The Role of Material Movement in Medication Management: An In-Depth Look

Medication Management

Last fall Swisslog Healthcare announced a strategic business shift. Our business centers around transforming workflows determining how healthcare is delivered in modern hospitals.

By combining our thought leadership in transport automation with advancements in pharmacy automation, Swisslog Healthcare is at the forefront of automation technology. Healthcare providers can leverage our suite of powerful efficiency-creating solutions to integrate automation, professional services, and intelligent software in holistic ways.

Material transport is the key to attaining our objectives connecting the supply chain in busy hospitals:

• Improve patient outcomes by creating better handling of materials and workflow experiences for users.
• Increase awareness and accountability assisting with hospital expense management.

The Business of Logistics

Sound material handling and logistics play a critical role in the success of a business, encompassing activities that facilitate movement of necessary goods and the coordination of supply and demand in accomplishing objectives.

A 1977 Harvard Business Review article titled Logistics – Essential to Strategy discussed how logistics creates both short and long-term implications for business. While hospitals are squarely in the health domain, business strategy provides the operations framework for modern healthcare facilities. The value of well-planned logistics is not limited to manufacturing or eCommerce but rather is applicable across almost every industry.

Perhaps more so now than ever, material transport elevates in importance as providers brace for the impending Silver Tsunami of senior patients, where an estimated 25% of the American population will be 65 or older within the next ten years. This demographic represents a segment living longer due to advances in technology and experiencing more chronic and comorbid illnesses requiring complex treatment plans. 

Also timely to this discussion is the limitation of available workers that may be unplanned and rather sudden. During normal business operations material handling may be manageable. What happens when staffing is short due to a work stoppage or a pandemic? An already strained healthcare system will be further stressed to deliver their normal service levels. Reliable, feature-rich support systems are essential.

Material Movement in Hospitals

Patients Feel the Effects

Why are logistics so important for hospitals? Patient census and condition complexity are factors. So are disruptive alternatives emerging to create competitive pressures, increasing healthcare consumerism, and hospital pursuit of high patient satisfaction scores in order to realize maximum reimbursement rates. In the face of these and other factors, facility administrators must ask, “What levels of service do our patients expect?” “How can we improve the patient’s experience while they are in our facility?” and “What do our competitors provide?”

One surprising answer may present an effective lever in terms of differentiation – logistics. And it’s a great place to apply lean methodology in search of improvement opportunities that could increase value to patients.

“Logistics are virtually a hospital’s most important support discipline. Timely movement of specified or necessary items ensures contingent downstream processes can take place. If movement is not timely, is delayed, misdirected, or incorrect the result is process delays and reduction of hospital efficiency,” says D. Eng. Sebastian Wibbeling, Head of Health Care Logistics at the Fraunhofer Institute for Material Flow and Logistics in Germany.

Efficient hospital logistics can support healthcare and medical processes in the best way possible, enabling optimal and safe patient treatment.

Applying Creative Thinking to a Practical System

Edward de Bono, a physician, psychologist, and author, pioneered lateral or creative thinking as an effective tool for fostering innovation and developing business strategy. If we approach hospital logistics following de Bono’s model, we might change the dimension in which we look at moving clinical goods and pathological material within hospital ecosystems.

Hospitals are unlikely to intentionally under-commission a pneumatic tube system (PTS), yet the result can still be seen – often stemming from poorly informed specifications lacking context. Reliability, scalability, and user expectations may inadvertently be undervalued, yet have lasting impact on systems where primary components have a lifespan of 20, 30 or more years.

Implementing a PTS to facilitate hospital logistics requires deep understanding of hospital operations requirements, clinical goals, current workflow patterns, understanding of anticipated areas of change or expansion, and many other factors influencing system performance in short term and over time.

Hospitals don’t have to navigate this alone. Our construction sales team consults with commercial architects, engineers, design firms, contractors and hospital administrators to understand relevant nuances that have material effect on transport system installation and performance.

A customer told us “We're going to move the pharmacy from the third floor down into the basement 300 feet further away.” When I say 300 feet, that's non-linear distance. The customer thought, “It's just a simple departmental relocation. Nothing changes with the PTS.”

We advised, “If you do that, here's what's going to happen to the carrier send rate if modifications aren't made to the system to accommodate the change. Is this okay?”

