Innovations: Helping track crash cart medications

Crash cart duty is a task that hospital pharmacists and pharmacy technicians dread. It requires meticulously counting through large trays full of medications to determine what was used by clinicians so replacements can be made, while also making sure that no drugs have expired.

Taking inventory of crash cart trays and other medication trays consumes time that pharmacists could otherwise spend educating patients, which they're increasingly asked to do as providers shift to value-based care. Even in this age of electronic recordkeeping, some pharmacies still record the inventory in handwritten logbooks.

“Here's a person who's very highly educated, very highly compensated, mainly picking up (and counting) vials,” said Kevin MacDonald, a technology executive who heard about the process and decided he could come up with a better way.

MacDonald, who had no experience in healthcare, concluded hospitals could use inexpensive microchips employing radio-frequency identification technology, or RFID, to take inventory of the trays. He says the solution he developed, called Kit Check, allows hospital pharmacies to cut the time it takes to fill kits and trays by 70% to 90% while also virtually eliminating errors.

The technology, first deployed at the University of Maryland Medical Center in Baltimore in 2012, has three components: RFID tags that can be attached to vials and pre-filled syringes, cloud-based software and a RFID scanner that looks like a mini refrigerator.

Pharmacy technicians print the tags in-house and add them to drugs soon after receiving a shipment. Pre-tagged medication is available from unit-dose repackager Safecor Health and PharMED-ium, an AmerisourceBergen subsidiary. Hospitals can buy blank tags under several group purchasing contracts through major distributors such as Cardinal Health and AmerisourceBergen.

After a kit is used, pharmacy technicians place it inside the scanner, which comes in a variety of sizes and can be connected to any computer able to access the cloud-based software. The software assesses how many vials or syringes are missing and need to be replaced, generating a list of replacement drugs that's double-checked and approved by a pharmacist. The tray is then refilled based on that document, which also lists expiration dates for each medication in the tray, with the earliest noted in large print at the top.

The cost of the system is based on how many RFID tags are purchased; they cost roughly a dollar each. The total can be anywhere from $30,000 to $300,000 a year, depending on the extent of the deployment. There is no charge for the hardware and software.

Carlsbad, Calif.-based MEPS Real-Time offers a similar solution called Intelliguard. MacDonald says Kit Check has stronger distributor partnerships and has the advantage of using cloud-based software and being more configurable to a provider's specific needs.

The technology allowed Mount Sinai Hospital in Chicago to reduce the time pharmacists and technicians spend checking trays by about 75% to 80%, said Sameer Shah, director of pharmacy and respiratory services. The software also helped Shah determine the hospitals were significantly overstocking the trays and therefore could reduce inventory by about 50%.

Mount Sinai, which adopted Kit Check in June 2015, currently uses it for trays in the operating and labor/delivery rooms, but soon the technology will also be used for crash carts and emergency boxes.

MacDonald wants to expand Kit Check to include more tools to help hospitals manage their supply spend, the second-biggest expense after labor costs. The OR in particular is a “black hole” in medication management, he said, because clinicians don't always document what medications are used. “What we're really doing is giving the hospitals better visibility and control over what's happening with their meds.”