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Literature Review
Health care facilities have used automated dispensing devices since the 1980’s. These devices were expected to reduce rates of medication errors, increase efficiency of pharmacy and nursing staff, reduce costs, improve inventory management, and streamline billing functions (Murray, 2001). Point of use technology has produced financial savings as well as improvements in staff efficiency, productivity, and satisfaction. The qualitative benefits of a POU system are cited for surgical departments (Lewis & Sweany, 1997), operating rooms (Graham, Brewer, & Byrd, 1999) and emergency rooms (Uribe & Baskel, 2000). Some of these benefits include elimination of searches for narcotic cabinet keys, change of shift inventories, stock outages, waiting for first dose medications, manual charging and billing, and an increase in cost controls (Lewis & Sweany). Based upon an interrupted time series analysis spanning one year pre and post POU implementation, the University of Louisville Hospital reported a decrease in cost per procedure from $319.95 to $267.93 (Graham et al.). At Evans Army Community Hospital, implementation of a POU system resulted in a reduction in cost per surgical case by 7.6% in the first nine months, an annual saving of over $100,000 in the operating room, and a one-time reduction of $603,000 of supplies on hand (Pyxis, 2002).
Results in hospital emergency rooms are similar. Loyola University Medical Center reduced its monthly supply cost by 10% and increased its ability to connect supply charges to specific patients (Uribe & Baskel, 2002). Patient charges per month increased from $3,345 to $26,070, while non-charges per month decreased by 60%. These changes resulted in significant increases in payments for the hospital.
The Army Medical Department’s (AMEDD) Business Plan for POU implementation calls for a phased approach to deployment of these systems to five major medical centers beginning in 1999 (AMEDD Logistics Systems Division, 1997). The AMEDD chose these facilities because they possess the patient volume to capitalize on the cost savings and proposed benefits. Results to date at Brooke Army Medical Center indicate a 16.5% reduction in medical and surgical supply utilization and a 40% reduction in inventory on wards and in the operating rooms. Walter Reed Army Medical Center saved $69,534 in the medical intensive care unit (MICU) the first year after implementation (Pyxis, 2001).
The AMEDD business plan outlines the basic methodology both before and after point of use implementation to measure the overall effects and quantify the savings involved. Specific measures established include: (a) one time inventory reduction as measured by decrease in supplies on hand; (b) reduced consumption as measured by cost per patient day and cost per case/visit; and (c) pharmacy costs as measured by restocking/ repacking, system management, missing first dose, and cassette fill/exchange. Although these are important measures of the impact and usefulness of the technology post implementation, they cannot be used to determine whether the system should be implemented.
In many ways, Landstuhl Regional Medical Center differs from other facilities selected for deployment of POU systems. In addition to operating in the European Theatre, LRMC is responsible for managing patient care occurring in eight geographically dispersed health clinics in the region. LRMC’s physical facility is over 50 years old and is geographically dispersed on the installation. In contrast, other medical treatment facilities chosen for POU installation occupy new buildings with centrally located support services. In many of Landstuhl’s wards and clinics, physical space for supply storage is minimal and storage areas often do not meet infection control requirements. Successful implementation of POU technology in a physically limited facility is illustrated by the day surgery center at NYU Hospitals Center. Point of use allowed the organization to save one operating room (OR) through realization of space efficiencies as well as save $142,460 annually in supply expenditures (Drescher, 2000). This OR generated $1 million in additional revenue. This facility was also able to implement the system without increasing the number of full time employees.