Michigan Medicine, one of the largest hospitals in Michigan and a premier academic medical center, comprises the University of Michigan (UM) Health System, UM Medical School, and one of the nation’s largest biomedical research communities. With a total of 1000 licensed medical and surgical beds, in 2018 Michigan Medicine had approximately 100,000 emergency department (ED) visits, 2.5 million inpatient clinic visits, and 2.1 million outpatient clinic visits. Committed to providing patients with high-quality, safe care, we are ranked fifth in the nation and first in Michigan in the US News & World Report list of the nation’s top hospitals.1,2

Pharmacy and nursing at Michigan Medicine make extensive use of emergency drug trays, which are located on every unit throughout the hospital. Emergency drug trays have been the primary means of providing crash cart medications to the nursing units for the past 10 years; in fact, we utilize more than 400 emergency drug trays in total. However, locating medications used in these trays after they had left the pharmacy was a constant nuisance. Thus, to ensure every medication used in these trays would be easy to locate throughout the facility, we sought to develop an automated system to improve our medication tracking.

Developing an Automated Medication Tracking Strategy

Pharmacy considered both bar coding and RFID-enabled medication tracking solutions, but ultimately chose to implement an RFID system to exert increased control over the medications used in the emergency trays. While bar coding is a reliable technology, it requires that a staff member actively scan each product and location to determine accuracy, all of which requires a significant investment of time. Conversely, RFID is a passive solution; as long as the RFID chip passes through a gateway or is triangulated with WiFi, identification can occur. We decided that RFID would best suit our needs for efficiency and a smooth workflow.

Homegrown System

In 2009, we implemented a homegrown RFID system to track the location of each emergency drug tray after it had been deployed from the pharmacy. With a recent expansion in the number of locations where these drug boxes were stored, we wanted to make sure that they could be located at any time in cases of misplaced or recalled medications; in addition, we sought to better identify expired medications. In the past, there had always been some boxes that were never returned to the pharmacy and were lost somewhere in the health system. If we could not locate the boxes, we were at risk for having expired medications available in the trays.

RFID tags were purchased and placed on each emergency box. These tags are triangulated using WiFi, so we are able to identify the location of every emergency box throughout the hospital at any time.

Automated Emergency Box Refill System

The homegrown system met our needs at the time, but a few years later we recognized that an additional solution would be required to confirm that the contents of each emergency drug box were correct. Thus, we investigated and subsequently purchased an automated, RFID-based system in the central pharmacy to refill and track each medication used in our drug trays.

After each tray is received in the pharmacy, it is placed in a queue where it is scanned to verify that each medication is correct. The software is programmed to recognize which medications should appear in the emergency drug box; after scanning, the system provides a list of the medications that are in the box and a list of medications that are missing (see the TABLE for the contents of the emergency drug boxes). If medications are missing, they are refilled and the box is placed a second time into the queue for confirmation. The system validates the lot numbers of each medication for accuracy and checks the expiration date of each medication to facilitate removal and replacement of expired medications.

Click here to view a larger version of this Table

Maintaining the Systems

Supporting and maintaining the automated tracking system is crucial to ensure ongoing use. Thus, we have a maintenance agreement with the vendor, while the homegrown system is maintained by the hospital’s Health Information Technology Services (HITS) staff.

The processes of implementing and utilizing our medication tracking systems rolled out smoothly, although maintaining a consistent supply of RFID tags for our homegrown system did prove challenging when one of the companies that supplied us with the tags went out of business. Efforts to procure these tags from a new company and set up a new system were labor-intensive, but we were able to switch companies and no new issues have occurred.

Benefits of Automated Medication Tracking

When using a manual process to fill emergency drug boxes, the potential for human error is ever-present. The automated system provides certainty that each medication in each tray is correct. This accuracy is especially critical for emergency drug trays, as they serve only to respond to life-threatening situations.

Using the homegrown RFID tray tracking system in combination with the automated RFID refilling software system has dramatically increased our efficiency in providing emergency drug boxes to the nursing units, while also ensuring the accuracy of the refilling process. Because our hospital utilizes hundreds of emergency drug boxes, maintaining efficiency is especially vital. Moreover, utilizing these two systems in combination has significantly improved our ability to locate any tray or any medication within a specific tray within minutes. In addition, expiration date tracking has improved our ability to remove expired medications from the trays in a timely manner.

Future Goals

Looking to the future, we would like to expand the presence of RFID technology in the pharmacy. For example, RFID could potentially be used in IV workflow management systems for product validation, in lieu of bar coding technology. RFID could also be used to facilitate bedside medication administration, maintain perpetual inventory, and to locate missing items on the nursing units.

RFID vendors should strongly consider expanding their technologies into these areas. In addition, the availability of pre-tagged medications would improve overall efficiency within health systems.

References

1. Michigan Medicine. Facts & Figures. www.uofmhealth.org/about%20umhs/facts-figures. Accessed March 26, 2019.
2. US News & World Report. University of Michigan Hospitals—Michigan Medicine. https://health.usnews.com/best-hospitals/area/mi/university-of-michigan-hospitals-and-health-centers-6440110. Accessed March 26, 2019.

John S. Clark, PharmD, MS, BCPS, FASHP is a clinical associate professor of pharmacy for the University of Michigan College of Pharmacy and associate chief of pharmacy services at University of Michigan Hospitals and Health Centers in Ann Arbor. He is also the PGY1 pharmacy residency director. John received his PharmD from the University of Toledo and his MS from the University of Wisconsin. His professional interests include patient safety, pharmacy staffing models, and survey readiness.