See how pharmacy automation can dramatically improve patient safety, trim medication inventory and more.

1. Case Study
At a Glance
Organization Cookeville Regional Medical Center
Cookeville Regional Medical Center
Cookeville, TN Patient Safety Thrives in Rural Tennessee Hospital
following Pharmacy Automation Conversion
Solution Spotlight
– Horizon Meds Manager™
– PakPlus-Rx® Overview facility serves 14 counties in the
Community growth fueled the rise of heart of the Upper Cumberland
– ROBOT-Rx® region in middle Tennessee. The
a small, country hospital into a
– MedCarousel® regional medical center. When an hospital is a publicly owned facility.
admittedly reluctant pharmacy The Board of Trustees is appointed
turned to automation solutions, the by Cookeville city government.
Critical Issues
results were significant increases in
– Reduce the risk of medication Cookeville Regional Medical Center
patient safety, productivity, and cost
errors scored in the top 25 percent of
containment—an outcome that paid
hospitals nationwide in patient
– Position for bar-code point-of- back the investment in less than two
satisfaction for 2005 and 2006 for
care administration and years.
both Inpatient Services and
computerized physician order
Emergency Services.
entry systems Challenges
– Reduce labor-intensive cart fill When Opless Walker was hired as The hospital continues to grow
and first dose operations Cookeville General Hospital’s first today. The hospital is in the midst of
pharmacist in 1971, the small, an $80 million expansion to
– Improve efficiency in a tight
country hospital had just 19 doctors accommodate a 10-15 percent
labor market
and less than 50 beds. For several annual patient census growth.
– Contain increasing costs years afterward, he and one Furthermore, because Cookeville is
technician performed all pharmacy consistently named one of America's
duties and were on 24-hour 10 most popular retirement
Results
emergency call every day. destinations, the hospital's patient
– Improved medication dispensing acuity rate steadily trends higher.
accuracy to 99.9% As the community grew, so did the
– Avoided a projected 215 hospital, the pharmacy staff, and its Despite this advancement, however,
potential ADEs annually, saving responsibilities. In just over a medication distribution hadn’t
more than $1 million generation, Cookeville Regional changed much since Op Walker
Medical Center became a modern, founded the hospital’s pharmacy
– Cut missing medications by 37%
thriving 247-bed regional referral practice. The pharmacy staff—nine
– Reduced cart fill labor by 44% center with access to the most pharmacists, 12 full-time and 13 part-
– Improved cabinet fill labor by advanced treatment options in the time pharmacy technicians—
82% world. continued to pick, pack, check, stock,
and conduct medication inventory by
– Accelerated medication picking
Cookeville Regional provides hand. Scheduled medications were
time by 60%
inpatient, outpatient, rehabilitation distributed via a 24-hour cart fill. First
– Trimmed medication inventory and emergency care in addition to a doses were dispensed by pharmacy or
costs by 20% host of specialty services such as The retrieved by nurses from one of 17
– Projected ROI of 136% percent Heart Center and The Cancer Center. unit-based medication cabinets. The
over five years With more than 140 physicians average daily dispensing volume was
providing care in 36 specialties, the 2,500 doses.

2. “Up until 2001, I was not sold on mirror. Patient safety is an issue
automation,” explained Walker, facing you and your family every day.
Cookeville Regional’s pharmacy If you or a loved one gets ill or
director. “I believed a human being injured, they’re coming here. Don’t
trained as a pharmacist or technician, you want them to have the best care
and with the proper check systems in possible?’”
place, could be expected to do a
good job and put out a quality The board unanimously approved a
product error free.” sweeping, three-phase
modernization initiative impacting
Yet, the system proved unproductive all areas of the medication-use
and fraught with potential failure process. The first phase, launched in
points. Pharmacists spent significant 2006, focused on central pharmacy
time on repetitious order entry, and automation, and included:
“I told the board, ‘Take a good dispensing, checking, and
distributing medications. There was • Horizon Meds Manager™ (HMM)
look in the mirror. Patient safety little time available for clinical pharmacy information system. All
is an issue facing you and your activities. Similarly, the nursing units pharmacy orders are processed
also followed manual medication through this system. HMM also
family every day. If you or a dispensing processes. The integrates with Connect-Rx®, the
management team believed its database and workflow platform
loved one gets ill or injured, manual-based pharmacy processes that powers pharmacy
they’re coming here. Don’t you were contributing to potential automation.
medication errors due to misfills, as
want them to have the best care well as controlling medication • PakPlus-Rx® packaging service.
inventory in the pharmacy and at The onsite packaging service
possible?’” medication-dispensing cabinets. ensures a continuous supply of
bar-coded medications is always
Opless Walker, Pharm.D. For instance, pharmacist checks of available. Also, because all
overnight cart fill picks revealed as medications are bar coded, it
Director of Pharmacy many as 35 picking errors each shift. provides an inherent double
While uncovered errors were check, helping to prevent
corrected prior to leaving the dispensing errors from occurring
pharmacy, it underscored larger before they ever have a chance to
challenges within the hospital’s happen.
medication-use cycle.
• ROBOT-Rx® system. The robot
Answers automates medication storage,
First-hand research about pharmacy dispensing, returning, restocking,
automation changed Walker’s mind. and crediting functions for about
“I’ve totally turned around,” he said. 450 of the hospital’s most
“I’m sold on automation because it commonly used medications.
potentially eliminates virtually all Technicians operate the robot and
human error factors.” pharmacists perform a 10 percent
random check. The system
While Walker recognized the value dispenses about 2,200 doses as
of bar-code automation technology part of the cart fill. Medications
with regards to medication safety, are dispensed into patient-specific,
workforce productivity, and cost bar-coded envelopes. The robot
containment, he needed to convince also dispenses most first doses.
the administration and the board of Overall, ROBOT-Rx accounts for
the city-owned hospital. approximately 92 percent of all
medications dispensed by the
Walker presented his research pharmacy.
findings—including a detailed
workflow study, cost-benefit analysis, • MedCarousel® system. Technicians
and site visit results. “My priority is use MedCarousel to pick
patient care,” said Walker. “I told medications for cabinet filling and
the board, ‘Take a good look in the for some first doses. The rotating

