By John Fanikos, RPh, MBA

BRIGHAM AND WOMEN’S HOSPITAL (BWH) IS A 725-BED, ACUTE-CARE teaching facility in Boston, Massachusetts. Our hospital utilizes Omnicell automated dispensing equipment and profile technology for storing and distributing controlled substances in over 80 inpatient and ambulatory care areas.
Our pharmacy was challenged to develop systems that ensured drug control and identified potential drug diversion. In addition, pharmacy was looking for reporting tools to optimize the automated dispensing system throughout the hospital.

Controlled substance drug diversion is a known problem in hospitals throughout the country. In order to safeguard patients and employees, our facility wanted a consistent, house-wide approach to monitoring controlled substance activity and the ability to readily identify diversion cases.

Product and Service Selection
After an evaluation of multiple vendors and their reporting tools was conducted, a multidisciplinary team consisting of nursing and pharmacy leadership chose Medacist’s RxAuditor. Of the reporting tools evaluated, RxAuditor’s patented diversion algorithm delivered unparalleled results. In addition, the other vendors under consideration did not provide the same level of customer support and implementation assistance that Medacist offers. RxAuditor’s reporting tools use a patented methodology to identify drug diversion in automated dispensing systems. On a daily basis, hospital-wide medication dispensing information is encrypted and passed electronically to Medacist. The data is sorted and returned in layers of drug-utilization reports. Each layer provides more and more details on the individual user and individual drug.

Medacist provided an initial 90-day retrospective transactional usage analysis that identified multiple individuals with Omnicell transaction patterns that exceeded those of their peers. The reports were user-friendly, and provided the drill-down details that made it easy for us to follow-up on potential drug diversion. Through Medacist’s customer and consultation services, we received customized reports for our hospital, as well as assistance with implementing internal pharmacy department processes.

Measurable Results
We continue to utilize RxAuditor to routinely indentify instances of drug diversion throughout the hospital. The reports identify patient care staff members that utilize a statistically higher number of doses than their peer group. Once those individuals are identified, RxAuditor then provides a user-specific drug audit report from which pharmacy and nursing can conduct a detailed audit.

With the assistance of RxAuditor, BWH has identified numerous individuals who were diverting controlled substances. Details surrounding the drug or drugs diverted, the location, and the timing are easily produced, providing our organization with a powerful management tool.

RxAuditor provides the reports as a service, and we can routinely contact their support staff with questions on an ongoing basis. RxAuditor has well addressed our needs to develop a reporting tool to better measure, monitor, and manage our automated dispensing system.

Future Plans
While we initially purchased RxAuditor for monitoring controlled substances, there are several additional reports available for optimizing our Omnicell automated dispensing system. Medacist’s RxAuditor also evaluates several key indicators across pharmacy’s clinical, operational, and financial metrics.

RxAuditor provides detailed reports on optimizing inventory management, override reports, JCAHO-specific reports, stock-out analysis, refill analysis, financial data, and other reports to provide pharmacy management with a comprehensive analysis of our automated dispensing system on a monthly basis. Through the RxAuditor reports, we have made great advances with optimizing individual Omnicell cabinet supplies, improving inventory turnover, and maximiz-
ing our investment in automation. RxAuditor also provides detailed benchmarking statistics that we utilize to measure the performance of our automated dispensing system. The benchmarking is completed through evaluating our performance in key workload indicators, such as override compliance, stock-out analysis, and financial reports, compared to other hospitals in the country. Medacist has hundreds of clients that they blindly benchmark our facility against to determine opportunities for improvement and to determine best-ofclass statistics. RxAuditor provides this unique service free of charge. This is an extremely powerful tool to illustrate system performance to hospital administration.

Overall, our experience with RxAuditor has been tremendous. We have implemented a truly proactive drug diversion-monitoring tool, and we continually optimize our automation usage through RxAuditor’s detailed reports. RxAuditor is a service-based solution that presents pharmacy and nursing leadership with a tool that drives the actionable information we need to the right person in a timely manner.

John Fanikos, RPh, MBA, is currently the assistant director of pharmacy at Brigham and Women’s Hospital in Boston, Massachusetts. He received his BS in pharmacy from the Massachusetts College of Pharmacy, completed an ASHPaccredited residency program at Brigham and Women’s Hospital, and received his MBA from Northeastern University.