At the University of Maryland Medical Center (UMMC)—an 800-bed tertiary care teaching hospital located in Baltimore—the pharmacy department provides a full range of pharmacy services to patients and employees, and supports a technician-driven and technology-dependent medication use process. As part of our standard workflow, the UMMC pharmacy department provides medications for emergency medication boxes and crash carts in the form of drug trays. Currently we stock more than 300 emergency carts with eight types of trays, the contents of which vary to meet the needs of the population served. For example, an adult emergency tray contains 24 unique medications and 100 total doses whereas a pediatric emergency tray contains 30 unique medications and 55 total doses. Any time a tray is opened, it must be returned to the pharmacy for review, regardless of whether any products have been used. Given the number of trays we administer, accounting for all materials in each tray became a time-consuming and tedious job.
Benefits of RFID Technology
In the past, the process of checking and refilling medication trays required a pharmacy technician to manually inspect each tray, determine medication replacement needs, and ensure all products were properly accounted for. The technician also recorded the expiration dates of all medications remaining in a tray, replacing those at or nearing expiration. After this review, the technician filled out a charge sheet to document the tray contents, quantities, and expiration dates, then notified the pharmacist that the tray was again ready for review and verification. This process averaged approximately 20 minutes per tray to complete.
Eventually, this manual process became too laborious and in April 2012, we decided to implement a new technology to manage this process, with the goals of improving efficiency, workflow, and employee satisfaction within the pharmacy. We chose to implement Kit Check, a radio frequency identification (RFID)-based technology that facilitates the stocking and checking of medication trays. In reviewing the available products for automating this process, we found several that use bar code scanning to enable management, but those still require manual scanning of each item. RFID allows the entire contents of a single tray to be accounted for at once.
During implementation, every tray and medication had to be scanned into the system and tagged by a pharmacist. We attach an RFID tag to each drug, which is embedded with that medication’s NDC number, lot number, and expiration date. While the initial labeling process can be time consuming, the system is quite intuitive, so our staff members were able to quickly adjust to the new process. However, thorough training on proper use is key to a successful implementation, and Kit Check representatives were very helpful during this process. As part of our rollout, we began using Kit Check for our pediatric trays first, as fewer of these trays are in circulation allowing us greater control. After the pediatric trays were successfully implemented, we expanded to other trays.
Accountability Improves Care and Safety
Using RFID has reduced our medication tray replenishment process to less than five minutes per tray and eliminates the need for a pharmacist check. When a tray is returned to the pharmacy, the technician places the kit into the scanning station. Within seconds, the scanning station identifies the type of tray being scanned and all products in that tray, including any foreign items, all missing medications, as well as medications that are expired or nearing expiration. The technician then restocks medications as appropriate and rescans the tray to verify the contents and that each medication has a prolonged expiration date. The system also generates a charge sheet that indicates drug name, quantity, lot number, and expiration date—an additional advantage in the event of a medication recall. Before Kit Check, if a medication was recalled, a pharmacist or technician had to inspect every tray to ensure they did not contain the recalled product. Now, a report is generated based on the recorded NDC numbers and lot numbers, so trays containing recalled medications are easily located.
Since implementation, our facility has virtually eliminated human error when restocking our trays. If an incorrect medication is added to a tray, the system alerts the technician and prohibits completion of the replenishment process. Additionally, the system eliminates the need for a handwritten charge sheet as this paper work is automatically generated. The replenishment process has been simplified from numerous steps to just three and removing the need for a second check by a pharmacist frees staff to focus on meaningful clinical work.
We have experienced great satisfaction with this technology since adoption and plan to expand it to include our operating room (OR) trays within the next year. Furthermore, UMMC is also considering purchasing an additional Kit Check scanning device and moving OR tray replenishment activities from the OR pharmacy to the central pharmacy to further enhance workflow.
Agnes Ann Feemster, PharmD, BCPS, is assistant director of clinical pharmacy services and investigational drug services at the University of Maryland Medical Center.
Adrienne Shepardson, PharmD, is central pharmacy manager at the University of Maryland Medical Center.
Marc Summerfield, RPh, MS, is director of pharmacy at UMMC as well as an adjunct professor of pharmacy at the University of Maryland.
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