Historically, manual processes have dominated the medication-use process and introduced the risk of human error. With the advent of bar coding, hospitals have been able to automate many pharmacy tasks, significantly increasing medication safety. While bar code technology implementation is now widespread, an ongoing reliance on laborious manual processes continues to present significant opportunities for medication errors to occur. A newer technology, radiofrequency identification (RFID), can supplement bar coding and other automation to improve safety and efficiency in the pharmacy.
What Is RFID Technology?
RFID is a novel technology that utilizes a small electronic device comprising a chip and an antenna. The chip carries a unique identifier for the object or medication to which it is adhered. Using RFID, items can be scanned within a few feet of a reader, as opposed to requiring direct contact, as is required with a bar code scanner. In addition, RFID readers can read hundreds of items at once.
For a conceptual example of the efficiencies gained with RFID technology, consider a supermarket checkout line. Each item must be individually bar code-scanned in order to be processed. Using RFID technology, all of the groceries could be placed on an RFID scanner and be read at once, significantly decreasing the time necessary to process items and tally prices. A University of Arkansas study found that scanning 10,000 items with bar code technology took 53 hours; when compared with RFID technology, the same 10,000 items were processed in just 2 hours.1
The current RFID market has an estimated value of over $10 billion annually.1 The majority of today’s RFID applications are found outside of health care, with large retailers demonstrating significant successes implementing this technology, particularly for supply chain integrity. In fact, large-box retailers have reported improvements in inventory tracking accuracy from 60% to greater than 95% after implementing RFID technology.2 RFID tags can also store more information than is currently possible with bar code technology. With increasing complexity in inventories—eg, multiple product sizes and colors, etc—RFID technology can track items to this level of specificity, which assists in maintaining an accurate inventory.1,2
These benefits have inspired other industries to incorporate RFID technology into workflows. RAIN RFID is a global alliance promoting the universal adoption of RFID technology (similar to other initiatives that exist for popular technologies, such as Bluetooth, WiFi, and near-field communication [NFC]). RAIN RFID utilizes cloud-based technology to connect RFID devices via wireless-based integration to facilitate universal adoption. RAIN may help apply the benefits of RFID more broadly across a variety of industries.1
While RFID technology can simplify labor-intensive workflows, it typically exists in combination with bar code technology, not in place of it. Both technologies have specific advantages and disadvantages that make them practical to incorporate in various management systems. While bar coding captures less data than RFID technology, RFID is more costly, so it may not be practical to transfer all bar coded items to an RFID solution.3
RFID Applications in Health Care
The benefits of RFID technology in non-health care fields can translate directly to health care, particularly in regard to efficiency, safety, and supply chain integrity. Real-time scanning positively impacts the pharmaceutical supply chain, ensures accurate inventory management, and increases operational efficiency and medication safety.
Supply Chain Management and Drug Shortages
Robust inventory management and smart ordering practices, combined with RFID technology, can help health systems significantly reduce waste. RFID technology can also assist in managing drugs on shortage as the technology pinpoints inventory location. In addition, the technology provides accurate, real-time data, allowing pharmacy to rapidly analyze and redeploy stock as necessary.2
Kit and Tray Management
RFID technology has gained rapid adoption in kit and tray assembly for emergency crash carts, anesthesia trays, and the like. Traditionally, kit and tray assembly has required a significant level of manual labor and oversight by pharmacy technicians and pharmacists, in order to verify that products are correct, lot numbers and expiration dates are recorded, and visual double-checks have occurred. Even those institutions using bar code scanning for tray assembly often are still required to manually enter expiration dates and lot numbers. The benefits RFID brings to crash cart assembly can be expanded to other areas that utilize kits, including rapid sequence intubation (RSI), open heart surgery, stroke, anesthesia, etc.4,5
Under RFID, most items must be manually tagged and loaded into the kit and tray system; however, the time necessary to complete this task is typically offset by the time saved through the assembly and checking of trays with the technology. Hundreds of items can be encoded with RFID tags at once, which improves efficiency. As RFID technology becomes more prevalent, manufacturers of medications that are commonly used in crash carts are beginning to introduce pre-tagged inventory with RFID capabilities that already contain a product’s NDC, expiration date, lot number, etc. Once items are tagged, assembled crash carts can be scanned and approved in less than 1 minute.6,7
RFID simplifies complex processes, eliminates manual assembly, and increases patient and employee safety by reducing the potential for human error.8
RFID technology is an underutilized resource that health-system pharmacies can leverage to gain efficiencies, enable smart inventory management practices, and improve medication safety. As this technology becomes more widespread and increasingly flexible in terms of cost and ease of implementation, RFID should be explored as an opportunity to improve pharmacy workflow and operations.
