Mar 23, 2015The pharmacy department at Toronto's North York General Hospital (NYGH) has found that an RFID kit-checking solution that it recently installed to manage its pharmaceutical trays not only eliminates errors, but also reduces tray-restocking times by, on average, 4.9 minutes. That equals 659 labor hours saved annually, according to Edith M. Rolko, NYGH's director of pharmacy and infection prevention and control.
With the Intelliguard Kit and Tray Management System, developed by MEPS Real-Time Inc., a passive ultrahigh-frequency (UHF) RFID tag is attached to each medication, which is then put in a tray and placed inside of a workstation with a built-in Impinj RFID reader. The system also comes with Intelliguard software, residing on the pharmacy department's database, that links each tag ID number with the medication's name, dosage, Drug Identification Number (DIN), National Drug Code (NDC) number, lot number and expiration date. The purpose is to ensure that trays are accurately restocked, with nothing missing or expired.
North York General Hospital is affiliated with the University of Toronto, and is one of the largest community academic hospitals in Canada offering acute-care, ambulatory and long-term services. Its pharmacy department employs 35 pharmacists and 35 technicians who not only fill individual medication prescriptions for patients, but also prepare and manage the trays that are sent to patient-care departments for use on an as-needed basis.
The majority of the trays are dedicated to resuscitations, and are transported around the hospital in crash carts for use during emergency events. The pharmacy provides two types of resuscitation trays for adults, and one for pediatric patients. The pharmacy department also supplies OR tray medications typically used by anesthesiologists. Altogether, there are 28 OR trays, 104 resuscitation trays, six trays for labor and delivery, six for endoscopy and five OR trays for day surgeries performed at the hospital's ambulatory care site. Trays commonly have between 78 and 138 medications packed in them, which has been traditionally very difficult for an RFID system to read.
Before the automated system was implemented, a pharmacy technician would need to manually check every medication in every tray sent back to the pharmacy department after it was used. This process of identifying any missing drugs, and thereby ensuring that none are nearing expiration dates or have been recalled, was extremely labor-intensive, the hospital reports, and could only be carried out by a technician with certified training. In the case of trays used for resuscitating a patient, a second individual would check the first technician's work.
Regulations vary in Canada and the United States—in some provinces or states, a technician must complete this task, after which a pharmacist must check that person's work. In some locations, such as in Ontario, regulated technicians can do the work themselves as part of their scope of practice. However, North York still required that a second technician confirm that each resuscitation tray was packed accurately before it could be sent to one of the hospital's departments. With the Intelliguard System, the second technician review is no longer necessary.
First, technicians apply an RFID tag to each medication. These "flag tags"—made with Impinj's Monza chips, using an RFID inlay reference design created for this use case by Impinj for MEPS—are designed so they stand away from the medication container's surface, thereby not obscuring the serial and lot numbers and manufacturer information printed on the container. The unique ID number encoded to each tag is linked to the medication's name, dose, expiration date, and NDC, DIN and lot numbers. Pharmacy personnel use a bar-code scanner (included with the MEPS workstation) to scan the manufacturer's medication label and program that data into the Intelliguard Kit and Tray Management software. The tagged medication is then placed inside the Intelliguard workstation, and staff members use the system's touchscreen to prompt the programming process, which encodes the tag with a unique ID number, then marries that ID to the medication's manufacturer information. RFID tags are programmed in batches by lot number and expiration date.
NYGH has two Intelliguard workstations: one in the pharmacy department's inventory room and used for encoding, the other in its main pharmacy and allocated for restocking. Each is considered its own system, though they share a database.
When a tray comes back from the hospital's patient care area, technicians in the main pharmacy must restock all medications that have been removed or used from that tray. First, the Intelliguard system reads the ID numbers on the tray's tags, compares them against that tray's assigned drugs and displays a list of all items that are missing, expired, recalled or soon to expire. Workers then restock the tray accordingly with RFID-tagged medications from the pharmacy shelves.
The Intelliguard system reads the tags of the tray's medications again, and displays a new list indicating that everything is correctly loaded in the tray, or identifying any mistakes that still need to be fixed. If any pharmaceuticals need to be removed because they have expired or will soon do so, that information is also displayed on the screen. Once satisfied, the technician prompts the system to print a report for that tray. That approval report is placed with the tray, which is then sealed in a plastic bag for deployment to the clinical care area.
The pharmacy department is also employing the system for billing purposes. When the OR uses medications, the pharmacy sends a bill to that department—something that was previously accomplished manually after each drug on the tray was used. Now, the Intelliguard system generates the billing automatically, by identifying which items were removed from each tray, and assembling them into a single monthly billing statement for each responsible department.
The system was taken live in October 2014, and the hospital then conducted a study to evaluate the technology's effectiveness in making the medication tray stocking process faster and more accurate. Rolko presented the study's findings at the Canadian Society of Hospital Pharmacists' Banff Seminar, held on Mar. 20-22 in Alberta. The study showed that using the Intelliguard solution to track each medication restocked in the trays was 100 percent accurate over the course of 16 individual tray restocking events, and that the system saved between two and 14 minutes of processing time for each tray.
The manual method of restocking trays, Rolko reports, "was so labor-intensive." When the hospital began seeking technology solutions, she says, it initially could not find anything that would work. It selected the Intelliguard Kit and Tray Management System because the tags are very small—1 centimeter by 2 centimeters (0.4 inch by 0.8 inch)—and do not cover the medication labeling, making it easier for clinicians to use. This is specifically important to anesthesiologists, who did not want large RFID tags impairing their ability to view a specific medication label. Rolko says she was pleased that the Intelliguard system requires that tags be encoded only when they are already affixed to a medication, thus preventing mistakes that could occur by placing a pre-encoded and/or printed tag on the wrong drug, thereby linking an incorrect item to that tag in the software.
The Intelliguard system has helped in other ways as well, Rolko says. For instance, when staff members found several pharmaceuticals with missing re-date labels in the refrigerator, they could still identify the drugs' expiration dates by placing each item into the Intelliguard workstation and reading its tag. In the past, she notes, such an incident would have required that workers throw the medications away.
In the future, Rolko says, she hopes to begin offering more surgery-specific trays for anesthesiologists in the OR. For instance, because the restocking of trays is no longer as time-consuming and labor-intensive as it was in the past, the pharmacy department believes it could restock trays specific to particular surgeries, such as cardiac or pulmonary procedures.
About once a week, Rolko says, a pharmacy department from another medical facility sends a representative to observe what North York General's pharmacy department is doing with RFID.
Shariq Hussain, MEPS' CEO and president, says that every installation of an Intelliguard Kit and Tray Management System is slightly unique to the hospital using it. The software can be offered as a standalone solution, with all software residing on the units themselves, or it can reside on a hospital's database, as is the case at North York General. A third option is to use the technology as a cloud-based service, with data residing on a MEPS-hosted server. "The software structure is very flexible for our customers," he states.
Although North York General Hospital opted to use two workstations—one for encoding tags, the other for restocking trays—smaller pharmacies are accomplishing both tasks using a single unit. The workstations can be mounted under or atop a counter, Hussain says, and can vary in size from 8 to 13 inches in height, depending on the form factor desired by a particular customer.
