New JCAHO video tells safety needs with vending machines

Healthcare Purchasing News, April, 2001 by Todd Shields

Similar to many hospital users of automated dispensing machines for medication and supplies, Donna Graves believes they truly assist nurses in saving time and costs and also save patients from ingesting mistakenly issued drugs.

But she still wants them to be better: "They need to be more user-friendly."

"They need to be completely idiot-proof," she added, when asked to elaborate.

Graves, the nurse manager of medicine in the intensive care unit at University of Texas Medical Branch, Galveston, further explained that because her floor colleagues usually work in emergency settings, automated dispensing units must be "very simplistic."

"Getting into the machines can't be too difficult. We're very busy, but they can be difficult when we're trying to return items or adding a patient (to the profile). It can get pretty detailed," she says.

"Some of these (computerized machines) are really sophisticated and can hinder a noncomputer-type person. Some older nurses just resist computers."

In acknowledging that potential problem, the Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL, has made a new educational videotape to help providers comply with its inspection standards on automated vending machines.

Appearing on the tape are healthcare professionals in nursing and pharmaceuticals from UCLA Medical Center, Los Angeles; Mercy Health System, Pittsburgh; and at the St. Francis campus of the Via Christi Regional Medical Center, Wichita, KS.

Mistake tonic

Commission representatives on the tape said the relatively new technology is a sure way to correct the inefficiencies of past dispensing systems, such as the single-unit drug dose and cart method. Nevertheless, they repeatedly reminded users that checks and balances must always be in place when using automatic gear.

"The Joint Commission requires that pharmacists enter and screen orders before drugs are removed from cabinets and administered. Without this and other safety precautions, automated machines are no more than high-tech stock systems," said a commission statement.

James Baker, director of professional services for Pyxis Corp., San Diego, said a common usage problem is that automated systems adhere to a nonpatient profile system --meaning nurses can withdraw or replenish drugs regardless of whether they match a patient's specific prescription.

Because usage is not documented or monitored, machines are stocked with an abundance of drugs that never get used, a lack of needed drugs or simply the wrong drugs, Baker explained.

The Joint Commission's biggest concern is the nonpatient profile automated cabinet. Hospitals use them for convenience and for saying time because they can add other unnecessary drugs to the system such as routine, first-dose medications, instead of specific narcotics for specific patients.

Supporting best practices, Baker said hospitals should stick to the patient profile strategy, so that exact sums of drugs are taken out based on a patient's daily prescription. Afterward, pharmacy technicians refill the machines with real-time orders.

According to the commission, the only exception to taking drugs out before a pharmacist rechecks a cabinet is in emergency cases ordered by a physician.

Use as directed

Throughout the educational tape, healthcare workers said the equipment will produce positive supply results and ensure patient safety only when staff uses it correctly.

For example, if a rushed nurse grabs too many pills at once instead of returning to the cabinet for refills, records are inaccurate and, consequently, get inaccurately replenished later in the day.

"You can take your supply all at once, but that's not right. There must be some degree of responsibility and accountability here," said Graves, explaining that nurses should record the number of pills or medical supplies they withdraw by pressing a corresponding button on the machine.

From a supply safety standpoint, computerized vending gear provides reports that indicate when drugs were taken, by whom, for whom and in what amount.

And in facilities that install vending equipment in emergency rooms, where sometimes the pace is hectic and tracking supplies is difficult, material managers who review patient profile reports can better capture charges, said a variety of healthcare professionals.

Training and audits

In preparing for JCAHO inspections, medical staffers from UCLA and Mercy Hospital said providers should establish policies for machine use and continually audit its reports. In addition, hospitals should provide in-house training and bring in trainers from the manufacturing side.

At Pyxis, users are invited to San Diego for learning seminars, and the company provides on-site training and an educational website with a tutorial.

During a visit, JCAHO typically questions staff members on training, security issues and the machine's accessibility in emergency situations.

Should an inspector find a violation, the hospital is asked to prepare and submit evidence that it has been corrected, followed by another on-site visit.