JerryFahrni.com Podcast | Episode 4: UCSF Mission Bay Pharmacy

By | August 17, 2015

Show Notes:
Host: Jerry Fahrni

PillPick by Swisslog1
BoxPicker by Swisslog1
RIVA by ARxIUM (formerly Intelligent Hospital Systems)

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1. Make sure to check out the videos for both PillPick and BoxPicker at the Swisslog website.

4 thoughts on “JerryFahrni.com Podcast | Episode 4: UCSF Mission Bay Pharmacy

  1. Ray Vrabel, PharmD

    RE: Kit Check Comments

    I found it interesting that you said that UCSF-MB has cut back on their use of Kit Check and that they are no longer using Kit Check for their Anesthesia drug trays. The reason give to you was because of expense and that Kit Check was too labor intensive.

    I understand why they might say it is more expensive due to the additional cost of the RFID tag used on each vial of medication, but I don’t understand what makes it more labor intensive for them, since the literature from both RFID drug tray vendors (Kit Check and MEPS) promote the labor efficiency.

    What is causing their processes with Kit Check to be more labor intensive…?

    Thanks…

  2. Jerry Fahrni Post author

    I don’t really know, Ray. We didn’t spend much time on the subject. However, I think this is a common perception with RFID technology because of the front loaded work involved with having to tag everything prior to placing items in trays. It may save them time on the back end when they have to replace items, bill for items used, etc, but it’s all in the way you look at it I suppose.

    Part of the reason for the change was due to a consultant that came in and looked at their process. I don’t know the particulars, but changing what went through KitCheck was included in the recommendations.

    To each his/her own. I don’t have strong feelings either way regarding the use of RFID for trays. In my mind it makes sense in some instances, but not all.

  3. Ray Vrabel, PharmD

    RE: Use of IV Robots by UCSF-MB

    Thanks for the great review of the UCSF-MB IV Room automation technology. One thing I learned is that UCSF-MB was not the largest RIVA installation in the U.S. (with 3 RIVA Robots). Which hospital in Asheville has more?

    What I would like to better understand is what type of automation the UCSF-MB pharmacy is using in their Pharmacy IV Room for products that are NOT made by the RIVA robots? You said that they have 3 RIVA robots, running two shifts a day, and they are making ~500 CSP’s per day (batch production, no patient-specific IV admixtures). What about all of the other IV admixtures?

    You also mentioned that they are an Epic shop, but they are NOT using Epic Dispense Prep/Dispense Check functionality in their IV room? Therefore, what technology are they using to ensure that for each patient-specific IV has (1) the correct ingredients and (2) the correct drug admixture amount (dose) has been added to each IV?

    Given the fatal Pharmacy IV Admixture Medication Error that occurred last December in Bend, Oregon (i.e., a vial of rocuronium was used by the pharmacy staff to prepare a fosphenytoin drip), I would expect a technology-focused hospital, like this one, to be utilizing barcode checking of IV admixture ingredients (i.e., bag, drug vials) prior to preparation of patient-specific IV admixtures, at a minimum.

    Systems to barcode check ingredients are relatively inexpensive. In fact, they are “free” to users of some of the larger EHR vendors (e.g., Epic, MEDITECH). Even the imaging/gravimetric systems (e.g., DoseEdge, BD-Cato, i.v.SOFT) are a bargin in comparison to the costs of making Pharmacy IV Rooms almost as clean as Pharmaceutical Industry Sterile Manufacturing facilities (thanks to USP ).

    Hospitals that are not using IV Workflow Automation Systems to ensure that,

    (1) the right drugs are being used,
    (2) in the right bag of solution,
    (3) at the right dose,
    (4) for the right patient,

    are fooling themselves if they think they are avoiding “human failure” during IV preparation process. These “Four Rights of IV Preparation” are even more important that the Five Rights at the bedside when it comes to patient-specific IV admixtures. The reason is simple. When the nurse scans the barcode on the pharmacy-prepared IV bag at the bedside, the nurse “assumes” the usually clear solution in the bag actually contains the correct drug and dose indicated on the printed label.

    This assumption did not hold true in Bend, Oregon last December. The hospital pharmacy was not using any IV Workflow Automation at the time. The order for an IV bag of fosphenytoin was prepared using rocuronium and then checked by a pharmacist. The pharmacy IV label generated by the hospital’s EHR had the correct order information for the patient and when the barcode on that IV was scanned by the nurse at the patient’s bedside, the hospital’s bedside barcode scanning system confirmed that the nurse had the correct IV bag for that patient. Minutes later, after the nurse hung what was thought to be a fosphenytoin drip, the patient went into cardiac arrest and was determined to be brain dead, effectively “suffocated” by the IV dose of rocuronium without any available respiratory support (which is normally available when rocuronium is used by anesthesiologists). What a tragic way to die. Totally immobilized, unable to breath, move, or talk until you lose consciousness.

    Hospitals have spent millions of dollars complying with the USP requirement even though there was no body of published research evidence of a significant “sterile preparation issue” across all hospital pharmacies. Instead, it was stimulated by a few isolated cases to totally mismanaged IV preparation rooms. If nothing else, USP was a boon to the companies involved in cleanroom facilities and technologies, the sterile garbing companies, and the many consultants who are needed to plan, implement, maintain, and support for these systems.

    We now have pharmacies preparing the cleanest IV preparations possible, yet we have done little to ensure that these “clean solutions” actually contain what they are supposed to. What’s wrong with this picture? Without much fanfare, pharmacy has adopted a new motto when it comes to IV preparation: Clean, but Deadly!

    In the absence of minimal IV Workflow Automation (i.e., barcode scanning of ingredients), all it takes is one “human slip” like what occurred in Bend, Oregan and you end up with two sons who no longer have a mother. Pharmacy needs to step up to the plate and fix this problem before some pharmacy director has to explain this to Scott Pelley or Steve Kroft on “60 Minutes”. That is “five minutes of fame” I would not want to experience.

    I look forward to your update…

  4. Jerry Fahrni Post author

    Ray-

    In regards to largest IV room, I was speaking specifically about physical space. The largest IV room I’ve been in to date is Mission Health in Asheville, NC. It was big, and they were running two RIVA robots. So technically speaking, UCSF has the most RIVA robots I’ve seen in one pharmacy.

    I need to review my notes, but I believe UCSF said they were using DoseEdge for their non-RIVA CSP production.

    Agree with almost everything else you had to say. Pharmacies must take advantage of technology designed to improve safety in the IV room. At a bare minimum they should be using barcode scanning to verify ingredients against the actual order.

    Jerry

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