Nick Gazda, PharmD, BCPS, is a PGY2 health-system pharmacy administration resident at Moses H. Cone Memorial Hospital (MCMH) in Greensboro, North Carolina. He completed his BS at the University of North Carolina at Chapel Hill and received his PharmD in 2016 from the UNC Eshelman School of Pharmacy. Nick is currently working toward his MS in pharmaceutical sciences with a concentration in health-system pharmacy administration from the UNC Eshelman School of Pharmacy. Starting in July 2018, he will step into the role of assistant director of specialty pharmacy at MCMH.
Kevin N. Hansen, PharmD, MS, BCPS, the assistant director of pharmacy at MCMH, provides oversight and leadership for pharmaceutical compounding and perioperative services pharmacy. He graduated from the Lake Erie College of Osteopathic Medicine with a Doctor of Pharmacy degree and received an MS in pharmaceutical sciences from the University of North Carolina Eshelman School of Pharmacy. Kevin’s professional interests include sterile compounding, quality assurance, and data analytics.
Kathleen E. Forbis, CPhT, AAS, is a advanced certified pharmacy technician at MCMH. She has an Associate’s Degree of Applied Science in pharmacy technology and is currently working on her BS in health care management. Kathleen’s areas of responsibility include sterile and non-sterile compounding, perioperative services, and code cart management.
Amber Santora, CPhT, is an advanced certified pharmacy technician at MCMH. Her areas of responsibility include perioperative services pharmacy and sterile compounding.
Case Study: Implementing RFID at Cone Health
Cone Health, a six-hospital, community teaching health system with 1273 beds in Greensboro, North Carolina, recently implemented RFID technology for its adult and pediatric crash cart trays, emergency drug boxes, and anesthesia trays for procedural areas. Prior to installation, there was a documented 12% error rate for trays that were processed through Cone Health’s original, manual system. Since implementing RFID technology, there have been no reported errors. Robust planning and close collaboration with our RFID vendor during the implementation process were critical to the system’s success.
Prior to implementation, it is critical to analyze the current state of practice to identify all potential applications for RFID technology. This will provide a framework for choosing a vendor and for developing an implementation strategy. Recommended steps include the following:
Step 1: Take Stock
Make a list of every kit (eg, trays, boxes, packs) assembled or managed by pharmacy. Record the total number of medications and material items included in each kit as well as the dimensions of the kit.
Step 2: Collect Data
For each kit, indicate the replenishment schedule (eg, 24 hours, after each case, etc). After analyzing prior data, provide the average number of items replenished per cycle and an error rate for each. If data are not available, consider performing a small study over the course of 1-2 weeks to capture this information.
Step 3: Perform Time Studies
Perform time studies for replenishment of each kit type. Furthermore, indicate the time spent by each staff member (eg, pharmacy technician, pharmacist, etc).
Step 4: Analyze Data
Analyzing the data can help determine where the best opportunities for RFID implementation exist. Ideal kits to prioritize for implementation are those kits with high error rates and those requiring significant pharmacist and technician time.
Step 5: Assess Space
After determining the locations where RFID will be implemented, it is prudent to do a walk-through of the area and review the space. Each vendor offers various RFID scanner sizes; scanners can be placed on a cart, a countertop, or even mounted below the counter. Review the dimensions for the kits utilized in this space to ensure the appropriate RFID scanner is selected.
Step 6: Consider Workflow
Determine any workflow changes that will be required for successful RFID implementation at your institution, including inventory tagging, encoding, and quarantining stock for pharmacist approval.
Step 7: Identify Future Applications
Some vendors offer additional RFID technologies beyond those for standard kit replenishment, including RFID refrigerators and cabinets, and RFID anesthesia workstations. Assessing these additional technologies is an important consideration when choosing a vendor.
Step 8: Calculate ROI
A 5-year ROI can be calculated using the following associated costs and savings that may be present:
Step 9: Assess Cost Models