How confident is Riverside Methodist Hospital in its new wireless tracking system for medications since beta testing last April and going live in July?

So confident that in late January 2010, the 1,058-bed, tertiary care hospital in Columbus, Ohio, began to change its medication distribution process for inpatients. Rather than deliver to medication storage areas on each unit, Riverside has started to deliver medications directly to patient rooms. The plan is for each patient to have his or her own locked cabinet, bar coded as a secure location, in order to help nurses save steps and improve work flow.

The MedBoard bar code–driven technology (from Pharmacy OneSource) will track delivery to each box, Charles McCluskey, PharmD, director of pharmacy and pulmonary services at Riverside Methodist, told Pharmacy Practice News. Dr. McCluskey estimated that the strategy will deliver drugs to 850 bedside boxes in patient rooms versus 130 storage rooms pre-implementation—a sixfold increase in the scope of drug distribution.

With that significant expansion, “We hope to maintain or further reduce missing doses and lessen stress on the nurses,” Dr. McCluskey said. “Nursing leadership is pretty excited about this initiative.”

The plan arose after Riverside Methodist, part of the OhioHealth system, calculated its gains from using MedBoard to better manage the distribution and tracking of IV admixtures. The hospital processes approximately 6,000 medication orders per day; about 90 of them are stat orders, and nearly 800 are IV admixtures, including chemotherapy for an oncology clinic remote to the hospital.

In the first six months of use, MedBoard helped Riverside reduce lost medication waste by 32%. Projected savings for fiscal year 2010 exceed $90,000. “The majority of our waste is generated in the IV area because these are the expensive and perishable drugs. The clock starts once we make a solution,” Dr. McCluskey said.

MedBoard tracks in real time the preparation of medications and their delivery route from pharmacy to nurses; pharmacists and technicians scan labels through each step in the chain to instantly update the progress. Two HIPAA-compliant electronic status boards on plasma screens within the pharmacy display the priority, order status and location of each medication; authorized nurses can see the same on any hospital computer. Color codes show if medications are overdue (red), approaching overdue status (yellow) or in progress (green).

The ability to see where medications are in the distribution process reduces nurse anxiety, lessens phone calls or electronic messages to the pharmacy for missing doses (from nearly 175 per day to 90 per day over the six-month period), and reduces the number of wasteful reorders. Specific gains that Dr. McCluskey cites: $12,000 in freed-up time for a medication-safety pharmacist and $50,000 in hospital staff productivity, due to the fewer phone calls and missing medication requests. “We’re starting to see some significant improvements in the service of our nurse customers,” he said.

“Our goal is to get the highest-priority medications to patients within 15 minutes,” added Robert Hammond, RPh, MS, pharmacy operations manager at Riverside. MedBoard improves pharmacy performance and reduces staff diversion by identifying the latest person to handle the product, Mr. Hammond noted.

The pharmacy at Riverside Methodist is the first of 17 OhioHealth hospitals to use MedBoard, and there are no current plans to roll out this technology to the rest of the health system. However, Dr. McCluskey is already eyeing other ways to extract value from MedBoard:

• Track medications not only from order to administration, but back to the pharmacy if they haven’t been administered for any reason.
• Project more accurately the number of IV admixtures to prepare at different times, based on utilization rates and returns back to the pharmacy.
• Integrate with Riverside’s 100 Pyxis cabinets (each with two sidecars) to better understand where bottlenecks exist in the replenishment process.

Saint Barnabas Eyes Technology

Robert T. Adamson, PharmD, corporate vice president of clinical pharmacy services at Saint Barnabas Health Care System, West Orange, N.J., said his facility also is very focused on streamlining drug inventories and is interested in MedBoard’s wireless technology. “With increased pressures on the reimbursement side from payers, we want to move toward just-in-time inventory,” he said.

To that end, “we measure our effectiveness in managing inventory by turns, with a goal of [cycling through] inventory at least 12 times a year.”

If that goal proves elusive, a secondary target “is to at least take our Top 50 medications and turn them as often as we can, because they account for between one-fourth and one-third of our annual drug budget. We purchase 8,000 different pharmaceutical products each year. We want to manage the Top 50, including oncology, very well.”

As for the MedBoard approach, Dr. Adamson said “it’s a significant first step toward a true electronic tracking system that will help manage inventory within the health care environment.”

One particularly effective application for MedBoard, Dr. Adamson noted, would be in the management of manually prepared IV admixtures. The manual systems at most hospitals send IV admixtures to patient floors without tracking, in bulk shipments with other medications, he said. This prompts anxious nurses to call for status and location, which robs the nursing units and pharmacy of productivity; it also leads to wasteful reorders.

“Everyone experiences this particular problem to some degree. It’s something everyone would love to fix,” Dr. Adamson said. “When nurses say, ‘We’re missing medication X for patient Y, telling them ‘we don’t know where it is’ and ‘we’ll get back to you’ doesn’t cut it.”

Cost is certainly a factor driving the need for a better alternative. “Remember,” he said, “manually compounded medications are very expensive—up to $500 per dose—and are short-dated, sometimes with as little as two to six hours to use.” If such a dose is misplaced or expires, “we can’t just say, ‘we’ll make another one.’”

The situation also frustrates pharmacists “because they know they prepared an IV admixture for a patient,” he said. “Once it leaves their possession, until now they’ve had no way of knowing where it is. Since we can’t use Pyxis for IVs, especially those that are made custom, MedBoard is a bridge for more accountability, status updates and information that enables us to say ‘the filled order will be right over,’ if that is the case.”

Dr. Adamson and three of the six pharmacy directors from Saint Barnabas saw the MedBoard technology at the 2009 ASHP Midyear Clinical Meeting and were intrigued enough to arrange for an online conference/demonstration in mid-February. If they go ahead and implement the technology, he envisions status boards in the central pharmacy and possibly at nursing units so nurses could see identical information at the same time. “That would save a lot of steps and phone calls,” he said.

Dr. Adamson gave MedBoard a further kudo: “It doesn’t force you to use their steps. We would be able to customize the system to meet our health-system’s needs. It’s like an empty shell we could populate to address our own operations.”

Because the six campuses at Saint Barnabas produce several thousand admixtures per week on average, Dr. Adamson said his team has “solely thought of this as an IV solution.” With Pyxis tracking other forms of medications, and MedBoard tracking IVs, he noted, “we’d have one continuous information loop.”

—Al Heller