The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts


AUTHORS: Donna Clayton, BS, RRT, RCP; Barb Hannibal, AS, RRT, RCP, Cheryl Hoerr, BS, RRT, CPFT; Barnes-Jewish Hospital, St. Louis, MO.

BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has focused increasing attention on medication management by Respiratory Care Services (RCS). RCS had been ordering all medications directly from the hospital pharmacy and storing them in a locked storage cabinet in the main RCS department. Therapists would access the storage locker, remove enough medications to get through their assigned treatments, and carry the medications to the floor in their lab coat pockets or within personal storage bags (fanny packs). A significant waste problem was suspected, but difficult to quantify. Concerns regarding medication security, storage and transport have prompted many RCS Departments to explore medication management alternatives. We conducted a nationwide random survey of 20 hospitals (avg. bed size = 816) to identify how others were storing and dispensing Respiratory medications. 14 (70%) of those surveyed are using Pyxis® or an equivalent system to store and dispense all meds; 2 (10%) are using the system to store at least some of their respiratory medications. Pharmacy manages par levels and is responsible for stocking medications for those departments using Pyxis®. 6 (38%) of those using Pyxis® reported delays in delivery of patient care related to inadequate par levels.

METHOD: Data was gathered from the hospital's financial system on departmental medication costs for fiscal 2003 and 2004. Data was also gathered from the department's Clinivision® system on total medication doses delivered during the same time frames. This enabled us to calculate the average cost per delivered dose for 2003 and 2004 prior to transitioning to the Pyxis® system. Similar data was gathered for January - May 2005. Trials of respiratory medications in the Pyxis® system were conducted in various units throughout January and February 2005. In March 2005 the majority of issues had been addressed and conversion progressed in earnest. Transition was completed before the end of March 2005. Medication costs for January and February 2005 were obtained from the hospital's financial system while medication costs for March, April and May 2005 were obtained from the Pharmacy. Delivered dose information for January through May was obtained from the Clinivision® system and used to calculate the average cost per delivered dose for January - May 2005.

RESULTS: The data gathered during the study is detailed in the table below.

Parameter 2003 2004 Jan/Feb 2005 Mar/May 2005
Med Costs $37,589 $45,678 $5,927 $3,981
Doses 64,551 71,665 11,899 19,017
Avg. Cost / Dose $0.58 $0.73 $0.50 $0.21

CONCLUSIONTransition of respiratory medications into a managed medication dispensing system appears to have resulted in a significant reduction in cost per delivered medication dose. We suspect that the Pyxis® system has allowed better control of medication and greatly reduced the waste associated with the loose system of medication management that was in place previous to the conversion. Delays in patient treatment have been experienced due to inadequate par levels in the Pyxis® but are decreasing in frequency as we develop more accurate usage patterns for each unit. Because the Pyxis® stations are unit based we have experienced delays in checking out medications due to competition with nursing for access.