Pros and cons of one-day dispensing for skilled nursing communities (2)
As a long-term care pharmacy, we are always looking for ways to improve medication management. In fact, we're currently piloting a new one-day dispensing program at three of our client communities.
As part of this pilot program, we deliver multi-dose strips that contain up to three medication orders per cell for next-day administration. This is a significant refinement of our unit-dose, seven-day dispense program for skilled nursing communities, which provides seven days of medication at a time – with only one medication order per cell.
Due to the success of the pilot, we plan to roll this program out to more client communities in February. However, the decision to move from seven-day to one-day dispense should be guided by several considerations, including those outlined below.
Pros of one-day dispense
- Eliminates the need for tray exchanges (a new strip of medications is sent every day).
- Faster med pass times because nurses open fewer cells.
- Potentially fewer medication errors (compared to seven-day dispense) because changes are made with the daily cycle.
- Better organized, smaller medication carts.
- Significantly reduced waste and labor costs because there is no need for strip medication returns.
Cons of one-day dispense
- Nurses must place one-day dispense strips in medication carts, which takes about five minutes per day.
- Due to the time it takes to prepare the cycle, discontinuation orders received after cutoff will not be reflected in the next day's multi-dose strip. The nurse will have to remove the discontinued dose from the cell; however each cell includes medication descriptions so that the nurse can easily identify which dose to remove.
- No additional stock is available for dropped or expectorated doses. (The nurse will have to replace these with doses from the convenience box.)
- With the one-day dispense system, controlled substances are not eligible to be placed in the strip and will be dispensed in bingo cards.
- There are typically no leftover medications to send home; however, your community can provide discharged patients with prescriptions instead (and also avoid paying for the medications they take at home).