Located in Saint Augustine, Florida, Flagler Hospital is a 312-bed, not-for-profit community acute care facility serving St. John’s County and specializing in bariatric surgery, heart care, cancer treatment and includes a brain and spine center. Our daily compounding volume averages about 180 doses per day and we compound I.V. products that are not commercially available in a ready-to-use form, ordered for the patient. So anytime we need to mix one or more drugs with an I.V. solution, we compound.
We had two main challenges with our compounding practices. One, our system did not allow us to assert with total confidence that the compounded products our technicians completed always matched the label. Secondly, we wanted to ensure that we were in compliance with the new USP Chapter <797> guidelines. In the past few years since we have renovated our I.V. room, our pharmacists work in a separate area, while the compounding technician works back in the secure area where they cannot easily be seen from the ante area. This is where ForHealth Technologies’ IntelliFlowRx really helped us.
Before, we had to physically enter the I.V. room — after gowning and gloving — to review the completed, labeled products along with the vials that were used. The technicians would leave syringes drawn back to the amount of drug that they were supposed to have put into the solution. With this system, we had no way of knowing if syringes or vials had been inadvertently mixed up. Furthermore, we did not have a very good tracking system if an error did occur. It was very difficult to determine who compounded the product and who conducted the product check. Overall, the process was cumbersome and error-prone.
With the IntelliFlowRx system, rather than having to sort a stack of labels, the technician starts the process by printing a pick list. This simplifies the process for the techs, as they know at the outset what ingredients they will need, the number of doses, and products to bring to the IV room. They are no longer guessing or grabbing more products than they need. In short, it organizes their workflow.
Once they are in the I.V. room, the system walks the technician through the process of how to prepare the product. It also documents — on camera — each step of the process as the product is being prepared. The bar-code system allows us to track the lot number and expiration date of every vial or solution. The pharmacists then have access to a web-based program where they can view what doses are available to be checked. This lets the pharmacist track exactly where we are in the process so that if they get a call from the floor they can easily report the status. Our pharmacists really appreciate the ability to monitor compounding remotely. The need to fully gown and glove and go into the IV room to conduct a double check is eliminated. All monitoring can be done from any station we choose within the department or on our mobile workstations. From their workstation, the pharmacist can see exactly what steps the technician took, including what drug was pulled, what solution was used, how much was put in, and what the final product looks like. We have even loaded the program into the pharmacists’ laptops so they can take it on the floor with them.
The system also offers alerts. If the technician chooses a wrong drug or one that is not in the formulary, an alert will stop them. Occasionally, staff can develop bad habits or workarounds. With IntelliFlow’s monitoring capabilities, we are able to pinpoint these issues and retrain our staff. This helps us not only to standardize our processes, but also to ensure that no deviations are occurring. The reporting capabilities allow us to track how many doses we are compounding. It also tracks the products we are using, which makes inventory management easier. And most importantly, we are able to actually see what the technician has done and conduct a thorough check. This is a safety issue that allows us to feel confident that our compounded products are accurate and correct.
Implementing the IntelliFlowRx system has helped us manage our workflow in the I.V. room. Our activities are now organized and every step in the process is documented. The implementation process also demonstrated areas where we had some defects in training, allowing us to institute a retraining process to ensure all staff is following standardized practices. In addition, we now have the ability to track products that have been prepared incorrectly, allowing us to catch errors before they become an issue. From a safety standpoint, the IntelliFlowRx system has given us the ability to ensure we provide the right drug to the right patient.
Toni Covato, RPh, MS, has worked as pharmacy director at Flagler Hospital for the past 15 years. She graduated from Duquesne University and obtained a master’s degree in drug information from Case Western.
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