Consider Automating the IV Workflow Process
The opportunity for medication errors to occur is rife when using a manual approach to sterile compounding. Even a small discrepancy can result in devastating consequences.
Transitioning from using a manual method of IV verification to an automated IV workflow system increases safety, standardizes processes, and reduces waste. In fact, IV workflow systems are increasing in popularity; per Pharmacy Purchasing & Products’ 2019 State of Pharmacy Automation survey, 63% of facilities with more than 200 beds plan implementations in the near future. This is not surprising, as this technology engenders strong satisfaction ratings; 90% of pharmacists surveyed are satisfied with their IV workflow systems and 72% rate their systems good or excellent.1
Gain Pharmacist Buy-In for IV Automation
It is not uncommon for some pharmacists to express the opinion that they could compound IV medications more quickly without using an IV workflow software system. While manual compounding may seem quicker initially, with experience comes mastery. Pharmacists who are skeptical of automating the IV workflow process are almost always won over by the safety benefits of the technology. Further, pharmacy leadership should also make it clear that use of the IV workflow system is not optional; it must be utilized for every dose.
Choose an IV Workflow Software System
Too often hospitals only acquire IV workflow technology after an unfortunate event has occurred. If your organization does not yet use an IV workflow software system, invite IV workflow software vendors to your hospital to show staff how their systems work. Staff members should be encouraged to observe and handle the systems to experience how a dose would be prepared and checked. Invite hospital executives to interface with the technology as well, so they can fully understand each system’s error prevention capabilities. Hands-on experience can be extremely helpful in educating administration on the safety benefits IV workflow software provides.
Consider the following questions:
Consider Multiple Workstations
Implementing more than one IV workflow software station can enable multiple areas of the hospital to benefit from the technology. For example, systems can be used in the following areas:
Once the commitment is made to adopt this technology, secure sufficient capital to support multiple workstations. It is prudent to apply this safety technology to as many products as possible. With USP <800> on the horizon, it is important to review safe handling processes for all hazardous drugs. As more non-chemotherapy drugs are likely to be classified as hazardous, implementing IV workflow technology will be increasingly advantageous.
Provide Safety Education
One approach that can increase safety is the implementation of a weekly “Patient Safety Day,” wherein one department each week chooses a patient safety topic to present to the other participating departments. For example, pharmacy may choose to present the topic of preventing and reporting near misses, with a goal of significantly impacting safety.
If near misses or compounding errors occur, it is important to discuss and report them, as critical errors have the potential to become useful teaching tools. Communicating a near-miss error to other departments, such as nursing, can prevent the potential error from reoccurring. Performing a root cause analysis can help determine the cause of the near-miss or error, and how to prevent it moving forward.
Some institutions have brought in nationally known speakers and advocates for patient safety to tell their medication error stories. This is useful to reinforce the potential of serious consequences that can result from medication errors. A personal account of how a medical error can impact a family is a powerful tool to reinforce the importance of safe IV practices. Moreover, such an approach can also help gain buy-in from administration for adopting an IV workflow software system.
Dedicate Sufficient Time to Build the Drug Library
Implementation of an IV workflow system requires a significant time investment in building the drug library. Although the process is labor-intensive, ensuring that all prescriptions are built into the library accurately is critical to the system working as intended.
Break down the compounding process piece by piece in order to build each step into the IV workflow system correctly. Drugs that are fast movers can be built into the library first; go live with only those drugs for a period of time so staff can get accustomed to using the system. Thereafter, additional drugs can be gradually introduced.
Perform Regular Walk-Throughs
To ensure staff members are utilizing the IV workflow system as intended, pharmacists should perform regular, unannounced walk-throughs of the areas where the IV workflow systems are deployed. This lean strategy allows the pharmacist to gauge users’ compliance with the system, and demonstrates that compliance is expected. Walk-throughs are also valuable for the facility’s senior leadership, as they can observe the IV workflow system in action; in addition, staff becomes aware that leadership values compliance.
Implement Other Lean Methods
Consider participating in Lean Daily Management, a set of principles and tools used to create a culture of improvement. Multiple departments can use this process, which is part of the Quadruple Aim. The goals of the Quadruple Aim are to:
1. Provide better care
2. Ensure the health of populations
3. Produce less waste
4. Experience more joy/job satisfaction
The objectives of Lean Daily Management are to provide excellent care to a population at the lowest cost possible, while at the same time ensuring that staff members experience more satisfaction and joy from their jobs. Each hospital department will have its own metrics on how to accomplish these goals.
1. State of Pharmacy Automation 2019 survey. IV Workflow Management. Pharm Purch Prod. 2019;(16)8:42.
Jennifer Karpinski is the senior editor of Pharmacy Purchasing & Products. She can be reached at firstname.lastname@example.org.
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