Hospital Storage and Security

Hospitals are busy and crowded places, filled to the brim with staff, patients and all of the necessary items to treat those patients. The storage and security of supplies and medication is of utmost importance in the military hospital setting.

by Kelly Fodel, MMT Correspondent

Hospitals are busy and crowded places, filled to the brim with staff, patients and all of the necessary items to treat those patients. The storage and security of supplies and medication is of utmost importance in the military hospital setting. Military Medical Technology is taking a broad look at some of the industry’s best ways to organize and secure medical supplies.

Each year, 41,000 patients pass through the emergency room at Fort Belvoir’s DeWitt Army Community Hospital. “It is a pretty busy department,” said Master Sergeant Roger Thompson, NCIC of the Emergency Medical Department.

Thompson said he is most concerned with security and limiting access to his department’s supplies and medications, “since we have a large number of people, like patients and the cleaning service, flowing through the emergency room. We are concerned about intrusion. The storage has to be able to prevent [theft].”

At the same time, staff members require easy access to items. The organization of large amounts of inventory in a limited space must also be considered when selecting cabinetry. “It has to be user-friendly… [we determine] if you are able to access the product without too much difficulty,” said Thompson.

Hospitals cannot consider secure storage without addressing medication. The pharmacy is a key area for secure cabinetry. Secure storage will help eliminate error, prevent staff abuse and ensure patient safety. At DeWitt Army Community Hospital, “we do roughly 1,800 to 2,000 prescriptions per day, so we are a large volume pharmacy,” said Major Lela King, chief of the Pharmacy Department. “You like to have the medications as close to the provider and the patient as possible so you have very convenient care. But at the same time, you have to make sure the appropriate things are in place so that they are safely put through.”

King said DeWitt Army Community Hospital places high value on security and safety and therefore requires any drug storage cabinet to be connected to the hospital’s automated electronic medical record. This ensures that the correct person is accessing the drug and, most importantly, that the correct patient is receiving the correct medication.

“Our facility uses the Omnicell cabinet. It is not just for security but also the safe administration to the patient,” King said. “What we look for in a cabinet is that it has unique security features that identify the unique individual that is accessing the cabinet. It is restricted only to those people who should access the medication. We look for a security feature that cannot be compromised.”

CONTROLLED SUBSTANCE CABINETS

Drug supply is an essential component of health care systems; some claim it accounts for up to 30 percent of health care costs. Unfortunately, drug theft or drug diversion now ranks among the top concerns of health care institutions because it puts patients at risk and drains operating budgets. It is a growing problem in the health care industry, causing regulatory investigation, fines and criminal activity within hospitals and health care facilities.

“Controlled substances are a big deal, because obviously we use a lot of controlled substances in a medical environment. But there are a lot of federal regulations and state laws that determine how we handle, and the accountability we have to have, with controlled substances,” said King.

The Comprehensive Drug Abuse Prevention and Control Act of 1970 created a closed system of distribution for those authorized to handle controlled substances. The law requires registration of all those authorized to handle controlled substances with the DEA. Complete and accurate inventories and records of all transactions involving controlled substances are also mandatory, as well as security for the storage of these narcotics. Controlled substances must be stored in a secure cabinet or vault, and the use history must be reviewable to detect unauthorized or questionable access.

“It is so we know exactly who [accessed the medication], and at what time, and how much of the medication was withdrawn,” King said.

There are a variety of narcotic cabinets on the market today. Omnicell, the choice of DeWitt Army Community Hospital, is marketing medication-dispensing cabinets, which are available in a wide variety of hardware and software configurations. Options include touch-screen software, magnetic card readers, and guiding light technology to help caregivers access medications quickly and easily. Some cabinets also use bar code scanning to confirm the identity of medication for restock.

Omnicell also produces the SecureVault system, which uses software and automated dispensing to track, monitor and control the movement of controlled substances from a central vault to other locations. This is particularly helpful during drug restocking and provides an audit trail for discrepancy resolution. SecureVault also integrates barcode technology to improve accuracy and speed.

Omnimed, which is not to be confused with Omnicell, features a single door, stainless steel Deluxe Narcotic Cabinet with an audit control high security electronic lock. The lock can control access with either an electronic key or a four-digit code. The high security platform has a dead latch and audit trail, tracing user access to the cabinet. Locks can be programmed for up to 500 individual users.

INVENTORY MANAGEMENT

DeWitt Army Community Hospital also uses Omnicell cabinetry for organizing and accessing other hospital supplies, which may include anything from gauze strips to patient gowns. “Once we identify the patient [in the system], we are able to take out the needed products for that particular patient,” Thompson said.

