(Management Case Study) Expansion of Medication Tray Check Technology Across Multiple Sites Within a Health System

Purpose: The maintenance of 600+ medication trays, which are utilized throughout a large academic medical center and 90+ on- and offsite clinics, is performed at a central pharmacy and pharmacy distribution services center. The current process involves inspection by a pharmacy technician and a pharmacist, serving to ensure accurate quantities, appropriate placement, and up-to-date expiration dates during daily tray replenishment and bi-annual tray exchanges. However, this manual approach leads to waste and the potential for medication errors. The following case study presents the implementation of medication tray check technology (TCT), poised to revolutionize operations by enhancing efficiency and bolstering patient safety.

Methods: Pre-implementation tray processing systems were assessed in both the hospital, managed by the central pharmacy, and clinics, managed at the offsite pharmacy services distribution center. Time studies were conducted to determine technician and pharmacist workload, and medication error studies were conducted to understand the type and frequency of errors found in trays. Plans were made to incorporate TCT into the workflow.
Internal and external communication needs were determined. Workflow updates were provided to frontline pharmacy staff, and their feedback was sought during weekly huddles at each site. Monthly status meetings were held with informatics and supplies management leadership teams to ensure success across departments.
Needs for new technologies, supplies, and medications were assessed. Scanners and printers were constructed two months in advance of the tray-scanning go-live to allow ample time for labeling medication and supply kits. Scanning kiosks were also constructed to facilitate tray building and workflow piloting.
Staff schedules were modified to accommodate the go-live of tray scanning and tracking. Manufacturer presence was provided for one week while trays were removed from storage areas, including medication rooms, code carts, and clinics. They were brought to the pharmacy, modified to accommodate TCT, scanned, and replaced for use. Trays were gradually incorporated into TCT over one month, and unlabeled tray inventory was reallocated elsewhere based on usage and appropriateness.

Results: Simultaneous tray scanning go-lives were performed at both the central pharmacy and offsite pharmacy distribution services building. An average of ten trays per day were incorporated at each site spread among three different tray types that were able to be initially incorporated into TCT. Included in this were the Advanced Cardiac Life Support (ACLS), Basic Life Support (BLS), and Contrast Reaction (CR) trays.
On average, pharmacists spent 3.0 minutes per tray before TCT implementation, while technicians spent 9.9 minutes replenishing tray contents. Technicians were also assigned two months of project days per year to manage the bi-annual tray exchange in addition to daily tray replenishment. With the implementation of TCT, pharmacists are now removed entirely from the process of checking items within the tray, and instead check medication labels for accuracy on an as-needed basis. Technician project days were reduced to 14 days per year to manage tray replenishment.
Most pre-implementation tray errors included missing medications, expired medications, and missing supplies. On average, 4.8 errors were caught by pharmacists upon tray verification. Supply kit formation and TCT implementation allowed for a reduction in tray errors and patient safety events.

Conclusion: Medication tray management via TCT has been shown to add efficiency and maximize patient safety. Pharmacist and technician time was reduced while medication errors due to the risk of human error was minimized. Tray location tracking and catalogued inventory expiration has allowed for the near-complete elimination of the bi-annual tray exchange with plans of greatly reducing the time and cost of the process. Project success was largely attributed to multi-departmental communication, leadership buy-in, and frontline staff feedback.