Help­ing track crash cart med­i­ca­tions

Modern Healthcare - - INNOVATIONS - By Adam Ruben­fire

Crash cart duty is a task that hospi­tal phar­ma­cists and phar­macy tech­ni­cians dread. It re­quires metic­u­lously count­ing through large trays full of med­i­ca­tions to de­ter­mine what was used by clin­i­cians so re­place­ments can be made, while also mak­ing sure that no drugs have ex­pired.

Tak­ing in­ven­tory of crash cart trays and other med­i­ca­tion trays con­sumes time that phar­ma­cists could other­wise spend ed­u­cat­ing pa­tients, which they’re in­creas­ingly asked to do as providers shift to value-based care. Even in this age of elec­tronic record­keep­ing, some phar­ma­cies still record the in­ven­tory in hand­writ­ten log­books.

“Here’s a per­son who’s very highly ed­u­cated, very highly com­pen­sated, mainly pick­ing up (and count­ing) vials,” said Kevin Mac­Don­ald, a tech­nol­ogy ex­ec­u­tive who heard about the process and de­cided he could come up with a bet­ter way.

Mac­Don­ald, who had no ex­pe­ri­ence in health­care, con­cluded hos­pi­tals could use in­ex­pen­sive mi­crochips em­ploy­ing ra­diofre­quency iden­ti­fi­ca­tion tech­nol­ogy, or RFID, to take in­ven­tory of the trays. He says the so­lu­tion he de­vel­oped, called Kit Check, al­lows hospi­tal phar­ma­cies to cut the time it takes to fill kits and trays by 70% to 90% while also vir­tu­ally elim­i­nat­ing er­rors.

The tech­nol­ogy, first de­ployed at the Uni­ver­sity of Mary­land Med­i­cal Cen­ter in Bal­ti­more in 2012, has three com­po­nents: RFID tags that can be at­tached to vials and pre­filled sy­ringes, cloud-based soft­ware and a RFID scan­ner that looks like a mini re­frig­er­a­tor.

Phar­macy tech­ni­cians print the tags in-house and add them to drugs soon af­ter re­ceiv­ing a ship­ment. Pre­tagged med­i­ca­tion is avail­able from unit-dose repack­ager Safecor Health and PharMEDium, an AmerisourceBer­gen sub­sidiary. Hos­pi­tals can buy blank tags un­der sev­eral group pur­chas­ing con­tracts through ma­jor dis­trib­u­tors such as Car­di­nal Health and AmerisourceBer­gen.

Af­ter a kit is used, phar­macy tech­ni­cians place it in­side the scan­ner, which comes in a va­ri­ety of sizes and can be con­nected to any com­puter able to ac­cess the cloud-based soft­ware. The soft­ware as­sesses how many vials or sy­ringes are miss­ing and need to be re­placed, gen­er­at­ing a list of re­place­ment drugs that’s dou­ble-checked and ap­proved by a phar­ma­cist. The tray is then re­filled based on that doc­u­ment, which also lists ex­pi­ra­tion dates for each med­i­ca­tion in the tray, with the ear­li­est noted in large print at the top.

The cost of the sys­tem is based on how many RFID tags are pur­chased; they cost roughly a dol­lar each. The to­tal can be any­where from $30,000 to $300,000 a year, de­pend­ing on the ex­tent of the de­ploy­ment. There is no charge for the hard­ware and soft­ware.

Carls­bad, Calif.-based MEPS Real-Time of­fers a sim­i­lar so­lu­tion called In­tel­li­guard. Mac­Don­ald says Kit Check has stronger dis­trib­u­tor part­ner­ships and has the ad­van­tage of us­ing cloud-based soft­ware and be­ing more con­fig­urable to a provider’s spe­cific needs.

The tech­nol­ogy al­lowed Mount Sinai Hospi­tal in Chicago to re­duce the time phar­ma­cists and tech­ni­cians spend check­ing trays by about 75% to 80%, said Sameer Shah, di­rec­tor of phar­macy and res­pi­ra­tory ser­vices. The soft­ware also helped Shah de­ter­mine the hos­pi­tals were sig­nif­i­cantly over­stock­ing the trays and there­fore could re­duce in­ven­tory by about 50%.

Mount Sinai, which adopted Kit Check in June 2015, cur­rently uses it for trays in the op­er­at­ing and la­bor/de­liv­ery rooms, but soon the tech­nol­ogy will also be used for crash carts and emer­gency boxes.

Mac­Don­ald wants to ex­pand Kit Check to in­clude more tools to help hos­pi­tals man­age their sup­ply spend, the sec­ond-big­gest ex­pense af­ter la­bor costs. The OR in par­tic­u­lar is a “black hole” in med­i­ca­tion man­age­ment, he said, be­cause clin­i­cians don’t al­ways doc­u­ment what med­i­ca­tions are used. “What we’re re­ally do­ing is giv­ing the hos­pi­tals bet­ter vis­i­bil­ity and con­trol over what’s hap­pen­ing with their meds.”

Kit Check uses RFID tags to help phar­ma­cists track med­i­ca­tions used in crash carts.

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