"When hospital facility staff and administrators are given context for the length of time it could take for things to get in and out of the pharmacy at the intended new location compared to its current location, they immediately understand the downstream impact on staff and patient care." 

-- Paul Ristuccia, Senior System Design Analyst, System Design and Simulation

Scaling Material Transport

At the core, good logistics is when a required item moves from a point of origin to a point of demand. Straightforward, right? In a small hospital or in a pinch, a person can quickly run some blood products from the blood bank over to the Emergency Department.

Yet those situations leave much to chance, creating operational waste. What other tasks might that person be suitable to complete during that transit time? If those tasks add greater value to patients or better align value with costs, waste is created. If a person transporting items is distracted or interrupted en route, the potential for waste exists in the form of time delay, spoilage, attention diversion, or even medication errors. The manual movement of materials also adds to the cost and usage of other building systems such as elevators.

The existence of staff does not necessarily mean it’s appropriate to deploy manual material handling for logistics purposes.

Effective Utilization of Resources

A large university hospital in a major metropolitan city exclusively using personnel to transport blood products, specimens, medications, and other material around the hospital ecosystem may invest over 1,600 FTE hours a day on transit. Extrapolated over a year, that’s 584,000 hours; if all hours worked are by a nurse earing $30/hr., the unloaded expense to the hospital is $17,520,000. That expense is not insignificant and doesn’t factor the impact on the employee’s morale. Taking a clinician away from the thing they love to do, care for patients, can be frustrating and demoralizing to their work attitude.

In contrast, the same large university hospital could have enlisted Swisslog Healthcare to consult on a design for a pneumatic tube system built to specifications matching the hospital’s unique workflow needs, turn-around-time expectations (TAT), and other established KPI’s.

Now, a large hospital is likely to use a PTS rather than manual transport. But the scenario provokes thought.

Let’s take another look. A study published in the spring of 2013 in the IOSR Journal of Business and Management titled "Innovative Methods to Improve Hospital Efficiency - Study of Pneumatic Transport Systems (PTS) in Healthcare" found a savings of manpower and 94.6 minutes for the total completion of sample transportation and results publication. Study authors Drs. Drun, Sudhakar, and Somu conclude: "...pneumatic transport systems are a valuable alternative to human-based transportation. There is a reduction in manpower usage, faster and safer transport of samples [when PTS is used] over human-based transport."

Human-based transport (HBT), however well-intentioned, create opportunities for material misdirection, mishandling, spoilage or waste. Items transported manually are frequently “batched” to cut down on repeat trips, however this results in a lot of work-in-progress and can lead to backups in the lab delaying resulting and further delays in patient care. Specimens are difficult to track when hand-carried, leading to calls to follow up on status or pinpoint location. Further, automated transport decreases repetitive motion disorders and increases the quality of experience of staff.

Another example of the flaws in manual material handling is an example experienced years ago. One of our employees was meeting with a hospital about installing a PTS in the existing facility. The executive in charge of the decision was adamant the manual movement of lab specimens and medications was working just fine, and that no PTS was planned to be installed. Prior to leaving the hospital our Swisslog employee stopped to use the restroom. In the restroom a patient’s medication was found sitting on a urinal! The person handling the movement of the medication had stopped to use the restroom on their way to make their delivery and inadvertently left the medication in the restroom. This was many years ago, but can you imagine the HIPAA violation this could create today? Or as the patient, how happy would you be taking an oral medication knowing where it had made a brief stop? Ultimately this single example was enough to change the hospital executive in charge’s decision and a PTS was installed.

The Role Played by Pneumatic Tube Systems in Connecting the Supply Chain

In the value stream of delivering medical care, the interconnected activities beginning with patient hospital visit and ultimately concluding with clinical action, automated transport facilitates many of the touchpoints.

Nursing

Nurses use PTS systems throughout their shifts, every day. When asked, they can quickly describe the value automated transport provides, both direct and indirect. Certain features and functionality can also have a significant impact on their work experience and outlook.

Nursing and Pharmacy staff appreciate our Nexus station for TransLogic PTS because it allows distribution of material of up to 5 carriers at one time. Carriers can be directed to one or multiple receiving stations. This means nurses can dispatch pathology specimens for two patients to the lab in two carriers, receive medications from the pharmacy in another carrier, and send or receive materials from the remaining two openings in the 5-carrier turnstile housed inside the station. These activities can happen in one event to make the best use of a nurse’s time through time-boxing or can take place as needed.

