Implementing IV workflow management system (IVWMS) technology is helpful for patient safety, but the planning can be challenging, one community hospital system discovered.
One good place to start is to allow ample time for preparation before going live, said Allie Torrence, PharmD, BCPS, an assistant director at Methodist Medical Center, in Oak Ridge, Tenn. “Regulations have changed for USP [General Chapter] <797>, and there’s a heightened focus on patient safety,” Dr. Torrence said. “We have drastically changed what we do in sterile compounding.”
To help meet the new requirements, which went live in November 2023, Covenant Health (the medical center’s parent organization) purchased an IVWMS system. The product features a camera and scale, and it allows for barcode scanning, volumetric and/or gravimetric accuracy. It also has an electronic system for compounding records and allows for a standard formulary and master formulation record (MFR).
Before going live, Dr. Torrence and colleagues assembled a team including a director or manager and the IV room supervisor from each acute care facility in their 10-hospital system, as well as IT pharmacists and technicians, to meet in person and discuss all MFRs they would need to create.
First, they prepared to use the barcode scanning feature, to add a level of safety and ensure the correct concentration, Dr. Torrence said. This involved having IT pharmacy technicians go to each facility and scan every product in the IV rooms to enter them in the system. The team also agreed on standard vial sizes for certain products and one recipe for each drug concentration. They also worked out a plan to create new barcodes as needed for new products or for products from different manufacturers if the usual items were not available, as well as a backup procedure in case the system was unavailable or a product wouldn’t scan. The goal, she noted, was to avoid delays in preparation while working with the IT clinical pharmacy group.
Next, they discussed the volumetric and gravimetric verification features such as how to handle overfill on certain products and ensuring the concentration would match the infusion pump library for nurses. They also decided which products would go through which type of verification, and worked to ensure their vendor had all specific gravities stored for each drug manufacturer.
Then the group tackled their MFRs. Following Chapter <797> stipulations, they needed the name, strength, and dosage form of every drug; identities and amounts of all ingredients; type of container; complete instructions for preparation; a description of the final preparation; beyond-use date (BUD) and storage requirements; quality control procedures; and more. Even if it were a product that was a one-off order that would not be batched, they also had to have a recipe for it with all required elements.
From there, the group worked through BUDs, reviewing every drug’s package insert, and using Chapter <797> maximum sterility requirements if the insert didn’t have BUD information. They created a spreadsheet to list each drug line by line, including drug strength, vial size, container, total volume, whether it worked in the pump library, BUD information, etc.
Once the team decided they were ready to go live, they created training materials for all staff and trained super users across the system to send to different facilities. They staggered implementations to go live at two Covenant Health facilities, one large and one rural, at the same time, and move on to others every two weeks to allow time to work out any kinks that arose. The team addressed workflow concerns from technicians by demonstrating how the extra work was helpful for patient safety.
As far as the implementation phase of the IVWMS project, “that has been completed, so we are now in the monitoring and control phase,” Dr. Torrence said. “New products and/or barcodes are added, as necessary, and all employees are trained to use the verification system.”
The team also recently completed an annual review for all IV products and the system formulary was updated to reflect necessary changes to BUD, labeling and compounding instructions. “Safety data are being collected for future analysis,” she said.
As for the health systems’ previous methods for IV verification, “those are only used during a period of technology disruption.”
Dr. Torrence reported no relevant financial disclosures. Portions of this article were based on a presentation at the ASHP 2023 Midyear Clinical Meeting & Exhibition, in Anaheim, Calif.