Ask almost any nurse where they want patient care supplies and medications, and they will most likely say inside or just outside the patient room.
Considering the mounting research from the past several years on how much time a nurse spends away from the bedside to hunt and gather medications, supplies, and equipment, along with the intense focus on quality outcomes and Lean processes, it is no wonder that more patient room designs are including bedside medication storage.
Providing bedside storage for medications is not a new concept. The early Friesen hospitals included a “nurse-server” concept that featured passthrough cabinets for supplies and medications. The operating model included medication supply delivery by pharmacists who stocked the medication drawers from the outside of the room while nurses accessed the locked drawer from the inside of the room.
The concept of medications at bedside has evolved to mobile carts, often with computers or workstations on wheels, where lockable drawers can be added to store medications for all patients a nurse is assigned to.
Adding medication drawers to casework in the room, or as a passthrough is also a popular concept. Whether a hospital chooses to store and dispense medications from a traditional medication room concept, at bedside, or a combination of both, the decision needs to keep patient safety as the priority and be inclusive of the following:
Pharmacy and nursing collaboration
Bedside medication storage processes require a close alignment and partnership in processes between pharmacy and nursing. It is important to identify who will place and remove the medications in the cabinets or carts at bedside, how they will be returned to pharmacy, and how often they will be stocked.
With bedside storage, the responsibility often falls on the nurses to stock the medications from a medication room. When you consider that controlled and refrigerated medications as well as floor stock are also kept in medication rooms or automated dispensing devices, nurses will still go to more than one location to “gather” medications.
Large teaching hospitals and academic medical centers, as well as high acuity specialty units, often have patients who require a frequent change in medications and dosages.
Short of having a pneumatic tube deliver these new medications into each patient room at the time of the order, it is possible that the process to deliver each new medication to the bedside could result in a slower turnaround from pharmacy to patient administration.
Medication rooms or automated dispensing locations should provide acoustical sound attenuation to limit human distraction, adequate lighting, and work surfaces for mediation preparation. The number of medication rooms/automated dispensing devices needs to be carefully planned to foster timely administration and eliminate excessive travel distances (typically not further than 50 feet) from any patient room and nurse queuing to retrieve medications.
Security is critical for both rooms and bedside solutions. Locking mechanisms should include “mistake-proof” solutions, such as automatic drawer closing.
Medication storage is more than a place in the design process; it is first and foremost about patient safety, inclusive of efficient processes and requires careful pre-design planning of processes between nursing and pharmacy.
Terry Thurston is the Director of Healthcare Operational Planning at BSA LifeStructures and brings more than 30 years of healthcare experience as an expert in operational, occupancy, and transition planning. Her experience as a chief nursing and patient safety officer allows her to bring a multi-faceted approach to designing safe and efficient healthcare facilities.