SMART’s dispensing start and end of day processes aim to complete all tasks necessary to begin and end the dispensing day correctly in accordance with all regulatory requirements and to ensure patient safety. As of this writing, the two processes are comprised of the following tasks:
Start of Day:
- Clear pending entries in the auto-check-in queues that were added after the last dosing close date. (i.e. kiosks, patient check-ins)
- Generate alerts for patients with high cardiac risk factors.
- Generate alerts for patients with expiring insurance authorizations.
- Generate AWL, SUSP and AWOL records for days the clinic was closed since the last dosing close date. (e.g. Monday start of day fills-in AWOLs for Sunday in New York)
- Produce medicating schedule: only for patients with status or order change(s) since last dosing close. (e.g. Patient has medication increase order posted late the day before)
- Generate patient attendance checklist report for business continuity (even if not configured to print) (i.e. If systems go down during dosing hours and patients must be medicated manually).
- Post balance-due holds for patients with past-due self-pay balances.
- Generate randomly-selected list of patients for urine screening “today”.
- Determine which alerts will prevent the associated patient from medicating until overridden. (Specifically for alerts that automatically change to delays after a specified number of days)
- Establish AWOL alerts and delays for patients who were absent the prior day(s).
- Print any reports configured in the clinic settings to automatically print at Start of Day.
End of Day:
- Clear pending entries in the auto-check-in queues for “today”.
- Generate AWL, SUSP and AWOL records for patients absent “today”.
- Automatically discharge patients AWOL for configured number of days. (If this feature is configured)
- Print any reports configured in the clinic settings to automatically print at End of Day.
- Produce medicating schedule for all patients on census in medicating TxUnits.
- Generate patient attendance checklist report for business continuity (even if not configured to print) (i.e. If systems go down during dosing hours and patients must be medicated manually)
- Move any doses that were prepared in advance but not used into the surplus inventory.
- Generate and saves a copy of the daily dispensing log and recap report, then prints them. (not configurable; DEA requirement)
- Generate Case History services due based upon the schedule of services in each patient’s assigned TxUnit.
- Automatically generate random clinical quality review patient callback lists, if configured.
- Automatically generate random take-home medication patient call-backs, if configured.
All of these processes have been performance-optimized to complete in the shortest amount of time possible. While marginal improvements might still be possible, significant reductions are not possible due to the sheer number and complexity of these tasks.
This is why both start day and end day tasks were designed to be interactive rather than automated background process. It is important that the user is able to contact SMART for assistance with resolving any issues with minimal impact on staff and patients.
The only viable alternative for removing burden for running Start of Day from the nursing staff is for the customer’s helpdesk or other staff to initiate the process from a central location well in-advance of the clinic’s scheduled opening time. This would remove the burden from nursing while satisfying the interactivity need and allowing time to call Smart should any errors be encountered.