Redesign of Medication and Supply Distribution in a Day Surgery Center

AORN Journal, Nov, 2000 by Nadine Iris Drescher

The day surgery suite poses unique challenges for medication and supply distribution. Here, the constant demand for readily available items is matched only by the need for improved cost, space, and time efficiencies.

At many institutions, facility expansion cannot keep pace with the rapidly increasing number of day surgery procedures. Meanwhile, the rising acuity level of the day surgery patient population creates an increasingly medication- and supply-intensive environment in which controlling access to medications and supplies, fully documenting all dispensing transactions, and accurately charging patient accounts become key issues for clinical and business success.

Installation of an automated distribution system allows managers, nurses, and pharmacists at NYU Hospitals Center day surgery center, New York, to significantly improve medication and supply access, control, documentation, and charging. Automated medication and supply distribution helps the day surgery center achieve space efficiency, limit the number of full-time employees needed for distribution, improve patient and staff member satisfaction, increase revenue, and strengthen its position for managed care contracting.

KEY ISSUES FOR REDESIGN

The Tisch Hospital, one of two hospitals at NYU Hospitals Center, occupies 15 floors of equal dimensions in a Manhattan building. Maximum space efficiency became the top priority after the plan to renovate a portion of the facility to house a larger day surgery department was announced (Table 1). The structural systems already in place limited the redesign because the constricted site offered no opportunity for physical expansion.

Table 1 KEY REDESIGN GOALS

Achieve optimal space efficiency

Increase revenue

Strengthen position for managed care contracting

Improve access to supplies and medications

Track use and adjust inventory

Document and track charges

Accurately charge patient accounts

Enhance patient satisfaction

Enhance staff member satisfaction

Original blueprints placed the day surgery center on a converted hospital floor, formerly two inpatient-nursing units; however, storage space for supplies was quickly lost. Instead of losing an OR, the day surgery construction coordinating committee decided to provide off-site warehousing and support space on another half floor. Committee members, therefore, could plan for decreased operational cost and optimal use of clinical space.

Program planners soon determined that more than good architectural design would be required to make the most efficient use of the space available, and process redesign became the next priority. Nursing staff members and leaders of OR services instituted service-specific pick lists for more efficient stocking and inventory control. More importantly, the decision to implement an automated medication and supply distribution system became an integral part of the redesign effort. The automated system would maintain decreased inventory par levels, which would be monitored for accuracy and adjusted according to actual use. The system also would enable managers to document and track charges, monitor and investigate medication diversions, and stock a variety of items in controlled cabinets. Tackling these issues is critical in today's health care environment. Providers constantly must meet the challenge to increase revenue, improve their position for future managed care contracting, and comply with the Joint Commission on Accreditation of Healthcare Organizations' key requirements for waste, control, locked systems, and documentation.

CHOOSING AN AUTOMATED SOLUTION

Department administrators and members of the hospital board of trustees chose to invest in an automated medication and supply delivery system to address the issues posed by the day surgery center renovation. Although automation required a major investment for the institution and a thorough process redesign for the department, administrators fully expected the system to produce short-term cost efficiencies and a greater long-term payoff.

Labor budgeting. Cost justification for the automated system was built into the total renovation effort. Still, committee members carefully considered the labor impact the system likely would have on other departments, especially pharmacy, materials management, and central supply--the departments involved in distributing medications and supplies to the day surgery center.

With automation, nonsurgical personnel needed to come to the day surgery center to stock cabinets, possibly requiring additional expenditures. Communication with the affected departments assured committee members that these personnel could continue to perform their duties with a slight shift of schedules. A locked automated system would, in fact, decrease manpower needs from the security department to monitor nighttime theft. In short, analysis demonstrated that day surgery could obtain all the supplies and support services required without increasing the number of staff members who deliver those supplies.