Managing medication trays in acute care pharmacy

Medication trays – a.k.a. med trays, code trays/kits/boxes/bags, transport trays/kits/boxes/bags, intubation kits, C-section trays, anesthesia trays, and so on ad infinitum – are common in acute care pharmacies.  I’ve seen them in every variation you can imagine in every pharmacy I’ve ever been in.

Depending on the situation, med trays can contain a large number of injectable medications. For example: code trays may contain several different neuromuscular blockers like vecuronium, rocuronium, succinylcholine; pressors like epinephrine, norepinephrine, phenylephrine;  other code drugs like atropine, vasopressin; reversal agents like naloxone and neostigmine; antibiotics, etc, while a C-section tray may contain local anesthetics in various shapes and sizes (lidocaine with or without EPI, SDV or MDV, bupivacaine of various concentrations, etc). The list goes on. It’s pretty crazy.

Anesthesia_Tray
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Saturday morning coffee [March 21 2015]

“Life is a dream for the wise, a game for the fool, a comedy for the rich, a tragedy for the poor.” – Sholom Aleichem

So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

I was sitting in The Main Street Café in Visalia, CA having breakfast with my brother when I saw the sign below hanging on the wall. Perk ‘Em Up….would make a great name for a coffee shop, no? Just in case you were wondering, the staff was great, but the food was mediocre. The pancakes weren’t very good at all. No flavor. Bacon was good though.

MUG_CoffeeShop
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Cool Pharmacy Technology – Intelliguard RFID Solutions from MEPS Real-Time

Last week I spent some time down south in San Diego visiting a couple of hospitals and speaking with the good folks at MEPS Real-Time. My objective for the visit was twofold: 1) see MEPS RFID Solutions in a live environment, and 2) speak with the people at MEPS and get an inside look at their technology. I was able to accomplish both goals.

MEPS Real-Time is a company that specializes in providing RFID solutions for healthcare specifically targeted at acute care pharmacies. Their Intelliguard® RFID Solutions product line currently includes a Kit and Tray Management System, Controlled Temperature Cabinets, and a Vendor Management Inventory (VMI) System.

MEPS_RFID_TAG
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#ASHP Midyear final thoughts

I concluded my time at ASHP Midyear in Anaheim on Tuesday evening. Here are my parting thoughts.

  • The show felt more lively this year than the past couple. It’s hard to explain, but it felt like people were interested in everything around them; a good sign.
  • There was an infusion of new products in the exhibit hall. The “normal” stuff was there, but it is clear that the vendors are once again ramping up. The introduction of meaningful use several years ago put a stranglehold on pharmacy budgets and projects. Everyone put all their eggs in one basket, i.e. all resources redirected to a single goal. During that time hospital pharmacies entered a black hole in regards to the implementation of new technology. It appears that equilibrium has been restored.
  • The “Pharmacy of the Future” Pavilion was anything but the pharmacy of the future. It was nothing more than a giant advertisement for the vendors. Nothing stood out as futuristic.
  • There was virtually no discussion/exhibits for track and trace. Given the state of H.R. 3204, the Drug Quality and Security Act (DQSA), this is going to be a big deal over the next several years. I expected to see more. Then again, the exhibitors have to reserve their booths a year in advance. Hard to plan around that.
  • Didn’t see much to do with Telepharmacy. In fact, I can only think of a single exhibit and that was an outpatient system.
  • The acquisition of CareFusion by BD is interesting for several reasons, but I wonder how the two companies will handle their i.v. workflow management systems. CareFusion has PyxisPrep and BD has BD Cato. Given the limitations of PyxisPrep in its current state it would be hard for me to imagine them not going with BD Cato as their flagship system in the i.v. room. Only time will tell.
  • The acquisition of CareFusion wasn’t the only big move that BD made this year. Apparently BD has partnered with Aethon for medication tracking outside the pharmacy.
  • Envision’s exit from the i.v. workflow management space should be interesting. With their intellectual property for image capture/remote verification going to BD, I wonder what will become of the rest of the product, i.e. the software. The product had a solid foundation and some nice functionality. Hmm, gives me a couple of ideas.
  • APOTECA was conspicuously absent from the exhibitor floor. I found that odd considering that they are one of only two manufacturers of hazardous compounding robots in the U.S. The company also introduced a semi-automated i.v. workflow management system, APOTECAps earlier this year. I fully expected to see the products on display at ASHP Midyear. Not the case.
  • Omnicell entered into an agreement with Baxter to both sell and integrate with DoseEdge. This should allow Omnicell to track CSPs prepared with DoseEdge throughout their suite of products. Everyone is scrambling to get into the i.v. room.
  • As mentioned previously, Closed System Transfer Devices (CSTDs) seemed to be popular among the exhibitors. At least three separate companies – EQUASHIELD, BD, ICU Medical – were showing off their products. I’m not surprised with USP <800> looming in the not too distant future.
  • RFID seems to finally be picking up some steam in pharmacy practice. Several companies were displaying RFID solutions. Several others announced partnerships with those same companies. The most popular areas for RFID appear to be refrigerated inventory management, anesthesia, and medication trays/carts.

