Wireless Password: 9166703926
New Technology to Prevent
Drug Diversion & Errors:
Remote Automation in LTC
Brad Savage, Senior Vice President
AlixaRx: Redefining Pharmacy Services
Long-Term
Care Pharmacy
Service
& Maintenance
Automated
Dispensing
Machine
Clinical
Pharmacist
Integrated
Software
e-Medication
Cabinet
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Post-Acute and Long-Term Care Today
Patients are released to post-acute and long-term care settings
“sooner and sicker”
Patients are discharged from hospitals 24/7; skilled nursing homes are
experiencing a dramatic increase in Friday night and weekend
admissions
Many of these patients are medically unstable and require immediate
access to medications
Shorter stays are becoming more common (rehabilitation, completion
of aggressive antibiotic therapy, etc.)
Critical Need: A new model of pharmacy care
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Traditional LTC Pharmacy
Emergency Kit
Punch-cards or Bingo-cards
Excessive Amount of
Medications In Circulation
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LTC Pharmacy with Remote Automation
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Benefits of Remote Automation in the LTC
SAFETY * ACCESS * SAVINGS
Enhances medication safety – simplifies the administration process
Decreases drug diversion risks – fewer “loose” controlled substances in circulation
“Returns Nurses to Nursing” - more time to focus on clinical tasks and less time
spent sort medications and taking drug inventories
With up to 95% of the most commonly prescribed oral solid medications available
onsite 24/7 – greatly improves access
• Result: improving access to medications can reduce hospitalizations for acute
and psychiatric care
Daily dispensing model greatly reduces medication waste
Reduces overall drug costs to all payors (governmental, third-party, private pay)
with post-consumption billing
• Only pay for the medication used, not wasted or excess drug
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Example of Controlled Drug Waste
Narcotic Destruction for Facility #981
March 18, 2013
RPh Time = 2.0 hours
Total
Drugs
Total
Full Cards Units Destroyed
Cost Per
Total
Unit
Cost
Lorazepam tabs
7 (x30)
508
$
0.45
$
228.60
Morphine conc (ml)
7 (x30)
346
$
2.03
$
702.38
Lorazepam conc (ml)
3 (x30)
90
$
3.20
$
288.00
Oxycodone ER
1 (x30)
42
$
3.00
$
126.00
Hydrocodone/APAP
1 (x30)
114
$
0.63
$
71.82
0
28
$
0.50
$
14.00
1 (x30)
113
$
0.63
$
71.19
Modafinil
0
12
$
30.00
$
360.00
Zolpidem
0
27
$
1.48
$
39.91
Alprazolam
0
8
$
2.10
$
16.80
Temazepam
Oxycodone/APAP
1,288 units
Census
Cost/Resident/Month
Total Census
------
$ 1,918.70
148 patients
$ 12.96
32,000 patients $ 414,853.19
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Support from Government Agencies
and Professional Organizations
Drug Enforcement Administration (DEA) - To address the issue of excess controlled substances in LTC
facilities, the DEA adopted regulations in June 2005 to permit remote automation in the LTC setting.
 DEA acknowledged, “[s]tates will need to amend their laws and regulations to fully implement
this change in the DEA regulations within their jurisdictions.” (Federal Register Vol. 70, No.92,
25463)
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Support from Government Agencies
and Professional Organizations
Centers for Medicare & Medicaid Services (CMS) – CMS recognizes remote automation is
“likely the most efficient dispensing methodology and the most effective in reducing waste.”
(Federal Register Vol. 75, No. 224, 71207)
 Issued the “Short Cycle Dispensing Requirements “which mandate that pharmacies
dispense Brand Name drugs in no more than a 14-day supply
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Support from Government Agencies
and Professional Organizations
National Association of Boards of Pharmacy (NABP) – NABP has been supportive
of remote dispensing in the LTC setting.

In 2011 NABP’s Task Force on Pharmacy Practice Technology Systems recommended:
o

NABP should work with Boards of Pharmacy to recognize that technology can be utilized to
improve patient outcomes…using laws and rules that are broadly written and place the
responsibility on the pharmacist on duty and the pharmacy permit holder.
NABP’s Model Rules contain provisions for remote automated dispensing .
o
These rules serve as a great resource to state boards of pharmacy to promote uniform regulatory standards.
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Support from Government Agencies
and Professional Organizations
Institute for Safe Medication Practices (ISMP) - ISMP has stated that automated
dispensing machines offer a variety of benefits to an organization (i.e., decrease
delivery time, greater control of medications, support security measures)
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CURRENT PERMISSIBILITY OF
REMOTE AUTOMATION IN LTC
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Remote Automation in the
LTC Setting Moving Forward
Over ½ the states permit some form of remote automation in the LTC setting
Given the numerous benefits with remote automation and problems with
the traditional model, change is imminent…the industry must change.
Challenges with Implementing Change to Permit Remote
Automation
Legislative Change vs. Agency Rule Change
May affect multiple laws/rules (BoP, DoH, etc.)
Rapid Development/Advancement of Technology
If regulated and implement properly, remote
automation is a great tool to reduce drug diversion
and decrease drug administration errors.
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Thank You
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Wireless Password: 9166703926