 averaged nearly2,000 per month, for a totalapproximate value of $1.9 million.

Automation also has promptedprocess improvements. Cart fill dutiesmoved from day to night, freeingFTEs for emergent duties. Techniciantime for first doses dropped from9.33 to 2 hours per day; pharmacisttime for first doses dropped from 5.3to 2 hours per day. Using bar-codescanning, medication crediting nowoccurs immediately after cart fill,rather than several days later usingmanual processes. And, importantly,the ROBOT-Rx system and AcuDose-Rx cabinets provide a real-time inventory control that thehospital didn't have previously.

"Nursing workflow stayed exactlythe same, which is critical to ouroverall success," said Blanchard."We're just using robotics in thepharmacy for tasks that werepreviously performed manually, andusing people for more critical tasks."Another time-saving tool is theMedDirect™ imaging system formedication order transmission.Explained Blanchard, "MedDirectreduces paperwork, improvescommunications with nursing,enables us to prioritize orderselectronically, and helps us easilyidentify potential problems early onin the medication order process."

Conclusion "At Evergreen, productivity is a keyorganizational imperative," saidBlanchard. "We report ourproductivity on a regular basis. Therobot and the cabinets havecontributed substantially todocumented improvements. If I'mover budget in staffing for aparticular month, or withpharmaceutical purchases, I'm ableto offset those by the time savingsand charge capture savingsgenerated by ROBOT-Rx, byAcuDose-Rx cabinet transactions, andby the number of interventionscompleted by our clinicalpharmacists. Automation enables usto make dramatic improvementsacross the board."

McKesson Automation Solutions500 Cranberry Woods DriveCranberry Township, PA 16066724.741.8000www.mckesson.com

“Nursing workflow stayed exactly

the same, which is critical to our

overall success. We're just using

robotics in the pharmacy for tasks

that were previously performed

manually, and using people for

more critical tasks."

Bob Blanchard

Director of Pharmacy

Evergreen Healthcare