3. shelves, bar-coding, and pick-to- Financial Performance
light technology improve picking “The pharmacy automation pays for
accuracy and speed. The high- itself in several key ways: reduced
powered inventory management inventory, reduced potential
software improves inventory turns litigation, and reduced patient
and reduces medication costs. stays,” Walker said. “After all is said
and done, our net income is very
Nurses retrieve some first doses, as good.” The hospital is on pace to
well as PRN and floorstock realize a payback period of 1.8 years,
medications from 17 previously and a return on investment of 136.5
installed unit-based cabinets. The percent over five years. Other results
cabinets also interface with a include:
controlled substances software for
narcotics. Said Walker, “We’re • Trimmed medication inventory
getting a lot less calls from nursing. costs by 20 percent. “One of these days, I’m going to
Nurses are reporting far fewer • Projected savings of $18,000 per
missing or incorrect medications.” retire. When I walk out of this
year by buying medications in bulk
form. institution, I want to be able to
Results • Experienced a first-year cost
Despite continued patient census avoidance of $11,200 from look back and know that I left it
growth, central pharmacy reduced expired medications. a safer place. With pharmacy
automation has dramatically
improved medication safety, Additionally, Cookeville Regional has automation, I have that peace of
productivity, and cost containment, established the foundation for the
according to Walker. next two phases of its closed-loop mind.”
solution: bar-code point-of-care
Medication Safety administration and computerized Opless Walker, Pharm.D.
“We’ve gone from 35 nightly cart fill physician order entry systems.
picking errors to zero,” Walker said. Director of Pharmacy
“We also increased our clinical Conclusion
pharmacy practice. The result is While the tangible outcomes are
prevention of approximately 215 significant, Walker believes that the
adverse drug events (ADEs) per year, hospital also is benefiting from a
saving our hospital a projected fundamental shift in public
$1,010,500, based on FDA estimates perception with regards to
for ADEs.” Other results include: medication safety. As a taxpayer-
funded facility, the hospital's
• Improved medication dispensing pharmacy automation project
via ROBOT-Rx to 99.9 percent required public approval. It was a
accuracy. highly visible issue that generated
• Cut medication picking and much publicity and anticipation.
restocking errors by 80 percent
through MedCarousel. “Patients, physicians, staff,
• Reduced the number of missing administration, and board members
medications by 37 percent. all have seen the highly visible,
fundamental changes we
Workforce productivity accomplished through pharmacy
Pharmacy automation led to automation,” said Walker. “The
dramatic productivity increases, medical staff and nurses now see
Walker said, including: pharmacists making a difference in
the patient care areas, and the
• Reduced cart fill time by 44 pharmacists feel more a part of the
percent. healthcare delivery team.” For
• Improved cabinet fill time by 82 instance, clinical pharmacists carry
percent. PDAs with them during rounds and
• Speeded the medication picking use them to access pharmacological
process by 60 percent. references when consulting with
physicians.

4. Walker continued, “The impact has Approaching all pharmacy
been profound. There is a much automation and clinical systems
higher degree of medication safety workflow with a more holistic view
awareness, and the perception is allows the hospital to drive best
that Cookeville Regional is among practices, ensure optimal process
the most quality-conscious hospitals change, enhance communications,
in Tennessee.” and enable the best care
possible. On a more practical level,
A critical component to the current this systems approach means:
and future success at Cookeville
Regional is following a systems • One system backbone to use and
approach when it comes to maintain
technology. Very few companies can • One interface to install
provide organizations with • One support desk to call
everything they need. But at • Solutions that grow together
Cookeville Regional, experience has
shown that working with a single- As Cookeville Regional advanced
source company can enhance the from Phase I to Phase II and Phase III,
functionality of each individual the transition will be much easier
product because of inherent because of this single-source
integration benefits. company approach.
McKesson Automation Solutions
500 Cranberry Woods Drive
Cranberry Township, PA 16066
724.741.8000
www.mckesson.com
Copyright© 2008 McKesson Corporation and/or one of its subsidiaries. All rights reserved. All product or
company names mentioned may be trademarks, service marks or registered trademarks of their respective
companies. AUTO 150_6/08