Automation exists in most hospital pharmacies, but there are crucial gaps and onerous workarounds. “Medication intelligence” would be the preferred approach, according to an annual survey by Kit Check, a hospital-pharmacy solutions provider. A related—and worrisome—problem is controlling diversion of products, especially controlled substances; even at this late date in the opioid crisis, 53% of those surveyed know of diversion incidents at their facility in the past year.
While diversion is a legal and patient-safety issue (and needs to be addressed by better hospital management in addition to technology), the broader worries are that:
• Drug shortages persist in hospital pharmacies: For the second year in a row, medication shortages ranked as the top challenge facing pharmacy personnel. About 60% of pharmacy staff reported dealing with up to 20 medication shortages at a time. More than 72 of respondents reported spending up to 15 staff hours to reconcile each medication shortage.
• Recalls also affect pharmacy personnel: 85% of those surveyed reported dealing with at least one drug recall every year. About 50% dealt with up to nine recalls every year, with the majority spending up to five hours handling each recall.
The Kit Check survey (performed during Q4 2019) shows that visibility into hospital pharmacy inventory steadily falls as drugs move from initial receiving to nursing floors, operating rooms and the like. The “medication intelligence” to address these visibility issues comes about through tracking technology developed by Kit Check, which includes the use of RFID tags on unit-of-use dosages, together with a scanning and reporting system. According to Tim Kress-Spatz, Kit check co-founder, the unit-of-use “granularity” not only provides better inventory control (in cases where multiple units-of-use are delivered to the pharmacy as one unit-of-sale), but also in addressing recalls where individual lot numbers can be tracked, no matter where they are in the hospital. “Hospitals are finding that automated inventory control significantly cuts the total cost of ownership” of the dosage, he says.
Adjusting to the pandemic
Kevin MacDonald, Kit Check CEO, says the company has witnessed the adjustments its 500 hospital clients are making to the Covid-19 pandemic. “Right off, some of our clients could see how shortages of important drugs like propofol (use to sedate intubated patients) were hoarded out of a fear of scarcity,” he says. “It’s the hospital pharmacy equivalent of the toilet paper scare consumers experienced.” Additionally, some hospitals set up “Covid” and “non-Covid” wings to their facility, and then tried to make the same distinction for the dispensing trays used in patient care. “It became important to keep the Covid and non-Covid sides separate, and our tracking technology has helped in that effort,” he says.
Mention of inventory control or visibility in pharmaceutical distribution quickly leads to discussion of the Drug Supply Chain Security Act (DSCSA), whose goal is to provide such visibility from the manufacturer of a drug to the point of dispensing. Kit Check is working with several manufacturers to provide its tags (which can link to DSCSA data) as the drug packages are produced. Overall the company is monitoring DSCSA development as it nears compliance deadlines for hospitals, but as Kress-Spatz puts it, medication intelligence “is where we’re headed, DSCSA or not.”
The survey is available here.