By Gina Shaw
The growing availability of manufacturer-enabled smart labels with radiofrequency identification (RFID) tags, along with increased interoperability between tagged medications and other pharmacy technology solutions, is paving the way for more hospitals and health systems to adopt RFID to track medications within their institutions.
“At AmerisourceBergen, we recognized pretty early on that there is a broad lack of standardization for RFID-enabled products,” said Dustin Roller, the vice president for innovation product development. “We have leaders adhering to the GS1 standards for universal recognition of RFID tags without a back-end interface, but others have back-end tags that follow their own standards. You have a choice on the software side: Do you want to allow your customers to make use of RFID tags from other vendors or not?”
Mr. Roller underscored the risks of taking a siloed approach to product development. “Proprietary RFID solutions that limit their capability to only tags that have been commissioned or enabled by their system are too restrictive to propel innovation and collaboration in this space,” he said. “We all have to open our doors a little bit in terms of collaboration to provide the best possible solutions.”
A Call for Interchangeable Tags
Interoperability is critical if hospitals are to make the most of RFID’s capabilities, agreed Anthony C. Scott, PharmD, MBA, the director of pharmacy services for Emory University Hospital, in Atlanta. “From a competition perspective, the vendors might prefer to have only tags that are compatible with their system, but if we want broader adoption of RFID, it’s important to be able to use these tags interchangeably with your software, no matter what system you have.”
Many hospitals have moved toward RFID-tagged medications in areas where they can significantly optimize workflow. “For example, many large programs start RFID adoption with anesthesia, OR, and crash cart kits and trays, because the current workflow for these in the hospital pharmacy is very manually intensive and ripe for human error,” Mr. Roller said. “You’re looking at individual vials by the hundreds or thousands, checking for expiration dates and the presence or absence of the correct fill. These are areas where the automation and accuracy of RFID can significantly improve on human processes.”
What’s more, RFID also can “free up your pharmacy staff for areas where [they can use their training to enhance] patient safety, engagement and operations.”
What’s New
UIC Adds RFID to Ambulatory Surgery
The University of Illinois Chicago (UIC) began using RFID in its main OR anesthesia trays almost five years ago, and found that individual tagging of as many as 75 items in each tray freed up significant pharmacist and pharmacy technician time—no more sifting through each item after the procedure to check for expiration dates, for example. A new ambulatory surgery center will open in September 2022, where UIC will implement a new application of RFID in the surgery suite, according to Matthew Gimbar, PharmD, UIC’s associate director of hospital pharmacy operations.
“Because it’s an ambulatory surgical center, we don’t want pharmacy spending a lot of time in the room restocking the OR carts,” Dr. Gimbar said. “So, instead of having 20 or more different items with individual tags, we will have one RFID for each anesthesia tray. We’ll pop the whole tray out of the drawer and replace it with a new one using RFID to track the switch, and then restock individual items on the used tray when we’re out of their hair. This allows us to improve customer service and increase OR efficiency.”
Emory has already seen significant improvements in asset tracking after adopting RFID for its pediatric code cart boxes and radiology emergency response kits in May 2022. “We’re now able to find items in real time instead of having to do wild goose chases, which has been a real time-saver,” said Dr. Scott, who has been an ASHP Foundation Research Project Member on RFID technology and development.
A second area where hospitals might find a significant return on investment from RFID would be management of high-cost drugs, Mr. Roller suggested. “There are millions of dollars tied up in these drugs, and the loss of even a few of them because of something as simple as not rotating stock correctly to ensure you don’t have expiration and waste could potentially pay for an entire RFID platform for a year.”
Specialty Pharmacy Costs, Inventory Managed via RFID
Specialty pharmacy is a perfect candidate for RFID, said James Roof, the director of inventory programs for Cardinal Health. “Specialty pharmaceuticals now account for more than half of drug spending, so tracking these medications should be a pharmacy’s first priority. Not only can RFID technology track specialty drug spending; it can also provide greater visibility to a pharmacy’s inventory,” he said. “Additionally, by using RFID, pharmacies can manage limited supply by automatically updating on-hand inventory and setting reordering thresholds based on par levels. Because specialty pharmaceuticals are often in limited supply, automated ordering can help ensure these critical medications are on hand when patients need them.”
RFID also can help facilitate compliance with regulations governing high-risk medications such as controlled substances. “Drugs that have a lot of regulatory compliance requirements at the state or federal level—that’s the third frontier for RFID,” Mr. Roller said. “These medications require you to have a very clear understanding of their quantities and transactions. For example, you may need to ensure a constant supply of a certain number of specific medications to provide Level I trauma center response times.”
Gwen Volpe, RPh, the director of medication technology for Fresenius Kabi, agreed that this is an important benefit of RFID technology. “With controlled substances, a tremendous amount of counting takes hours from the pharmacist’s day that could be spent on patient care. RFID virtually eliminates that,” Ms. Volpe said.
One Wish-List Item: Deeper Penetration in Anesthesiology
One leading pharmacy IT expert would like to see RFID-enabled automated anesthesia workstations offered more broadly.
“Today, we support 35 anesthesia carts across our ambulatory operation. The safety and inventory benefits are excellent, but there are still improvements to be made,” said David Aguero, PharmD, the director of medication systems and informatics at St. Jude Children’s Research Hospital, in Memphis, Tenn.
“Because we have those workstations, we don’t use traditional procedural trays that provide everything needed to anesthesia staff in a single transaction,” he continued. “Automated anesthesia workstations provide great benefits and interface with the EHR effectively, but require additional steps for anesthesia staff (ex. accessing multiple bins and maintaining inventory) and I’d like to make this easier for them without increasing pharmacy workload.”
They treat some non-controlled substances as controlled for diversion monitoring purposes, and they focus heavily on propofol because they perform a high volume of conscious sedation on their pediatric population.
“Pharmacy operations can now purchase pre-tagged medications or have them tagged prior to arrival into our inventory. If we had access to a workflow-effective RFID cart offered by one of the vendors we utilize today to capitalize on EHR-integrations, I’d be advocating for an opportunity to purchase that solution,” Dr. Aguero said.
Mr. Roof, of Cardinal Health, argued that when deciding whether a hospital or health system can afford to invest in an RFID system, the most important question may be, can health systems afford to say no? “Evaluate the potential risk and liability associated with dispensing the wrong product or not being able to treat patients because the medications needed are not available,” he said.
Avoiding Burnout
Part of the return-on-investment calculus also should be based on the ability of RFID to mitigate pharmacist burnout—a growing concern in the pharmacy profession, Mr. Roof noted. “Pharmacists are being challenged with doing more with less, and in some cases, with less staff,” he explained. “Stretching employees to the point of burnout may lead to costly medication errors and put patients at risk. Through automation and reduced waste, RFID can help lower costs, as well as support overstretched staff through greater efficiencies, increasing the quality of care.”
The sources reported no relevant financial disclosures beyond their stated employment.
This article is from the September 2022 print issue.