implementing technology to improve medication safety and efficiency in the pharmacy kelley reece,...
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![Page 1: Implementing Technology to Improve Medication Safety and Efficiency in the Pharmacy Kelley Reece, Pharm.D. Assistant Manager MD Anderson Cancer Center](https://reader038.vdocument.in/reader038/viewer/2022110205/56649c755503460f9492826d/html5/thumbnails/1.jpg)
Implementing Technology to Improve Medication Safety and Efficiency in the Pharmacy
Kelley Reece, Pharm.D.
Assistant Manager
MD Anderson Cancer Center
Houston, Texas
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MD Anderson Cancer Center (MDACC)Division of Pharmacy
• 557 Pharmacists and Technicians• 14 Production Areas• Ambulatory Treatment Center (ATC) prepares
135,000 chemotherapy doses/yr.
Photo courtesy of MD Anderson
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Chemotherapy Preparation Risks
High-risk patient population
Narrow therapeutic range drugs
Sound-alike/look-alike
drugs
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I.V. Chemotherapy Preparation Errors Exploratory Study
• Field observations at six Canadian cancer centers– Reconstitution (2 sites)
• No diluent verification
– Mixing (5 sites)• Multiple preparations in the biological safety cabinet
(BSC)
– Labeling (3 sites)• Patient-specific label not paired with bag
White R, et. al. J Oncol Pharm Practice.2013 Feb 1. [Epub ahead of print]
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Medication Error Reporting
• Dispensing errors range <0.1% up to 65%– Methods of detection unreliable
• MDACC preparation errors– Self reported error rate 0.12%– Most frequent reported errors
• Wrong amount of IV fluid• Wrong IV fluid• Wrong amount of drug
White R, et. al. J Oncol Pharm Practice.2013 Feb 1. [Epub ahead of print]
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Manual I.V. Preparation Process
Photo courtesy of K. Reece
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Failure Mode and Effects Analysis for I.V. Preparation Steps
• Process steps – detail, detail, detail• Failure modes – What could go wrong?• Failure effects (severity)• Causes (probability)• Controls (detectability)• Process improvement / recommended
actions
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MDACC FMEA Process SummaryI.V. Process Steps # of Steps # of Failure Modes
1) Review Label 4 19
2) Gather Components 8 28
3) Preparation Plan 8 24
4) Vehicle Bag Preparation 13 49
5) Vial Preparation 23 106
6) Final Product Preparation 12 58
* Vinca Alkaloids Process 15 19
* Intrathecal Process 14 31
Total 97 334
334 Potential Failures x 170 doses/day = 56,780 chances for error in one day
FMEA=failure mode and effects analysis
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MDACC Software Requirements
Gravimetric preparation
method
HL7 Interface with current
pharmacy software
Barcode scanning
Electronic documentatio
n
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BD Cato Implementation
• Initiated pilot in October 2012• Involvement from pharmacy, informatics, and
software vendor• 28 drugs currently in production• Over 15,000 products prepared
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BD Cato Hardware Components
Image courtesy of BD Cato
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BD Cato Software Features• Intercepts human errors in real-time• Order entry interface (HL7) enables dose management
queue• Standardizes process steps• Automatically documents preparation steps• Prints patient label with correct beyond-use date (BUD) and
infusion rate • Manages vial inventory• Records drug waste• Generates reports including productivity and inventory
management
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I.V. Management System Pilot Evaluation
SafetyProductivity
Waste
The Office of Performance ImprovementMiguel Lozano
Sr. Quality Engineer
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Potential Risk ReductionI.V. Process Steps # of Failure Modes
1) Review Label 19
2) Gather Components 28
3) Preparation Plan 24
4) Vehicle Bag Preparation 49
5) Vial Preparation 106
6) Final Product Preparation
58
* Vinca Alkaloids Process 19
* Intrathecal Process 31
Total 334
# of Failure Modes with I.V. software
16
14
20
2425
44
13
19175
52% of Failure Modes Impacted by BD Cato
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Detection of Preparation Errors
Pre Cato 5 months Post Cato
Total doses prepared 49910 2802Total errors
intercepted/self-reported611 1292
Error rate 0.12% (self-reported)
4.52% (intercepted by BD Cato)
1. All I.V. preparation errors2. One error type-drug volume out of 4% tolerance range
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Prep Times
Technician Mixing Pharmacist Verification0
1
2
3
4
5
6
7
8
9
10
Before PilotAfter Pilot
Min
utes
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Cost of Opened Vial Waste
Nov-12 Dec-12 Jan-13 Feb-13$0.00
$200.00
$400.00
$600.00
$800.00
$1,000.00
$1,200.00
$1,400.00
$1,600.00
$1,800.00
CYCLOPHOSPHAMIDE Vial Waste
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Cost Savings$47,430/year
Eliminated manual process steps
Non-Value Added
Indirect Labor Costs
$110,628/year
Decreased mixing and checking time
Direct Labor Costs
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The Joint Commission Sentinel Event Alert
• Warning issued about technology-related adverse events
• Suggested actions– Assess workflow processes– Careful planning and implementation– Staff training programs– Monitor continuously
The Joint Commission. Safely implementing health information and converging technologies. Issue 42; Dec 2008.
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Summary BD Cato intercepts errors in real-time System uses more accurate gravimetric
validation method Eliminates manual processes and standardizes
processes Provides step-by-step automated
documentation Allows barcode scanning for drug and vehicle Provides more efficient and accurate verification
process
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Questions?