1
RFID: Another Way to Ensure Safety P reventing medication errors should be at the forefront of every discussion about institut- ing a new technology such as radiofrequency identification (RFID), according to William W. Churchill, MS, RPh, FMSHP, the chief pharmacy officer at Brigham and Women’s Healthcare (BWH), in Boston. When he first discussed RFID tech- nology with senior executives, Mr. Churchill talked about “the intangibles,” rather than cost, when weighing the technology’s benefits. “I did not go into this intend- ing to save money. It is not a cost-saving initiative initially, due to the expense of the tags and the equipment nec- essary to use the system. In our case, this was a quality improve- ment, medication-safety proposal,” Mr. Churchill said. “Being able to articulate the value proposition is the key to whether or not you get the senior leadership support to be able to move ahead with something like this.” Geoffrey Cox, PharmD, the director of pharmacy services at Medstar Georgetown University Hospital, in Washington, D.C., said after the initial setup, an RFID system should not only save technician and pharmacist time, which can then be directed to some other area of the pharmacy, but also better manage inventory and prevent waste—all issues that help the bottom line, which can sweeten the discussion with the financial folks. Dr. Cox said his team uses Kit Check RFID to track the location, expiration status and inventory levels for medications in several key areas, including anesthesia trays, code carts and emergency kits. For cart fill, he noted, replenishment “takes only a few minutes. When we did it manually, it took more than 30 minutes.” He added that since implementing the RFID system, no one in the operating room (OR) has complained about expired medications being found on the trays. To further streamline the use of RFID, Georgetown purchases PharMEDium anesthesia syringes that are tagged with the radiofrequency chips, Dr. Cox noted. “PharMEDium provides prefilled syringes that are embedded with RFID labels, so we don’t have to do the tagging process,” he explained. “We just scan them and the information is updated into our system, and the trays are ready to go.” The BWH pharmacy uses two different RFID technologies, Mr. Churchill explained. Kit Check RFID is used in the OR anesthesia and code carts to ensure that medications are available imme- diately for complex surgical cases and are not expired. “We’ve been using RFID for a few years now. We’ve had nearly 2 million doses of medication that have been prepared, sent and delivered using RFID with zero errors at this point. It would be difficult to get better results than that,” Mr. Churchill said. BWH also uses Cardinal Health’s RFID technology for managing blood clotting factors. Cardinal Health provides an RFID refrigerator, and the factors come into the hospital already tagged with RFID labels. “All of the activity [with the clotting factors] is tracked. When we get to a point that we go below par, the system cues us up to order replacement supplies,” he said. In addition, it warns when products are about to expire. “Not only does this give us tracking of very expensive medications, but also it gives us some cost savings because we are on an inventory consignment program and don’t have to store millions of dollars’ worth of clotting factors in our inventory, as well as we have virtually eliminated waste due to outdated factors.” A Flexible Technology RFID, which uses radiofrequency waves at several different frequencies to transfer data, is being used in several areas of the pharmacy, according to a recent review (AMIA Annu Symp Proc 2015;2015:1242-1251). However, RFID is not being adopted as quickly as other medication safety and tracking technologies, such as barcoding, the review pointed out. But Dr. Churchill noted that there is a place for both scanning systems, especially in the pharmacy. CHRISTUS Spohn Health System – Shoreline in Texas just recently implemented technology by Intelliguard RFID Solutions, noted Leigh Ann Frachiseur, the pharmacy technician supervisor. Although the initial implementation was quite time-consuming, the new technology does save time in the long run, while improving inventory control and reducing waste. “One of the areas where it helps us the most is keeping up with outdated meds or meds that will expire soon. We can pull them from one cart and put them somewhere else,” Ms. Frachiseur said. “So, for example, we have three vasopressors that are going to expire in this kit; we can take them out of that kit and use them in our IV lab instead.” Because implementation is still fresh in her mind—the technology was implemented in May— Ms. Frachiseur could offer a few tips. She said plan for the work up front, and make sure there are enough staff to tag the drugs and enter the information. And if the budget allows, purchase enough inventory to do all the kits at once, rather than individually. “We were on a tight budget, so we would get enough tagged for one kit, then pull all the untagged items and get them ready for another kit,” she said. “It was a lot of extra work.” Don’t be afraid to ask the company for help with the initial tagging, Ms. Frachiseur added. Dr. Cox said having the company help would not only save labor setup costs, but also the company representative would be on-site to answer any questions during the implementation. Ms. Frachiseur told Pharmacy Technology Report that technicians should be warned to watch where the tags are placed on the syringes. “If you put the tag on the plunger, it won’t go into the syringe. It’s a little thing,” but it will really frustrate the nurses, she added. Frustrated nurses will hurt staff buy-in, and that buy-in, not only from nurses but also anesthesiolo- gists and other hospital physicians, is important, Dr. Cox said. They have to understand why phar- macy is changing their carts. “I think the implementation should be in two phases: The pharmacy department staff gets buy-in because it can be seen as a lot of work initially. Everything has to be input into the pharmacy programs and electronic health records. They have to tag all the drugs. “Then you have to educate the departments. They have to know what is in it for them, and that is that they won’t see any more expired drugs,” he said. In the ER or OR, “there is usually no time to waste, so you want to make sure that they always have a good drug that is not going to expire.” Mr. Churchill recommended that pharmacies take the time to understand their existing pro- cesses and how RFID will change them. Look at how resources are deployed and how they will be deployed once the technology becomes routine. None of the sources reported any relevant financial relationships. Reprinted from ‘I did not go into this intending to save money. In our case, this was a quality improvement, medication-safety proposal.’ —William W. Churchill, MS, RPh, FMSHP
