Hospitals should look at big picture when choosing technology

October 24, 2005

In the mid-1800s, Lady Sarah Winchester spearheaded the building of the bizarre California mansion that bears her name. While she did have a flair for design, her spontaneous plans and the results proved chaotic. Staircases led nowhere. Many doors opened to walls or steep drops, and a few bathroom doors had windows. The Victorian anomaly may be fun to visit, but it would be frustrating to live in.

In the mid-1800s, Lady Sarah Winchester spearheaded the building of the bizarre California mansion that bears her name. While she did have a flair for design, her spontaneous plans and the results proved chaotic. Staircases led nowhere. Many doors opened to walls or steep drops, and a few bathroom doors had windows. The Victorian anomaly may be fun to visit, but it would be frustrating to live in.

Truth be told, we have tended to develop and apply automation to the medication-use process without a master plan, only to discover that some of the stairs lead to nowhere. In all fairness, when we started the adventure back in the 1980s, it was impossible to see what technology the new millennium would bring. Pharmacy information systems were developed without our foreseeing physician order entry. Drug dispensing cabinets were developed without our anticipating point-of-care bar-code scanning. Each was developed independently of the others, and they haven't always fit.

Of course, there is the ever-present challenge of interfaces-getting the systems to talk to one another. While we have made great progress with the more mature technologies, we continue to have challenges with the newer ones. Vendors have solid two-way interfaces between dispensing cabinets and pharmacy information systems. Some bedside-scanning systems are doing a good job at this as well.

But beyond software interfaces, there is the often-overlooked issue of workflow interfaces. Perhaps the systems communicate nicely, but work may not flow naturally when caregivers interact with one and then the other. For example, it is not uncommon for hospitals neck-deep in automated dispensing cabinets to ask, "When our nurses are scanning at bedside, will it make sense for them to pull all the medications from an automated cabinet down the hall?"

I commend those who ask the tough questions. It takes courage to admit that a system we have built and sworn by for years may need to be investigated, taken apart, and reassembled in order to realize our full potential in automating the medication process.

Whether starting from scratch or adding yet another component, hospitals would do well to pause, back up, and take a look at the big picture. It is important to understand how each part of the process relates to the whole before automating the next.

Hospitals just now considering adding cabinets are probably wise to begin with the bedside-scanning component in mind. Along with those who already have dispensing cabinets, they will want to consider how leaner cabinet formularies and different drawer configurations might better serve their bedside vision.

A few hospitals that have eliminated patient cassettes in favor of nurses dispensing all medications from automated cabinets are rethinking and retreating from this paradigm. By reducing cabinet inventory and returning to filling patient cassettes with routine medications, pharmacy departments discovered they don't need as many cabinets. Some are actually filling room servers, finding that nurses value the proximity of meds to patients. Others, equally thoughtful, have ended up sticking with and swearing by the cart-less approach.

Which blueprint is right? That is a question your hospital has to answer. As terrain impacts architectural planning, the particulars of your hospital should be carefully incorporated into your technology planning. Lady Winchester's example is worth eliminating, not emulating.

The Author is president of The Neuenschwander Co., Bellevue, Wash.