The Central Pharmacy

Pharmacy personnel must perform precise work in a fluid environment where they face constant interruptions and distractions, often distinctly separate from their original task. Safe medication order review, prep, and delivery is difficult to manage under the pressures of various electronic alerts, environmental stimuli, questions from people by phone and in person, and a host of other variables. Returning complete focus to the original task can take as much as 20 minutes.

One 2003 study found hospital pharmacists fielded as many as 10 calls per hour, and 25% of all phone calls to the hospital pharmacy were related to missing medications. A 2010 study found 12% of pharmacist interruptions and distractions were directed related to missing dose inquiries.

Amid the frenetic pace experienced by nursing and pharmacy personnel, the reliability and transparency delivered by TransLogic PTS with stations featuring advanced carrier tracking and security options provide both sending and receiving staff with confidence of carrier delivery and authorized receipt.

Impacting productivity, costs, and patient satisfaction, carrier tracking and verification reduces staff diversion from their core responsibilities. Nurses are apprised of the status of carriers containing medications in real-time so they can administer without delay. Duplicate orders may also be mitigated, lowering the cost of re-dispense and waste from excess inventory subject to expiration.

The Central Laboratory

A lab’s function is often key to an early diagnosis. The earlier diagnosis may lead to less invasive care via preventative strategies, and lay groundwork for faster recovery and earlier detection. Clinical laboratory tests guide more than 70% of all medical decisions made by physicians, allowing diagnosis and treatment to be immediate, precise and targeted for greater efficiency to patient and hospital.

More than 7 billion lab tests are performed in the United States each year, according to the American Clinical Laboratory Association. The increase in test volume drives the need for higher workflow efficiencies. Again applying lean concepts to healthcare operations, its evident pneumatic tube systems streamline the traffic of specimens presented for testing and reduce demand on nursing staff to choose between their primary tasks with direct patient care and transporting specimens to the lab.

A 2008 article in the Pennsylvania Patient Safety Advisory titled Pneumatic Tubes: A Possible Patient Safety Vacuum? endorses the deployment of PTS :

"...the need to rapidly collect and transport physical materials for examination and diagnosis exists. Examples of these materials include specimens obtained for laboratory testing. An efficient, rapid, and secure means of transporting various items such as blood and tissue samples, drugs, radiographs, and documents throughout the facility can be lifesaving.

Pneumatic tube systems (PTS) allow fast and reliable transport of medical material. There are numerous advantages in using a PTS, perhaps the most important among them being improved turnaround time for transported items. Others include the reduced risk of contamination, loss, or error by eliminating some human factors, assuming that the specimens are prepared accordingly and transported in the correct containers."

From the procurement of specimen samples to the final delivery of test results, critical pathways can be enhanced by making improvements to meet the time-sensitive workflows and operational needs of this essential department.  

A delay in getting a specimen to the lab can lead to test invalidation due to an expired specimen and require another specimen be collected or a delay in treatment based on the findings of a test result. The outcome can be impacted anywhere from a minor inconvenience to the patient by being delayed to something much more severe. 

A potential stroke patient being tested and subsequently treated (if confirmed) has a ticking clock; every minute the diagnosis and medication is delayed can result in irreversible damage to the patient’s brain. In this example speed isn’t a convenience, it is a direct factor in the patient’s outcome.

Blood Bank

Just as codes of employee conduct vary from company to company, policies vary from hospital to hospital regarding use of the PTS.

While some facilities opt to move blood products manually, research shows the restriction isn’t clinically necessary; blood can travel safely via PTS.

According to an article in the October 2012 issue of Biochemia Medica (journal volume 23, June issue 2), no effects are seen in blood samples transported from the point of collection to the hospital laboratory by pneumatic tube system. In a comparison of blood samples in a test, blood cell counts, erythrocyte sedimentation, PT and aPTT test results are the same between samples transported manually and those issued by PTS.

Maintaining PTS Performance and Availability

Systems of all configurations and ages benefit from routine evaluation. Proactive measures can add life to a system, maximize uptime, and boost performance by replacing worn parts, calibrating sensitive electronics, testing and adjusting components, and a host of other measures. This approach reduces overall system cost over time and frees facilities staff to concentrate energies in other areas.

