A MISSION ROOTED IN INNOVATION AND CUSTOMER CARE

Founded in 2008, UnitedRx LLC is a long-term care pharmacy serving nearly 30,000 patients across more than 300 skilled nursing facilities, primarily located throughout the Midwest. Their mission from the start has been to provide state-of-the-art pharmaceutical services combined with the personal touch of a local pharmacy.

According to Chuck Benain, RPh, UnitedRx’s CEO, the company has remained true to that mission over the years. “We focus on putting our customers first — and everything we do is with the intention of supporting them as best we can. That’s really how we’ve built our business.”

That’s why UnitedRx has consistently invested in the latest technologies to add automation and efficiency in its processes. “We were one of the first to put automated dispensing cabinets in facilities so nurses had instant access to medications,” says Benain. They were also an early adopter in offering unit-dose strip pouch packaging over punch cards in a skilled setting.

“One of the challenges in skilled nursing facilities is that medications can change frequently,” he explains. Strip packaging is ideal in this situation because it allows pharmacies to run shorter cycles — bi-weekly or even weekly. Additionally, since packages are unit dose, when there is a change, only one pouch needs to be swapped out, not the entire strip. The result is less medication waste overall.

“When we began offering strip packaging, probably only about 10% of our skilled nursing facilities were using the service,” says Benain. Today, Jeffrey Medrano, director of operations for UnitedRx, says that number is closer to 60%.

THE CHALLENGE: AGING TECHNOLOGY AND LIMITED ACCESS TO DISPENSING DATA

As their original strip packaging machines were nearing the end of life, Benain says they began exploring alternatives. “Machines were breaking down all the time, and I was constantly on the phone working on a resolution or waiting for someone to come onsite to do repairs.” His pharmacy technicians were frustrated and many times brought to tears, he says. “What we do every day is almost like an orchestra of how we get medications to our customers. When a machine is down, there’s always a risk that we won’t meet our commitments.” This often meant added stress for pharmacy techs and extra overtime expenses to ensure medications are delivered on time.

Accessing dispensing data was also a challenge, says Medrano. “With our legacy system, if I wanted a count of a particular medication across the four machines we were running, I’d have to go to each machine and pull the data individually.” That’s because each machine ran on its own server. The process of compiling data could take up to 30 minutes — or longer if a machine was in use and he had to return. After running reports, he’d have to export them into Excel and manually reformat the data. “There was no way for the system to put all that data in one place for us. Getting the information I needed for inventory was just cumbersome.”

Aside from the four legacy systems, one of UnitedRx’s pharmacy locations was using a Noritsu strip packager. “When we started exploring other options, it occurred to us that the Noritsu machine rarely needed a service call,” Medrano says. Benain, familiar with Noritsu from other companies, decided to learn more about their solutions. “I went to St. Louis and visited a pharmacy that was running one of their machines, and they really liked the product,” he says. “I also met with the engineers who designed the system, and it was just a great experience, so I decided to try them out in one of our pharmacies.”

THE SOLUTION: A SYSTEM PURPOSE-BUILT FOR PERFORMANCE AND INTELLIGENCE

UnitedRx implemented Noritsu’s NX4000 strip packaging system, the NexusRx software, and the automated visual verification solution. “We noticed a difference right away,” says Benain. “These machines are built like tanks. We weren’t having daily breakdowns or any weekly problems.”

As a result of that initial experience, the company has since installed a total of six NX4000 machines. “What we found from the outset is that Noritsu was very responsive to our needs,” Medrano says. “I didn’t want to move too quickly. It was important that all our employees felt comfortable with the new system before we moved facilities over.” They began with weekly phone calls for about six months leading up to implementation to go over each step and identify potential challenges. Then they transitioned one or two facilities to the new machines.

“An implementation like this is a fine balance,” explains Benain. “You can’t just stop everything and switch over to a new system. On the other hand, I was eager to get producing because I knew what a difference it would make for us.” Medrano agrees, saying that once they realized how much better the Noritsu system was, they ramped up quickly. “I’d say we went from zero facilities onboarded to 100 in about a month.”

THE RESULT: OPERATIONAL EFFICIENCY, LOWER ERROR RATES, AND EASIER ACCESS TO DATA

Medrano says the Noritsu system operates similarly to their previous technology, but its speed and efficiency are unmatched.

A large medication roll of 1,000 might have taken us a couple of hours to process before. Now that same 1,000 takes less than 10 minutes.” He also notes that it’s easy to deploy a facility onto the system when switching from bingo cards to strip
packaging. All they need to do is set the facility up in the system, which is much more straightforward with Noritsu’s software. “Then we put facilities on a 30-day countdown to ensure all medications are billable on the same day. When the 30 days are up, we’re ready to go. There’s no extra transition.” He also says that the process is so easy, he could start filling strip package prescriptions for a brand-new facility almost immediately.

UnitedRx has found that the Noritsu machines and software are very intuitive. “I can train a new employee on running the machines and filling trays in less than a day and have techs working independently within the first three or four days,” says Medrano. That’s partly because the company set up all six of its machines in the same way, as Noritsu had recommended for enhanced efficiency and consistency. “All the medications are in the same canisters across all six machines, so the learning curve is pretty short.” Even simple tasks, like changing the roll of paper in a machine, are easier, he explains. “So even though the technology is similar, it’s these kinds of things where I can see we are saving time.”

The automated visual verification is also another time saver, says Benain. The system takes a picture of every package and compares the image to the pharmacy’s custom medication library. The result is a highly detailed view of each medication package. “If there’s a broken tablet or it’s not the right shape or color of the medication that’s supposed to be in the package — the system tells us to check the pouch.” Pharmacists can review images and confirm or replace medications as needed. The system is typically flagging less than 3% of the pouches, leaving 97% with no need for additional review. Images are also stored in the system, allowing pharmacists to review any pouch if nurses have questions.

“For me, what’s made my job easier is Noritsu’s openness to giving us access to data,” says Medrano. Where data is concerned, the biggest difference from the legacy system is that all machines now run on the same server. “That means I can pull reports that reflect data across all six of our machines.” Any new machines they add will also be run from the same single server.

A SHARED COMMITMENT TO CUSTOMER CARE

Over a typical week, UnitedRx is now running about 280 batches of different cycles. This is more than double the volume we were running on our legacy systems. Even with this volume, Medrano says they only see Noritsu about once a month for regularly scheduled preventative maintenance. “If we were running the same volume through our legacy machines, I’d estimate we’d have a service call about every four days.” When they did have an issue with one of Noritsu’s machines during implementation, Benain says the company’s service was exemplary. “They tried to fix it a couple of times, but understood what we’d been through before — so just decided to replace it.” Medrano agrees, saying the company is very responsive to their needs. “If a pharmacy is having an issue, they’ll send out a technician to identify the problem and they’ve resolved our issues quickly.

The bottom line, Benain says, is that Noritsu understands UnitedRx’s business and understands their customers. “They are empathetic to our cause, and just made the whole process so easy for us. They listened to what we needed and gave us valuable input on how to make our processes more efficient. Noritsu was really there for us — and I don’t believe I would buy from another provider at this point.”