Automated dispensing systems not only keep your meds and supplies secure and in stock, they restore the human touch to surgery: Nurses can do what they do best, while electronic supply cabinets resembling candy vending machines manage inventory.

"It takes the nurse out of inventory control and puts her back at the patient's bedside," says Nadine Drescher, RN, MPA, the director of day surgery at Tisch Hospital of NYU Hospital Center in New York. "That extra hand-holding during the early stages of induction can make all the difference in the world."

Omnicell's automated dispensing lockout cabinets have managed medication and supply chains for Ms. Drescher's hospital-based outpatient facility for five years. Staff each have a unique login and password and appropriate level of access (RNs have higher levels of access than techs, for example). Ms. Drescher reviews daily tracking reports to ensure three-days' inventory is maintained. The cabinets are integrated with her hospital's inventory and billing systems.

"Without an automated system, anybody could basically walk in to your supply area and take anything off the shelf," says Ms. Drescher. "This can be a problem, especially during off-hours. Now you can't gain access without a password."

Read on to learn how automated dispensing systems let surgical facilities manage medications and supplies.

The economics of operational efficiency
Medical storage systems have evolved into sophisticated pieces of automated equipment that

• keep medications and supplies secure,
• tell if you're taking the right items for the patient or case,
• manage your med/supply inventory and
• ensure the right account is charged the right amount.

Of course, all these capabilities will cost you. Fully automated systems start around $30,000 and go up (sometimes way up). Just upgrading your open shelving can cost $25,000. (In open shelving, you can add barcoding/scanning systems and tiny radio transmitters; you can even buy shelves with antimicrobial mats.)

Those who have high-tech storage are quick to sing its praises. Facility managers say medication errors are all but eliminated, meds and supplies don't "walk out the door," the right item always gets picked and items get charged to the right account. Some surgery centers have reduced supply personnel or re-allocated staff time once spent on inventory.

"Used properly, automated storage is significantly less expensive than a manual system. You don't have to fill out all the paperwork; it's documented by the sys-tem. If you take 15 units of 'x,' those 15 units are correctly charged to the patient listed," says Vickie Axsom-Brown of Practice Resources LLC, a consulting administrator for two South Carolina outpatient facilities.

What's new?
Connectivity sums up what's new in high-tech storage systems. These systems have always communicated with a server that's the "brain" of the system, but manufacturers have further refined and enhanced the exchange of information from the storage unit to a fac-ility's departments. Here's a look at three innovations.

• Interchange from MedSelect. Departments use a fax server and tablet PCs to order meds. It's a paperless environment, yet the pharmacist can rotate, annotate and underline prescriptions, just as on paper Rx's. This product may be best suited to hospitals and large health provider networks, where many physicians are ordering meds dispensed through a central pharmacy.
• Supply Center from Pyxis. This "talks" to departments through a high-powered Windows NT server. The multi-processor PC lets information be sent from the closed storage unit to the patient registry to the OR to the inventory master list - all the way to billing - in language each department understands. When you enter a patient in the registry, Windows integration "sees" this through telephone lines or network topography (ethernet pcpip). A nurse enters a name in the system, it unlocks the correct supply items, she presses the "take" button, and the system reorders the item and bills the patient account.
  
  "This is very important [to hospitals] in light of the Ambulatory Patient Classification (APC) codes." says Rob Sobie of Cardinal Health, owner of Pyxis. "If you are billing appropriately, you can charge for all supply items, as well as the procedure."
• Case Management from Omnicell. Staff can pick cases ahead of time, even if you don't have the patient's name until the day of surgery. The system works with physician preference cards, picks the items for the nurses, then records that they've been picked. If the case is cancelled, "you don't have to put all the items back," says Omnicell Product Manager Gary Wietecha, MD. "The system can accurately reassign them to other cases."

Think ATM
"[Automated storage systems] are a lot like a self-contained business unit that debits, credits, deposits and withdrawals, all at one location," says Mr. Sobie. "Our systems are Win-dows-NT based, and we write proprietary software, which manages inventory, access, patient information and so on."

Technology for MedSelect's automated storage products was developed by Diebold, which makes ATMs, says Brett Grauss, vice president of sales for MedSelect. "You can't get the money out of an ATM without authorization, and you can't get meds out of our machine without authorization."

He believes unit-dose medication vending is best because it complies with FDA-mandated unit-dose barcoding. The unit-dose machine works much like a snack vending machine with a corkscrew that drops the item of choice. "Shrink that vending machine to one-half of its size, take away the see-through glass, and that's what it is," he says.

A step down from full-blown automation are products like the Partner Cart from MedCart. The carts' serial ports integrate with Microsoft ACCESS software. Information such as an audit trail can be downloaded and manipulated. The company calls this the Silent Partner feature, because it tracks the time, date and users who accessed the med drawer. The cart also has DrawerCatcher double-lock technology and a Palm-Pilot style "touchpad."

Though automated systems offer security benefits, don't depend too much on them. "It's up to humans how it's used," says Matt Grissinger, RPh, a medication safety analyst for the Institute for Safe Medication Practices. "If you're worried about who's accessing drugs, lock up the meds. Don't a have false sense of security. It can be a glorified storage closet. The minute the drawer opens, you can take anything."

Technology is only as good as the humans who handle it, says Ms. Axsom-Brown: "What you put in is what you get out. If it isn't right, you aren't doing something right."