Nowadays, pharmacies are rethinking their way of their work, including patient safety, quality and some other standards, which came with the health care reform. The common medications practices are changing on long-term care market. The most important impact has the new system of the drug dispensing, which is designed to reduce the waste of prescription medications. Those techniques are daily, weekly and automated technique.
With the changes in prescription delivery, managing and dispensing models we can clearly see the changes in long-term care (LTC) facilities. Those changes will affect the work of health care professionals, like nurses or other specialists in LTC and their patients. It’s really important for LTC to understand their functions and the way they could work with the changes to select the best solution for their work convenience and their customers’ benefits. Two systems are available now. The first one is the centralized system, another one is the facility-based dispensing system. Those categories are also separated into several different types. They support new “seven-day or less” legislation language, and based on different parameters, like capital requirements, efficiency, timeliness, and others.
Centralized dispensing
Requires a local pharmacy, which is located nearly LTC entities and services them. Pharmacies should pack the medications (usually it is 30-day supply) and deliver it to long-term care facility one or several times a day. Centralized dispensing usually means multidose strip and punch cards methods of packaging. Multidose strip packaging – automation technology which helps to dispense a lot of different medications during a long-term treatment. Multidose strips have shown the 50%-time reduction in the administration and preparation of the medications, so nurses can spend more time on health care for patients, rather than administer their drugs. Systems, which were designed for packaging medications in multidose strips are usually used to create seven-day quantity dispense. Sometimes, it’s used for three or four days dispenses. Unfortunately, in LTC facilities, where medications and patients are changing frequently, it is a bit inconvenient to use the system of multidose strips. For example, the medications should be removed from the package, if the prescription was changed and this leads to the waste of medications. In any case, multidose strips are more convenient and efficient than traditional cards. Unlike multidose strips, punch cards are the most used method of delivery and administration of medications. It’s not convenient to use the method for the 30-day supply of medications all the time for all the LTCs around, pharmacies widely use practice when they reduce supplies from 30 to 7-day supply or even less. This method can decrease the waste of medications, but it uses more time for administering (almost 4 times more, than multidose strips), this method is significantly expensive and could lead to drugs errors.
Here you can find an article that describes drug error consequences.
Facility-based medications dispensing
Systems are always located at the LTC facility. In most cases they are located at the nursing facility, there, in some cases, in-house pharmacy is located as well. In the case of facility based dispensing, medications are administrated in daily bases or unit-doses, which leads to the total elimination of medications waste. Another advantage of the system is the time manner. Usually, there is no any additional time for medications transportation and medications are available in time. There are three different ways to implement facility-based dispensing: remote dispensing systems, Emergency dispensing kits, drug-specific medications carts. Remote dispensing systems are secured, automated and provide the medication dispensing on patient-specific manner. It leads to the eliminations of medications waste, as the medications are dispensing only when needed and for every patient individually. As the system is located at the nursing facility, the system also reduces the time passes and nurses can spend more time with residents of the LTC facility. The remote dispensing system is twice effective than seven-day supply dispersing system. The system is not widely used in all the states because of the regulations issues. In 2009, the National Association of Board of Pharmacy (NABP) introduced its rules for remote dispensing system regulations. With the grow of the market adoption, the remote dispensing systems will be used more often.
Another way of medications dispense is the usage of Emergency Dispensing Kits (EDK). Those kits are widely used to storage and dispense controlled substances. There is also an improved system available, like automated medication cabinets. They include a formulary of a unit-dose medication and the quantity of the medications is always should be the same, as in formulary. Nurses have and access to those kits and cabinets and use them in emergency cases. Some of LTC facilities combine EDKs at the nursing facility with multidose strip dispensing system packaging.
The last option for Facility-based medications distributing systems is drug-specific carts. This is the new concepts and the system combines an electronic cabinet, Medication Administration Record (e-MAR) and medications cart. Medications are in the drug-specific punch cards and the nurse can get them when uses the e-MAR for a patient identification (barcode technology is usually used for this purpose). The main disadvantage of the system is the lack of medications stocked on-site. So the medications, which are not stored on-site should be taken out the pharmacy (centralized dispensing method). Also, the system will be more expensive than traditional carts but will not save more time for nurses. But still, this is the concept and it will be developed further, so it’s early to consider the system to be inefficient.
Influence on LTC facilities
For sure, there will be an impact on LTC facilities by “Seven-day-or-less” dispensing. As we can see now, there are a lot of solutions, which could be used by different LTC entities and should have a positive impact in any way. Besides, a lot of dispensing systems were implemented and successfully used across the U.S. Every method, every system and the strategy are unique for each health care providers and they should stay tuned, get the information about the changes and trends on time, consider the opinion of the partners (pharmacies, for example) and residents to choose the best strategy for the specific case.
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