CareFusion announces partnership with Kit Check at #ASHP Midyear

Last night I attended the first ever CareFusion Insider Event held at ASHP Midyear. The event was designed to spotlight CareFusion and their product line. Some new things were announced like the introduction of a Pyxis Mini and a new focus for the Rowa Dose System. CareFusion has had the Rowa Dose System for a while, but it was initially targeted at markets outside the U.S.

Something I hadn’t expected was an announced partnership with Kit Check. I have written about Kit Check and Anesthesia Check before.

According to the press release “today announced the companies will partner by connecting their hardware, software and RFID solutions to offer improved efficiency and accuracy in medication handling from pharmacy dispensing to OR point of use”.

It’s unclear how deep the integration will run, but it’s clear after last night’s event that CareFusion is pushing a more integrated approach across the entire healthcare continuum.

I’ll be stopping by both the Kit Check and CareFusion booths over the next couple of days to find out more.

#ASHP Midyear 2014 game plan

ASHP Midyear is next week in Anaheim, California. I arrive in Anaheim on Sunday afternoon, and will be there until Wednesday morning. I always look forward to Midyear as it gives me an opportunity to connect with friends I haven’t seen in a while and learn some new things.

One of the great benefits that Midyear offers me is an opportunity to look at large amounts of pharmacy automation and technology in one place at the same time. Midyear is the only place where you will find so many vendors in one space. The exhibit hall is typically full, and it’s where I spend a lot of my time.

While I enjoy visiting with all the exhibitors, limited exhibit hall hours means that I have to prioritize where I spend my time.

My must-see list this year includes:
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Pharmacies and RFID

RFID technology is intriguing in many ways. It offers some advantages over bar code scanning technology, but then again it tends to be more costly and labor intensive. I’ve always thought RFID technology would find significant use in pharmacy practice, but that hasn’t happened. It has found some niche areas in healthcare, but not to the extent that I thought it would.

I read two RFID articles over the weekend, and on the surface they appear to be in stark contrast. But after giving it some thought I’m not so sure that’s entirely true.
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Kit Check passes 100 customer mark

Kitcheck.com: “Kit Checkâ„¢ … today announced that over 100 hospitals are using its cloud-based software solution. The first customer site was installed at the University of Maryland Medical Center in April 2012 and the user base has grown quickly, including more than 50 sites added since January 2014.” – Pretty interesting numbers coming from Kit Check once you get past the marketing jargon. Yeah, I’m calling shenanigans on this statement in the press release: “Kit Check Vice President of Sales Doug Zurawski, Pharm.D., commented, …  “Kit Check already represents the fastest adoption rate in history for hospital pharmacy software and our growth continues to accelerate.” Fastest adoption rate for hospital pharmacy software in history? I’d like to see the fact checking for that statement. I’m going to reserve the right to take that statement with a healthy dose of skepticism. Still, having 100 customers using RFID technology to manage medication trays is pretty impressive.

If you’re more than just a casual reader of this blog then you know that I support RFID technology and believe that it has a niche in pharmacy practice. And one of those niches is medication tray management.

I first mentioned Kit Check back in January 2012. Back then Kit Check was really the only game in town, but times have changed. Not by much, but they’ve changed. Today Kit Check is directly challenged by Intelliguard by MEPS Real-Time, Inc, and to a lesser extent MedKeeper. Each has their potential pros and cons.

Does this mean that RFID is poised to take off in pharmacy practice? Hardly, but it does mean that people are beginning to see the potential benefits of using this type of technology. As long as the companies in this space continue to improve usability I can see potential uptake in the near future.

RFID vs barcode technologies

MedKeeper: “Based on similar use cases, the comparison between bar code and RFID technologies is inevitable. Several papers have reviewed the use of these technologies in hopes of defining best practice. Young concluded that a coordinated use of these technologies might provide the best compromise between implementation costs and potential benefits.   RFID technology, with its high cost, may be most appropriate for patient identification, while the lower cost of bar code systems may be more appropriate for material inventory.[3]

Sun et al.[4] arrived at a similar conclusion. In this case, the authors evaluated medication error reduction. Due to the high cost of RFID tags and readers the authors proposed a system utilizing less costly bar codes for unit-dose medications while using an RFID-embedded wristband worn by patients for identification.”
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