As medical technology rapidly evolves, new intelligence products are continually leveraged to solve complex issues within health care systems. Solutions such as dose tracking software, closed-system transfer devices (CSTDs), automated dispensing cabinets (ADCs), and IV technology-assisted workflow systems have become standard practice for their ability to promote efficiency and medication safety.

Radio Frequency Identification (RFID) is another technology that can enhance workflow efficiencies and safety within health care. A wireless system composed of readers that extract unique identifiers from tags by emitting radio waves, RFID can transmit data without requiring a line of sight.1 RFID technology is most commonly used within the health care sector to manage medication trays, crash carts, and intubation trays for emergency departments and operating rooms. RFID solutions can also be used to track medications and medical equipment across hospitals, and they can monitor these items for recalls, temperature changes, and unit inventory management.

Selecting a Vendor

The RFID software market offers an array of solutions to address different issues. When selecting a vendor, keep in mind that each solution comprises a variety of features; the best fit will depend on the individual needs of your facility. See the FIGURE for an overview of each solution currently on the market and their offerings.

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Among these options, there are several pharmacy specific RFID solutions available for implementation. The ability to instantly identify medications in specific locations, with software to maintain, record, and track the movements and storage of medications is a major improvement over a manual solution. A study comparing RFID technology to bar coding technology has shown that RFID tags are generally considered a technological leap from bar codes.² Multiple RFID tags can be read simultaneously without the scanner being in direct line of sight to a tag, maximizing efficiency during scanning. Additionally, RFID systems have been shown to reduce costs, time, drug diversion activity, misidentification issues, and human errors, leading to greater effectiveness than bar code scanning and a larger potential to create health system wide change.2 To truly understand the impact of RFID technology, it is imperative to examine where RFID is used and the gaps it has addressed.

Restocking Medication Kits

Replenishing medication kits accurately and efficiently is a challenge for many hospital pharmacies. The manual replenishment of these trays is labor intensive, requiring pharmacy technicians to perform a complete inventory of all medications stocked in an individual kit, investigate the products for expiration, update each medication count to the right amount, and then present the tray to a pharmacist for checking. An alternative practice is for pharmacists to verify that products are labeled appropriately after which technicians will estimate the number of products that need replenishment within each tray through a brief visual inspection of each kit. However, in both of these practices, the potential for human error at any point in the process could allow a potentially dangerous medication error. The labor demands and patient safety risks inherent in the manual replenishment of medication kits make this process a prime candidate for improvement with RFID solutions. 

 CASE STUDY 
Exploring Stationary vs Mobile RFID Solutions

UNC Health is North Carolina’s largest academic health system with 16 hospitals, 20 hospital campuses, and more than 500 clinics throughout the state. UNC Hospitals Hillsborough Campus is a 163 bed, community hospital operating within UNC Health focusing on elective surgical programs, family medicine, acute rehabilitation, oncology clinics, among other practices. The use of medication trays at UNC Hospitals Hillsborough campus is frequent due to the large focus on elective surgical programs, which prompted pharmacy leadership to explore the use of an RFID solution to optimize the medication kit replenishment process. Over time, this optimization project underwent several changes to finetune workflows and increase efficiencies.

Stationary Solution

In August 2019, the pharmacy department implemented RFID technology to restock medication trays for use in the operating and procedure rooms. The first RFID implementation was a stationary RFID scanner located inside the pharmacy. A dedicated space for tray processing was created with high density shelving to store large quantities of drug inventory. Templates of each medication tray, including the medication and their quantities, were then set within the RFID software. Once the initial tray setup was complete, a medication tagging operation was established. Upon receipt of the medication inventory for kit replenishment, a pharmacy technician assigned each medication a unique RFID tag. The RFID tag allowed for computer identification of pertinent drug information such as medication name, lot number, quantity, and expiration date.

The daily workflow involved pharmacy technicians using the RFID-tagged medications to replenish new trays and verify the contents through the stationary RFID scanner. Pharmacists then confirmed the appropriateness of the contents of each tray through the RFID software and indicated their approval within the system. Following pharmacist approval, the pharmacy technicians would deliver these fully stocked trays to their designated locations in the ADCs and swap them with the used trays from the day’s cases. Next, the used trays were brought back to the pharmacy and scanned to identify which medications required replenishment or removal. This process involved pharmacy technicians scanning a bar code on each tray during both dispatches and return to the pharmacy to update the tray’s location.3

One of the benefits of this stationary RFID solution is the ability to track individual medication levels on a daily basis, including where and when it was placed within the ADCs. This concrete data shows exactly what medications are used each day, serving as a valuable resource to adjust par levels. This usage data can also be compared with documented administration reports to identify any potentially missed charges. Apart from the additional task of tagging medications upon receipt, the workflow for replenishing kits and trays by the technician with a stationary RFID model was similar to the prior manual replenishment model, easing the learning curve of technology implementation.

