Pharm Team hits a homerun for safety and savings

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Pharm Team hits a home run for safety and savings

The Children’s Pharmacy is home to more than 60 phar¬macists and 130 pharmacy technicians and interns, working behind the scenes to verify and dispense thousands of medication doses daily. It’s almost inconceivable that, until recently, tracking that process was completed manually.

Peter Lutz, PharmD, associate director of Pharmacy, was certain that barcode track¬ing was the perfect tool for Pharmacy, but no healthcare technology companies seemed interested in developing a prod¬uct that provided the kind of closed-loop accountability the hospital wanted. “You’ll be asked to fill an order for one medicine, and there are five different versions of it available,” says Lutz. “Pharmacy technicians were filling hundreds of orders a day without using barcode scanners. What are the chances that the wrong version was never going to be selected? Meanwhile, they’ve been using barcode scanners in grocery stores since the 1960’s.” Recently, Lutz oversaw the implementation of two new barcode scanning systems in Pharmacy—one of which was developed in-house at Children’s—that have increased efficiency and safety, while saving the hospital millions of dollars.

The first system, DoseEdge, applies barcode scanning, automat¬ed calculations, step-by-step recipe instructions and digital photos to the preparation of IV doses, reducing the potential for error and al¬lowing pharmacists to complete the final check of their order faster and from any computer on the hospital network. Manual calcula¬tions that used to be performed using calculators and paper log sheets are a thing of the past. Now, pharmacy technicians scan the IV label’s barcode and all the information they need is immediately projected on their computer screen. If the wrong medication is cho¬sen, DoseEdge won’t allow the technician to continue, and provides step-by-step instructions for exactly how to proceed. As each dose is prepared, the technician takes digital photos of each step that a pharmacist can access remotely for review. By allowing pharmacists to double-check orders remotely as soon as they’re made, Pharma¬cy has reduced the average time it takes to deliver an IV medication to a patient by 20 minutes.

The second system, Medication Tracking—affectionately known as “PhedEx”—continues on where DoseEdge leaves off. A system of software and customized applications and hardware, Medication Tracking was designed, developed and implemented by Pharmacy’s Crystal Tom, PharmD, BCPS, and James West, CPhT, Application Specialists Christopher Hynds and Dennis Gotto from Information Services, and a team from Pharmacy Nursing. With the sponsorship of Eileen Sporing, MSN, RN, SVP of Patient Care Operations and chief nursing officer, Dan Nigrin, MD, MS, chief information officer, and Scott Ogawa, chief technology officer, Medication Tracking was created over the course of two-and-a-half years.

With Medication Tracking, the technician uses a barcode scanner to verify that the medication chosen to fill an order is correct before forwarding it to the pharmacist. Once the pharmacist reviews the medication and marks it “verified,” it’s passed along to a courier with a handset/mobile barcode scanner, who again scans the medication label to confirm possession, then scans another barcode at the door, in order to track departure time. The courier scans another barcode at the patient’s room to confirm time of delivery—and that the delivery is being made to the right place. If the patient is transferred to another unit while their medication is en route, the courier is notified in real-time, and can change course without delay.

Both DoseEdge and Medication Tracking are also tied directly into CHAMPS, the hospi¬tal’s clinical information systems. Medication Tracking is easily accessible by the doctors and nurses who work hand-in-hand with Phar¬macy. At any time, they can log into CHAMPS and check the exact status and location of any medication they’ve ordered.?“With DoseEdge and MedTracking com¬bined, you’ve got barcode verification all the way through the process,” says Al Patterson, PharmD, director of Pharmacy. “We track ev¬ery step from the time the doc decides to give the medication to the time it’s administered—what we call ‘from brain to vein.’ ”

Tracking every step of the process allows for further workflow improvements. Isolating the average time elapsed between steps allows Pharmacy to break down the process and mea¬sure vital metrics like turnaround times, person¬nel performance and systems performance.

Improving the medication process has also created tremendous opportunities to reduce waste. In the past, Pharmacy refilled batches of specific IV doses, such as antibiotics, every 24 hours. Many of those doses ended up be¬ing changed or discontinued before they were administered. As a result, roughly 30 to 50 percent of those doses were not administered and were wasted. “In an adult institution, that’s not a big a deal because those doses can be transferred to another patient,” says Patterson. “In pediatrics, 70 percent of the time, the doses are patient-specific based on size or age and can’t be recycled.”?“We had long since realized that it was better to make doses more frequently, but we were limited in our space and staff time,” says Lutz. “When everything was done on paper, it could be hours before we found out we needed to change or stop a medication.” With the real-time online communication provided by CHAMPS, Pharmacy was able to open a satellite on 7N, closer to the patients, where they can make IV refills every two hours instead of every 24. The result? In 2009 and 2010, Pharmacy reduced their cost of wasted medication by a combined $3 million—and they’re not finished. The hospital is currently awaiting FDA approval of hardware that will allow IV pumps to communicate directly with CHAMPS. This will allow continuously administered medications and infusions (IV “drips”) to be prepared when needed while providing another level of support for some of the highest-risk medications.

While the cost savings are exceptional, Patterson emphasizes that the driving force behind all of the improvements they’ve made in Pharmacy is always patient safety. “What Pete and his team did was take our existing CHAMPS systems and add safety checks that didn’t exist before, in order to build one of the safest overall hospital medication systems there is,” says Patterson. “Pharmacy at Chil¬dren’s just took a quantum leap.”

Boston Children’s is so much more than a hospital—it’s a community of researchers, clinicians, administrators, support staff, innovators, teachers, patients and families, all working together to make the impossible possible. ”
- Sandra L. Fenwick, President and CEO

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