Maximizing space and improving accessibility is the goal of Spacesaver’s FrameWRX storage system, which was launched in October 2007. This modular system can be configured in any number of ways to give a health care facility endless options for supply storage. FrameWRX uses multi-colored plastic shelves and bins that can be rearranged on demand, without the hassles of tools or fasteners. This is ideal for hospitals that need to change their storage systems easily and quickly.

“Hospitals are always out of space, and they never have enough space, and they have tons of stuff,” said Jason Freeman, Director of Healthcare at Spacesaver Corporation. “The reason people are buying [FrameWRX] is because it maximizes storage. Hospitals have a ton of bins with items like catheters and tracheostomy tubes and straws. They need a good way to organize one-unit items that are clumsy and hard to store.”

Stainless steel carts are the niche product of Blickman, which provides a host of medical supply components for hospitals. The cart features temperature-controlled warming cabinets with glass doors, digital controls and dual compartments. Smooth-rolling case carts can be customized with extra locks and handles. Blickman’s variety of carts and cabinets are constructed from 18-gauge stainless steel with a seamless welded face to prevent dirt collection and resist corrosion.

At the supply and support level, many options exist for cataloging and securing inventory. InnerSpace has launched System 100 as its latest advancement in clinical supply management. System 100 uses embedded Radio Frequency Identification (RFID) technology and biometric security access to inventory high-cost clinical supplies in hospitals. System 100 features an intelligent rolling cart, which is plugged in and connected to the hospital’s network. The facility applies RFID tags and places its high-cost clinical devices in the cart. There are no buttons to push or additional processes to follow, so staff compliance is not an issue. System 100 constantly tracks and monitors cart access and supply movement, and inventory levels are automatically adjusted as supplies are removed from or added to the cart.

POINT-OF-CARE SOLUTIONS

Hospitals are focusing on acquiring “point of need storage” at the point of care as a way to improve efficiency, reduce errors and enhance patient safety. Thanks to the well-publicized shortage of nurses and a large amount of inventory scattered across the hospital, some studies have shown that hospital employees spend a large amount of time “hunting and gathering” supplies. This is time that could be better spent tending to patient needs. “Point of care” storage is a reasonable solution to this issue.

“What we do is provide point of need storage for the nurse or health care practitioner, so they can spend more time with the patient,” said Spacesaver’s Freeman.

Spacesaver’s new Server cabinets are engineered to provide supply storage directly in the patient’s room. This greatly increases efficiency, providing staff with convenient access to necessary supplies. The cabinet is stocked from outside of the room, with supplies being pushed inside. Spacesaver estimates that this cabinet holds about 85 percent of the items a nurse would need at the patient’s bedside. Spacesaver also claims that it helps reduce hospital-acquired infections by limiting traffic into patient rooms.

From an information technology standpoint, many hospitals are turning to compact storage carts that can be wheeled from room to room, for point of need access to electronic patient records. Omnicell has produced mobile cart systems that feature a compact footprint and all-in-one computer that uses wireless technology. These carts travel with the nursing staff from room to room and are used to update patient records on an electronic chart. The cart can serve as a stand-alone mobile computer, and also as a medication cart with lockable drawers. The drawer system logs user access and can limit access by certain users.

McKesson markets the AcuDose-Rx as a point of care solution. This automated cabinet can dispense narcotics and other medications in all patient care units, specialty care areas, outpatient clinics and in the operating room. McKesson claims that the cabinet reduces medication errors by more than 70 percent and nearly eliminates missed dosages. Medications are stored in separate drawers in the cabinet, and AcuDose-Rx only allows the correct medicine and dosage to be released after the nurse enters the correct patient information.

LOOKING TO THE FUTURE

Looking to the future, it should be remembered that different health care facilities feature varying levels of technology, dependent on budget, and all have their own unique needs. At DeWitt Army Community Hospital, facility leaders are hoping to upgrade to a barcode system in the pharmacy to improve accuracy and safety. The Emergency Department also plans to one day incorporate a modular system for narcotics in ambulances to prevent accidental misplacement or theft of medication. This modular system would be a contained, audited system that can be removed from the ambulance and transported to the pharmacy for restocking.

King noted that storage systems are ever-evolving, as are the hospitals that implement these tools. “As we move forward in developing state-of-the-art medical facilities, those safetydriven and space-saving technologies will be seen more and more.” ♦