A preventative maintenance agreement (PMA) provides assurances the logistics system, essential to hospital operations, is well-maintained by trained service engineers, Swisslog Healthcare employees (not contractors). Our field technicians are generally located within 2-hour driving distance from customer facilities to be readily available to perform proactive as well as reactive service if the need arises.

Creating a New Normal when Crisis Hits

The hospital as a system is only maintained by the many invisible processes running in the background. Efficient planning, management, and optimization of these flows – a logistics stream and supply chain – is as important to a hospital as it is in other industries.

Appreciation for efficiencies may be renewed when circumstances place new or increased demand on limited resources. In the current COVID-19 pandemic where clinicians and staff availability is at a premium, manual and repetitive processes threaten patient service levels.

One Swisslog Healthcare customer, a large university hospital, recognized the importance of minimizing exposure and cross-contamination risks among staff. The central pharmacy typically manually transports high cost and specific classes of drugs (in accordance with applicable laws) prescribed to patients by physicians. Charged with reducing person-to-person contact, the pharmacy director modified policy to better address social distancing requirements during the crisis. The Secure Send feature of our Nexus station for TransLogic tube systems enables pharmacy technicians use the control panel security features to restrict access to carriers exclusively to authorized users assigned a PIN code and/or card access badge. In combination with an alert and messaging system, nurses are empowered to promptly access critical medications upon delivery from the pharmacy.

Chain of Custody Technologies

Available chain-of-custody features include WhoTube, our secure-access technology for PTS station doors. WhoTube works with hospital personnel ID badges to release carriers into the PTS station bin and unlock station access doors.

Another feature available is RFID technology monitoring carrier tracking and inventory management. Sensors placed throughout the tube system, interchanges, and stations register RFID chips embedded in carriers. Users receive real-time notifications when materials arrive at the intended station.

In situations where cross-contamination is a concern, the RFID technology enables segregation of carriers by group or individual. Color-coded carriers can be mapped to operational processes or select departmental use. With RFID, facilities gain a complete overview of the location, quantity, and availability of all materials deployed within the PTS system.

When staffing is less-than-ideal as the healthcare field is experiencing with coronavirus, the utility of PTS is even more evident.

Optimize PTS with Advocates

Pneumatic tube systems were introduced in hospitals by Swisslog Healthcare almost 100-years ago. We continually work to improve the utility and functionality of this engineering keystone managed by the facilities department; an essential resource used by every department in a hospital.

System Design and Simulation

In a recent interview, Swisslog Healthcare Senior System Design Analyst Paul Ristuccia explained how the System Design and Simulation team helps existing and prospective customers plan and optimize PTS to suit the specific criteria of each hospital’s stakeholder user groups.

“We develop different approaches to building a PTS design that meets the needs of the facility, gives them growth for the future as they add services or increase the usage demand on the system. To validate our recommendations, we draw on our vast installation base to attach performance criteria to a particular design and simulate it to determine how well it meets the expectations of users.”

Blending data with situational understanding and experience, the team can anticipate PTS usage to and from the pharmacy to make recommendations adding utility or longevity to a system. No other company can offer hospitals the consultative depth we offer our PTS customers.

Concierge Support through Customer Success

Just because something works doesn’t mean it can’t work better.

It’s not uncommon to grow accustomed to processes; routine provides structure necessary to execute faster. But we may miss opportunities to optimize performance because we simply fail to break down the processes and workflows to examine for where our work provides the most value to patients and where waste is generated.

Operational waste comes in several forms identified in literature discussing lean principles. Swisslog Healthcare recognizes our customers benefit from our expertise in mapping efficient workflows. We staff a full Customer Success team of professionals who help them realize more out of their PTS systems through workflow optimization, implementation of various options, re-engineering configurations, and other strategies so hospitals gain the most utility out of their PTS systems.

Improving Workflows and Services Impacting the Well-Being of Patients

Inefficient and inadequate intra-facility material movement increases costs on human resources and healthcare delivery. Inadequate systems introduce risks and consequently reduce the quality of patient care.

Swisslog Healthcare helps hospitals save time and resources so greater investments can be made in the caregivers helping patients get well again.

The healthcare landscape is changing, and so are we.