Miles Bennett, DO, was always frustrated when a toddler with an excruciating ear infection was brought to the emergency department at midnight and couldn’t be sent home with antibiotics in hand.

“Even though I am in a large suburb with the city only minutes away, there are not any nearby 24-hour pharmacies,” Dr. Bennett said. “Patients would have to drive long distances to get their meds or else go home and wake up the next day to go back to the pharmacy.”

The process of obtaining medications was not just inconvenient for patients or their guardians; in some cases, it would also prolong their pain and discomfort. Sometimes the medications were never picked up.

Two years ago, Dr. Bennett, now chief medical officer at AdventHealth in Winter Garden, Fla., had a conversation with his director of pharmacy, Oscar Santalo, PharmD, about how they might fix the problem. Having outpatient pharmacies open 24 hours a day, seven days a week would be cost-prohibitive, but having a medication-dispensing kiosk in the ED might do the trick.

A Starting Point

The kiosk program started with one kiosk at his facility at AdventHealth Millenia ER, just outside of Orlando, Fla. There is now another at

AdventHealth Winter Garden, Fla. This program spares the patient a drive to an outside pharmacy, and any interaction with a pharmacy or a medication-dispensing kiosk. Medications in the kiosk are accessed for the patient by a health care worker. The patient receives the filled prescriptions at discharge and can go straight home.

So far, about 5,000 prescriptions have been dispensed from these two locations, and AdventHealth plans to expand the program to six more sites in the next six months. The machines can hold up to 800 bottles of medications at a time, and they offer up to 176 prescriptions made from up to 78 medications. A formulary determined by a committee made up of emergency physicians, pharmacists, and nursing staff determines which medications are dispensed.

“It is a data-driven decision based on what staff [are] using,” Dr. Santalo said. “I presented the top 100 fast-moving prescriptions, which helped us to standardize what’s in the kiosks.”

“Oscar keeps a close eye on things and is able to adjust on the fly during flu season, for example,” added Dr. Bennett. Florida law prohibits medication kiosks from dispensing controlled substances.

What’s the Cost?

As for prices, Dr. Bennett said they are competitive for self-pay, which is mostly the case for their patients, many of whom are tourists in the Orlando area. For over-the-counter items, Dr. Bennett and Dr. Santalo looked on Amazon.com and walked the shelves at Walmart stores to be sure their pricing was competitive.