The Southeast Missouri Mental Health Center (SMMHC) boasts a rich history dating back to its establishment in 1899 as State Hospital No. 4. Welcoming its inaugural seven patients in early 1903, the institution quickly evolved into a community accommodating over 1,000 patients during the tumultuous decades of the 1930s and 1940s. Within its expansive campus, amenities flourished, encompassing a diverse array of facilities such as a barber shop, drug store, post office, bowling alley, cannery, dairy, greenhouse, mattress factory, pool, power plant, and even a graveyard. Over the years, the institution implemented prevailing psychiatric treatments of the era, ranging from hydrotherapy in the 1920s to the controversial practices of lobotomies and electro-shock therapy in the 1940s. However, with the advent of pioneering advancements in mental health treatments and programs during the 1960s, the center witnessed a gradual decline in its population as patients increasingly benefited from more humane and effective care approaches.
“We couldn’t have asked for better results – both from cost savings and staff satisfaction,” said Gabel. “In fact, our surveys show a 94% satisfaction rate from the nurses both on ease of use and time savings. The impact has been far-reaching!”
The hospital underwent a significant transformation in 1987 when it was rebranded as the Southeast Missouri Mental Health Center. Presently, it comprises two distinct facilities – APS (Acute Psychiatric Services) and the Sex Offender Rehabilitation and Treatment Services program (SORTS) – positioned approximately 200 yards apart. As a state-funded inpatient facility, it has over 300 beds, catering primarily to patients who have spent a considerable portion of their lives institutionalized, with an average length of stay exceeding 10 years.
Within its pharmacy division, the center manages a substantial load of 7,000 active orders, processing 15,000 patient specific multi-dose bags per week, with a significant portion of patients requiring the administration of 15 to 20 doses of medications daily. However, the physical limitations of their outdated and cramped space posed considerable challenges to their operational efficiency. Additionally, the demanding nature of caring for their patient demographic took its toll on the nursing staff. Manufacturer supplied unit dosed medication posed tremendous burden on nursing’s ability to administer medications efficiently. Popping open hundreds of manufacturer’s supplied unit dose foil packs per med pass caused tremendous strain on the nurse’s hands – many complaining of sore, cracked, and chapped hands along with employees developing Carpel Tunnel Syndrome. Despite a very efficient EHR and barcode scanning, getting medication out of their unit dose packaging held up the workflow of administering such large quantities of medications.
Before the pharmacy refresh
Recognizing the need to address nursing satisfaction issues and streamline operational processes, the center embarked on a strategic initiative to revamp its pharmacy layout and workflow, aiming to optimize resource utilization and enhance patient care delivery.
Thanks to substantial allocation of COVID relief funds, they were able to complete an overhaul of their pharmacy. They added a Parata ATP™ 2 Pouch Packager and Parata InspectRx™ Pouch Inspector system, in addition to redoing the pharmacy layout and workflow with HD Stock furniture. The result? A dramatic transformation of their pharmacy space! The revamped layout provides dedicated workstations for technicians equipped with the ATP2 and InspectRx systems, fostering efficiency and improvements in medication preparation processes. Additionally, a separate island area has been designated for the pharmacist, optimizing their workflow, and ensuring seamless coordination between pharmacy staff members.
It didn’t take long for SMMHC to realize the benefits of adding automation and updating their workflow. According to Gabel, it took about two weeks to adjust to the new way of working, but once everyone settled in, they began to see positive outcomes. First, the layout promoted a less labor-intensive way of working. Because they have two facilities in close, but separate locations, medication deliveries were a challenge. They previously had a box truck that would be loaded and driven to the other building, carrying very large and heavy medication cassettes weighing over 50 lbs each. With the addition of pouch packaging, they have been able to reduce that delivery to a grocery-sized paper sack for each nursing station weighing less than 5 lbs.
After the pharmacy refresh
While they certainly appreciate the benefits of the new pharmacy layout and workflow, perhaps the biggest benefit they’ve seen is from the nursing standpoint. Making the switch to pouch packaging has increased the ease with which their nursing staff operates. The pouches reduce frustration during medication administration (med pass) – a process that is often challenging in their environment. Simplification with pouches has gone a long way to increase nursing satisfaction.
“Nursing satisfaction was a key driver for us in pursuing implementing automation,” said Gabel. “So, to see the difference the pouch packaging has made in their workflow is encouraging.”
Another area where they’ve seen improvement in workflow is the tracking of missing medications, observing a reduction in the occurrence of missing medications. In fact, they’ve seen an 86% reduction in medications missing. Additionally, says Gabel, “Since implementing automation, we have seen improved medication safety, reduced discrepancies, and are more efficient in tracking medications.”
Additionally, they’ve documented significant positive financial outcomes. After almost two years up and running, Gabel evaluated if the Parata implementation was as financially successful as they had hoped.
The Parata™ automation handles all oral solid medications, which are about 20-25% of the overall drug spend at SMMHC. Gabel did a 12-month comparison of the oral solid medication spend pre- and post-implementation of Parata and found that they had a savings of $165,824 dollars over the 12-month period. Given that their patients are taking an increasing amount of medication while the cost of medications continue to rise rapidly, Kelly was thrilled to see the impact of medication automation.
Overall, the pharmacy overhaul has been well received and a major success. Kelly and her staff not only appreciate the improvements to both pharmacy and nursing workflows, but they also couldn’t be happier with how the pharmacy looks and feels!
“We couldn’t have asked for better results – both from cost savings and staff satisfaction,” said Gabel. “In fact, our surveys show a 94% satisfaction rate from the nurses both on ease of use and time savings. The impact has been far-reaching!”
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