Although the use of a stationary RFID solution enabled workflow efficiency and minimized patient safety risks, there were further opportunities for improvement within this process. Under the stationary model, two complete sets of trays were required for each ADC—one new set stored in the pharmacy and one that existed within the ADC. The duplicate trays required additional storage space as well as increased inventory costs associated with replenishment.

Mobile Solution

To address these improvement opportunities, in August 2022 UNC Hillsborough Pharmacy leadership piloted a mobile RFID solution. The mobile RFID solution has an RFID scanner attached to a delivery cart containing RFID-tagged medications. During the pilot stage of this project, a new workflow was established for tray replenishment: Pharmacy technicians replenish each tray at the ADC by placing the used tray within the scanner and subsequently replenishing the stock from the cart averting the need to return used trays to the pharmacy. Trays are then approved virtually by pharmacists prior to use, ensuring that each tray is scanned, and contents are appropriate. This mobile RFID model allows the pharmacy technician to replenish only the inventory that is missing or expired, thereby freeing space in the pharmacy and reducing inventory costs while maintaining the same level of medication tracking as provided by the stationary RFID model.

While the mobile RFID cart model improved efficiency and cost concerns in comparison to the stationary RFID model, it has limitations. There is a potential for increased time required at the site of use as pharmacy technicians restock medication trays one by one. Additionally, the risk of human error remains a possibility in the pharmacist check, especially as pharmacists no longer visually inspect each tray prior to delivery. Nonetheless, even with these potential concerns, UNC Hillsborough Pharmacy leadership preferred the mobile RFID solution due to the minimized patient safety risks from RFID implementation, as well as improved workflow efficiencies and cost savings associated with this solution. Due to the success of the RFID implementation and mobile pilot, the next steps include exploring the possibility of extending the mobile RFID model to the UNC Medical Center operations, which would encompass approximately 60 ADCs.

Utilizing Data Analytics

RFID technology is still evolving, and there is vast potential for optimizing its usage. Well-designed internal analytics are key to unlocking the ability to track tray/kit utilizations, watch for drug shortages, make formulary decisions, monitor pharmacist and technician activity, and document wasting of medications.20 This data also provides hospitals with the ability to determine the optimal method of RFID technology implementation for their specific institution.

Conclusion

RFID has the potential to revolutionize patient care. This technology can help eliminate medication loss, improve product control and security, save valuable pharmacist and pharmacy technician time, and reinforce medication safety by making sure that right medications are reaching the right patient at the right time. As RFID technology becomes increasingly accessible, pharmacy has a responsibility to share data analytics and seize opportunities for peer-to-peer learning on the subject. Continual optimization efforts are necessary to make this vision a reality, but the benefits and growth of RFID technology show a promising opportunity for innovation.

Nivedha Poondi, PharmD, is a PGY1 health system pharmacy administration and leadership resident at UNC Health. She is also completing her master of sciences at UNC Eschelman School of Pharmacy with a specialization in health-system pharmacy administration. Nivedha received her bachelor of science degree in biology from Illinois Wesleyan University and her doctor of pharmacy degree from University of Illinois Chicago.

David N. Luter, PharmD, BCPS, is a clinical manager of pharmacy responsible for leadership and oversight of the UNC Hospitals Hillsborough Inpatient Pharmacy. He earned his doctor of pharmacy degree from the UNC Eshelman School of Pharmacy and completed a PGY-1 residency at UNC Hospitals.

Matt Lamm, PharmD, MS, is a director of pharmacy at UNC Health. He currently oversees pharmacy services for three UNC Hospital locations and four offsite infusion centers. Matt received his doctor of pharmacy degree and MS in health system pharmacy administration from the UNC Eshelman School of Pharmacy.

Samuel Eberwein, PharmD, MS, BCPS, BCSCP, is an assistant director of pharmacy responsible for leadership and oversight of pharmacy business and finance at UNC Health. He earned his doctor of pharmacy degree from Campbell University and Master of Science degree with an emphasis in health system pharmacy administration from the UNC Eshelman School of Pharmacy while completing a 2-year health system pharmacy administration residency at UNC Hospitals.