Q&A with Scott Soefje, PharmD, MBA, BCOP, FCCP

This is part 2 of a two-part series on IV workflow management. Part 1, presented in PP&P’s March 2017 IV Safety Supplement, discussed increasing safety in IV compounding, while part 2, presented here, addresses overcoming challenges in IV workflow software implementation.

PP&P: How should an organization develop an IV workflow software rollout strategy?

Scott Soefje: The University Medical Center Brackenridge IV workflow system rollout is occurring in stages. We determined that the software would be most beneficial for high-risk drugs, so it was implemented first in the cancer clinic. Six chemotherapy agents were initially added to the software; additional drugs are then added each week until all medications used in the clinic are prepared via the IV workflow system. Once that is achieved, the software will be implemented in the inpatient hospital and then in other oncology areas throughout the network. Thereafter, we will target the non-oncology drugs within the hospital at one site, and roll out this process throughout the network.

PP&P: What challenges should organizations be aware of when implementing IV workflow software?

Soefje: Several issues should be top of mind throughout the IV workflow software implementation process, including interfacing the software to the EMR, configuring gravimetric weighing, stacking NDC numbers, setting aside sufficient space for the computer and related equipment, and making time to enter NDC codes into the system.

• Linking the EMR and the IV Workflow System. Interfacing the IV workflow software with the EMR requires attention to detail, as there may be cases where the drug database is not configured to allow proper sharing of information from the EMR to the software. For example, in the EMR we do not differentiate between PVC and non-PVC IV bags, but the workflow system does have a setting for that criteria. When the EMR sent the NDC for an IV bag that was set for non-PVC only, the IV workflow system rejected the compound because the NDC was for the PVC-containing product. Using the manual system, the technician was aware of this issue and would simply pull the correct IV bag. It is important to set time aside at the outset to make any necessary database adjustments.
• Proper Configuration of the Gravimetric Weighing Process. One barrier we encountered when configuring the gravimetric weighing process was that the ability to photograph products was initially tied to the capacity to weigh the bags. Because many items mixed in the hospital are measured in units or in volume, the densities of these products are unavailable, making weight calculations impossible. We had to unlink the photography and the capacity to weigh the medications, in order to use the system for those products that are measured in units or volume.
• Stacking NDC Numbers. Some hospitals enter the most common NDC numbers used and then stack additional NDC numbers for different vendors; the advantage of doing this is that the bar code readers will scan these bar codes as the same product.
• Plan Space for the Computer and Equipment. Ensure there is sufficient space for the computer and equipment in the cleanroom. Moreover, evaluate how the computer will be mounted and if it will impact workflow. We opted to use wall-mounted extendable arms to hold the computers; however, in one area of the cleanroom, the only space available for the mount was behind the technician, requiring them to turn around to work on the computer. Also, consider the size of the equipment that must reside in the hood. We are moving to a new facility soon; until then, we are relying on mobile carts to provide sufficient space for the required equipment.
• Dedicate Sufficient Time for Entering the Drug Database. Each IV product must be entered into the system database along with the NDC numbers; often, the bar code must be entered as well, and any special information required for compounding the product. Systems that pull the drug information from a national database speed up this process, but if this feature is not available, then pharmacy staff must enter the information into the system manually and develop a process to maintain and update the database. This can be a time-consuming task, so plan accordingly.

PP&P: What benefits has the hospital realized as a result of implementing IV workflow automation?

Soefje: Although we are still in the early stages of our implementation, we have already realized significant benefits, including time savings, standardization of IV processes, and increased assurance that the medications provided to patients have been accurately compounded.

• Time Savings. Because the IV workflow software enables pharmacists to verify medications from any computer in the hospital, the chemotherapy pharmacists no longer need to leave the clinic, garb up, and enter the cleanroom to verify the amounts prior to drug preparation. This also decreases the time required for technician compounding, because after assembling the preparation, they no longer need to wait for the pharmacist to come into the cleanroom to check it. Although the bar code reading, photographs, and weighing add small amounts of time to each preparation, the overall time to complete compounding is decreased due to the time saved waiting for pharmacist checking.
• Increased Standardization. During the IV workflow software implementation, we had to adjust the EMR database to reflect how we were actually mixing the compounded items. For example, we standardized volumes, and addressed how to handle overfill and when to withdraw the amount of the drug injected. While doing so, we concurrently made strides to standardize chemotherapy preparation. The instructions in the IV workflow system walk the technician through the process of the preparation, which standardizes how every technician mixes the IV because the steps are clearly outlined and photographic evidence is require with each step. This standardization will be implemented throughout our network as we adopt use of the IV workflow system network-wide.
• Safety. At this point in our implementation, we are still verifying a small number of medications using the IV workflow system. As such, we have not yet detected significant errors. However, other institutions using the software have detected potential errors. Where patient safety is concerned, it is important to remember that even preventing one error makes the process worthwhile.

PP&P: What are your future goals for utilizing IV workflow software?

Soefje: Our immediate goal is to continue to roll out the system throughout the entire network, with the ultimate goal of compounding every drug in the pharmacy using the IV workflow system. In addition, we aim to develop a process that allows any pharmacist in the network to check IVs; thus, we could assist other sites on busy days. Moreover, we would like to utilize the software to evaluate workload statistics for IVs used throughout the health system. Lastly, the system could be used to decentralize pharmacists from the central pharmacy, increasing face time with patients.

Scott Soefje, PharmD, MBA, BCOP, FCCP, is the director of pharmacy at the Dell Seton Medical Center at The University of Texas at Austin. He is the immediate past-president of the Hematology/Oncology Pharmacy Association (HOPA). Scott earned his Bachelors Degree in pharmacy from The University of Texas at Austin and his PharmD from the combined program at The University of Texas Health Sciences Center at San Antonio and The University of Texas at Austin. He is board-certified in oncology pharmacy and recently earned an MBA from George Washington University.