Larksfield Place Transitions to Automated Medication Dispensing

by HCE Exchange on January 26, 2016

Reg-Hislop-thumb

As hospitals and other healthcare facilities rapidly change to meet new demands and implement technology, post-acute care and skilled nursing facilities have lagged, often because of legal and policy issues.

Larksfield Place, a not-for-profit Continuing Care Retirement Community, has implemented a major initiative to transform medication delivery.

President and Chief Executive Officer Reg Hislop came to Larksfield after heading a healthcare capital development group and previously serving as CEO of a large post-acute care system. Hislop said Larksfield’s culture has enabled him to form closer relationships with the employees and residents, and it has provided him with the opportunity to innovate.

“Small companies are wonderful for innovation,” he said. “I know my customers and what matters to them.”

Larksfield Place is an independent facility in South Central Kansas with a staff of about 300 and more than 400 residents. The campus has 22 free-standing villas, 170 independent-living apartments, 40 assisted-living apartments, 32 memory-support rooms, and 90 licensed nursing-care beds.

Implementing automated medication delivery

Over a year ago, Larksfield Place began an initiative to transition to automated medication dispensing using Pyxis.

Although hospitals have been using automated systems for more than a decade, in a long-term care facility, state and federal regulations support medication administration that is similar to how it would be for an individual living at home. This means patients individually receive and pay for 30-day supplies of medications, which are distributed to them by the nursing staff.

Larksfield partnered with Wesley Medical Center on the project, but had to spend about a year working with the state legislature to get approval to initiate the program. It is still considered a demonstration project, but the results so far are looking positive and may sway the legislature to change the laws.

“We have shared data with the state on two different occasions, and legislators have been impressed by how we have lived up to our claims of efficiency, safety, clinical improvements, and reduction in delays,” Hislop said. “Our initial goals have been more than substantiated.”

Improving efficiency through interconnectivity

The primary advantages of an automated system are its ability to rapidly change pharmacologic care and reduce waste.

“If a physician changed medication four times within a few days, patients aren’t getting four 30-day supplies,” Hislop said. “The only drug taken and charged is the one that was dispensed. We make sure the right medications are given at the right time at the proper dose and lowest cost.”

The pharmacy component is interconnected electronically with both Larksfield’s system and the Wesley system. This connectivity then allows Larksfield to link its laboratory with radiology.

“This means doctors can monitor their patients anywhere, write new orders, view lab results, change medications, and view radiology results all through the same access point or portal,” Hislop said. “Ultimately, we will use this same connection to provide our residents and families with access to their healthcare data, such as their prescriptions, their labs, their X-rays, and so on.”

Larksfield is also working with Wesley to establish a laboratory partnership.

Impacting outcomes and cost reductions

Hislop said Larksfield has already seen cost reductions through the program, and automated dispensing helps improve medication safety as well.

No specific medications are allocated to the patients, which eliminates redundancy, and medications are dispensed one at a time to individuals. Nurses search by category of drug rather than name, making it extremely difficult to give the wrong medication to the wrong patient.

In addition, Larksfield, in partnership with Wesley Medical Center, has two geriatric-certified pharmacists on site.

“Our pharmacists provide clinical integration,” Hislop said. “We are lucky to have these sharp young individuals. There are only about 4,000 geriatric-certified pharmacists in the country, and we have two.”

The program is showing great success so far, but it has been difficult to get all of the pieces in place between attaining legislative approval and changing the culture that has been embedded in the organization for more than 20 years.

Marrying technologies has also been a challenge.

Because Pyxis is a hospital-based system, it doesn’t integrate into any software systems for post-acute care, so Larksfield is working on managing the IT aspects. Furthermore, the organization plans to continue expanding its IT infrastructure to include e-prescribing and personal health records for patients in the coming years.

Hislop said healthcare must continue changing at all levels, and organizations need to come together to provide patient-centered care.

“The world has changed, and the call is for all of us to be more efficient, more patient-focused, and more specific in our outcomes,” he said. “We can’t do that in the silos healthcare has typically been in. We have to partner to solve bigger problems, which is what we have been working on here with Wesley Medical Center.”

-by Patricia Chaney

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