Implementation of a workflow system with electronic verification for preparation of oral syringes.

PURPOSE: The implementation of a commercially available, Web-based, barcode-enabled workflow management system for filling and checking patient-specific oral syringes at the Cleveland Clinic is described. SUMMARY: Historically, the process for preparing oral syringes has been a manual, repetitive procedure at Cleveland Clinic. Within this process, paper logs are the sole source of information. These logs can be difficult to locate or interpret. It remains a rote process with numerous manual steps offering opportunity for human error. Traditionally, automation, such as barcode scanning, has not been available during oral syringe preparation and checking. Based on increasing regulatory demands and documentation gaps identified, solutions were explored in the pharmacy's nonsterile compounding environment. An electronic verification workflow system was developed, implemented, and evaluated with a focused assessment of throughput and patient safety relative to oral syringe preparation. This was a retrospective study conducted in an academic, tertiary, acute care medical center. Analysis was completed at 3 months to evaluate efficiencies. Data regarding experiences at the Cleveland Clinic shows promising benefits with regards to United States Pharmacopeia chapter 795 compliance, the pursuit of incorporating advanced informatics and automation in manual processes, and standardization of workflow within an enterprise setting. CONCLUSION: Implementation of an electronic workflow verification system that integrates barcode verification and image-capture capabilities has maintained regulatory compliance in the nonsterile compounding environment including preparation of oral syringe doses without impacting throughput.

Developing an electronic system to manage and track emergency medications.

PURPOSE: The development of a Web-based program to track and manage emergency medications with radio frequency identification (RFID) is described. SUMMARY: At the Cleveland Clinic, medication kit restocking records and dispense locations were historically documented using a paper record-keeping system. The Cleveland Clinic investigated options to replace the paper-based tracking logs with a Web-based program that could track the real-time location and inventory of emergency medication kits. Vendor collaboration with a board of pharmacy (BOP) compliance inspector and pharmacy personnel resulted in the creation of a dual barcoding system using medication and pocket labels. The Web-based program was integrated with a Cleveland Clinic-developed asset tracking system using active RFID tags to give the real-time location of the medication kit. The Web-based program and the asset tracking system allowed identification of kits nearing expiration or containing recalled medications. Conversion from a paper-based system to a Web-based program began in October 2013. After 119 days, data were evaluated to assess the success of the conversion. Pharmacists spent an average of 27 minutes per day approving medication kits during the postimplementation period versus 102 minutes daily using the paper-based system, representing a 74% decrease in pharmacist time spent on this task. Prospective reports are generated monthly to allow the manager to assess the expected workload and adjust staffing for the next month. CONCLUSION: Implementation of a BOP-approved Web-based system for managing and tracking emergency medications with RFID integration decreased pharmacist review time, minimized compliance risk, and increased access to real-time data.