Comprehensive workflow evaluation to improve medication distribution to the emergency department in an academic medical center

Melanie J Mills; Alec Martschenko; Keven Gomez; Madison L Hooker; Charlotte Pastoor; Tyler A Vest

doi:10.1093/ajhp/zxae084

Comprehensive workflow evaluation to improve medication distribution to the emergency department in an academic medical center

Am J Health Syst Pharm. 2024 Mar 25:zxae084. doi: 10.1093/ajhp/zxae084. Online ahead of print.

Authors

Melanie J Mills¹, Alec Martschenko², Keven Gomez³, Madison L Hooker⁴, Charlotte Pastoor⁴, Tyler A Vest⁵

Affiliations

¹ University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, USA.
² University of Maryland Medical Center; Baltimore, MD, USA.
³ Loma Linda University Health; Loma Linda, CA, USA.
⁴ Duke University Hospital; Durham, NC, USA.
⁵ University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC, and Duke University Health System; Durham, NC, USA.

PMID: 38527294
DOI: 10.1093/ajhp/zxae084

Abstract

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: The fast-paced environment of the emergency department (ED), with frequent admissions, discharges, and transfers, poses a challenge for pharmacy departments to effectively distribute and store medications. The purpose of this study is to propose a unique workflow of patient-specific medication delivery to the ED from a hospital pharmacy to reduce the number of missing medications resulting in medication messages and redispenses.

Methods: The medication delivery workflow proposed in this study consists of batching the preparation and distribution of patient-specific medications sent from the pharmacy to the ED in the 1 to 2 hours prior to their administration time. Chi-square analysis was completed to compare medication redispenses and "missing medication" messages before and after the intervention, with the significance level set at P < 0.05.

Results: The percentage of redispensed medications was effectively decreased following implementation of the workflow change from 21.6% to 9.2% (P < 0.001), with unit doses having the greatest reduction (25.8% vs 6.1%, P < 0.001). Benefits of this workflow change were also illustrated through a reduction in the percentage of missing-medication messages sent by nursing staff from 97.7% to 93.9% (P < 0.001).

Conclusion: This study showed that implementation of standard, hourly batches of medications dispensed from the pharmacy to the ED resulted in a significant reduction in the total percentage of redispensed medications and missing-medication messages. The overall reduction in redispensed medications as a result of this innovative workflow change not only benefited nursing and pharmacy staff but can reduce medication waste and improve patient care through timely administration of medications.

Keywords: emergency department; medication distribution; missing medications; pharmacy; redispenses; workflow evaluation.