Implementing Technology to Improve Medication Safety and Efficiency in the Pharmacy

1. Implementing Technology to Improve Medication Safety and Efficiency in the Pharmacy Kelley Reece, Pharm.D. Assistant Manager MD Anderson Cancer Center Houston, Texas

2. MD Anderson Cancer Center (MDACC)Division of Pharmacy • 557 Pharmacists and Technicians • 14 Production Areas • Ambulatory Treatment Center (ATC) prepares 135,000 chemotherapy doses/yr. Photo courtesy of MD Anderson

3. Chemotherapy Preparation Risks

4. I.V. Chemotherapy Preparation Errors Exploratory Study • Field observations at six Canadian cancer centers • Reconstitution (2 sites) • No diluent verification • Mixing (5 sites) • Multiple preparations in the biological safety cabinet (BSC) • Labeling (3 sites) • Patient-specific label not paired with bag • White R, et. al. J Oncol Pharm Practice.2013 Feb 1. [Epub ahead of print]

5. Medication Error Reporting • Dispensing errors range <0.1% up to 65% • Methods of detection unreliable • MDACC preparation errors • Self reported error rate 0.12% • Most frequent reported errors • Wrong amount of IV fluid • Wrong IV fluid • Wrong amount of drug • White R, et. al. J Oncol Pharm Practice.2013 Feb 1. [Epub ahead of print]

6. Manual I.V. Preparation Process Photo courtesy of K. Reece

7. Failure Mode and Effects Analysis for I.V. Preparation Steps • Process steps – detail, detail, detail • Failure modes – What could go wrong? • Failure effects (severity) • Causes (probability) • Controls (detectability) • Process improvement / recommended actions

8. MDACC FMEA Process Summary FMEA=failure mode and effects analysis

9. MDACC Software Requirements

10. BD Cato Implementation • Initiated pilot in October 2012 • Involvement from pharmacy, informatics, and software vendor • 28 drugs currently in production • Over 15,000 products prepared

11. BD Cato Hardware Components Image courtesy of BD Cato

12. BD Cato Software Features • Intercepts human errors in real-time • Order entry interface (HL7) enables dose management queue • Standardizes process steps • Automatically documents preparation steps • Prints patient label with correct beyond-use date (BUD) and infusion rate • Manages vial inventory • Records drug waste • Generates reports including productivity and inventory management

13. I.V. Management System Pilot Evaluation Safety Productivity Waste The Office of Performance Improvement Miguel Lozano Sr. Quality Engineer

14. Potential Risk Reduction 52% of Failure Modes Impacted by BD Cato

15. Detection of Preparation Errors 1. All I.V. preparation errors 2. One error type-drug volume out of 4% tolerance range

16. Prep Times

17. Cost of Opened Vial Waste

18. Cost Savings

19. The Joint Commission Sentinel Event Alert • Warning issued about technology-related adverse events • Suggested actions • Assess workflow processes • Careful planning and implementation • Staff training programs • Monitor continuously • The Joint Commission. Safely implementing health information and converging technologies. Issue 42; Dec 2008.

20. Summary • BD Cato intercepts errors in real-time • System uses more accurate gravimetric validation method • Eliminates manual processes and standardizes processes • Provides step-by-step automated documentation • Allows barcode scanning for drug and vehicle • Provides more efficient and accurate verification process

21. Questions?