Department of Pharmacy, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Am J Health Syst Pharm. 2013 Aug 1;70(15):1322-35. doi: 10.2146/ajhp120512.
The results of a study to estimate the human resource and cost implications of changing the medication distribution model at a large medical center are presented.
A two-part study was conducted to evaluate alternatives to the hospital's existing hybrid distribution model (64% of doses dispensed via cart fill and 36% via automated dispensing cabinets [ADCs]). An assessment of nurse, pharmacist, and pharmacy technician workloads within the hybrid system was performed through direct observation, with time standards calculated for each dispensing task; similar time studies were conducted at a comparator hospital with a decentralized medication distribution system involving greater use of ADCs. The time study data were then used in simulation modeling of alternative distribution scenarios: one involving no use of cart fill, one involving no use of ADCs, and one heavily dependent on ADC dispensing (89% via ADC and 11% via cart fill).
Simulation of the base-case and alternative scenarios indicated that as the modeled percentage of doses dispensed from ADCs rose, the calculated pharmacy technician labor requirements decreased, with a proportionately greater increase in the nursing staff workload. Given that nurses are a higher-cost resource than pharmacy technicians, the projected human resource opportunity cost of transitioning from the hybrid system to a decentralized system similar to the comparator facility's was estimated at $229,691 per annum.
Based on the simulation results, it was decided that a transition from the existing hybrid medication distribution system to a more ADC-dependent model would result in an unfavorable shift in staff skill mix and corresponding human resource costs at the medical center.
本文介绍了一项研究的结果，该研究旨在评估在大型医疗中心改变药物配送模式所涉及的人力资源和成本影响。
进行了一项两部分的研究，以评估替代医院现有混合配送模式（64%的剂量通过推车填充分配，36%通过自动化配药柜[ADCs]分配）的方案。通过直接观察评估混合系统中护士、药剂师和药剂技术员的工作量，并为每个配药任务计算时间标准；在一家采用涉及更多 ADC 应用的去中心化药物配送系统的对照医院进行了类似的时间研究。然后，将时间研究数据用于替代配送方案的模拟建模：一种方案不使用推车填充，一种方案不使用 ADC，一种方案严重依赖 ADC 分配（89%通过 ADC，11%通过推车填充）。
对基础案例和替代方案的模拟表明，随着模型中从 ADC 分配的剂量百分比增加，计算出的药剂技术员劳动力需求减少，护理人员的工作量相应增加。鉴于护士是比药剂技术员成本更高的资源，从混合系统过渡到类似于对照设施的去中心化系统的预计人力资源机会成本估计为每年 229691 美元。
基于模拟结果，决定从现有的混合药物配送系统过渡到更依赖 ADC 的模式将导致医疗中心员工技能组合和相应人力资源成本的不利转变。
