Like the entire medical community during the onset of the COVID-19 pandemic, Florida’s Coral Gables Hospital was bracing for an intense wave of infected patients.

THE PROBLEM

In preparation, it established three goals: Effectively treat COVID-19-positive patients, avoid cross-contamination with other patients and protect frontline healthcare workers. The hospital worked toward a strategic plan to deal with the pandemic and also knew that common, ongoing obstacles in the hospital setting such as drug shortages would be further exacerbated.

In order to quickly keep track of the drugs it had on hand, anticipate how much more it would need to adequately treat patients, and uncover safe alternative medications where appropriate, the hospital team searched for a reliable technology solution to assist.

Additionally, in an effort to protect staff and non-COVID-19 patients, the hospital needed a way to keep track of which medication trays and carts were used in a room with an infected patient to ensure proper sanitization occurred before that medication tray or equipment was transported or used by another medical professional.

PROPOSAL

Coral Gables Hospital already was using technology from health IT vendor Kit Check, which offers an RFID solution aimed at increasing visibility into medication inventory. Many of the medications used to combat the symptoms of COVID-19 and used in intubation were RFID tagged and their usage recorded in the Kit Check system.

This allowed the hospital to have insight into medication usage to ensure that all high-priority COVID-19 medications were accounted for and to keep track of medications that were in danger of shortage.

“Furthermore, the Kit Check team also offered a new ‘Sanitization Check’ feature to existing customers, which hospitals could activate during the dispatch of kits and trays,” said Richard Stephen Tayon, PharmD, clinical informatics coordinator for the department of pharmacy at Coral Gables Hospital. “If Sanitization Check is turned on, a prompt appears that allows our pharmacists or technicians to indicate whether a tray has been sanitized from COVID-19 exposure.”

Hospitals can choose to make the setting optional or required and, if required, the system will not allow the tray to be dispatched unless the sanitization box has been checked, he added. According to the Kit Check team, 90% of the 43 hospitals using this feature currently are making this a mandatory step.

"There is no denying that our medical professionals have their hands full throughout the COVID-19 pandemic, and having reliable technology that provides accurate and real-time insight into critical medications is pivotal to our success."

Richard Stephen Tayon, PharmD, Coral Gables Hospital

“Finally, because the technology was extremely flexible and the Kit Check team was willing to help, we started brainstorming ways to rework the existing tool to meet our changing pandemic needs, including making the kits disposable and setting up specific stocking stations in operating rooms, rather than having one specific stocking area in the hospital to avoid cross-contamination,” he said.

MARKETPLACE

There are various medication-management technologies on the health IT market today. Some of the vendors of these technologies include BD, Cureatr, DrFirst, Kit Check, LogicStream Health, Medication Management Partners, Medisafe, Mediware Information Systems and Talyst.

MEETING THE CHALLENGE

The technology provided the hospital pharmacists, pharmacy technicians and extended medical staff with insight into where all high-priority COVID-19 drugs, such as those used for intubation like propofol and fentanyl, were throughout the hospital, down to the unit level, Tayon explained.

“This allowed us to understand where the medications were going, how much was being used to treat specific patients and when they were in danger of running out, which was extremely beneficial throughout the height of the pandemic,” he said. “Additionally, we created designated kits for COVID-19-specific medications and made them completely disposable.”

For instance, if a nurse used a kit full of propofol and fentanyl to help with intubation or pain management in a COVID-19-positive patient, that kit could then be broken down and disposed of once the medication was administered.

Staff pharmacists chose to implement the Sanitization Feature and to make the sanitization check mandatory so that the hospital could be 100% sure that all medications being stocked and dispatched via kits and trays were properly sanitized before being handled by staff or administered to the patient.

“Furthermore, with the help of the Kit Check team, we implemented independent operating room scanning stations for pharmacy personnel,” Tayon said. “During the onset of the pandemic, antibody and diagnostic testing were in very high demand, so there were obstacles related to the availability and reliability of these tests. To ensure safety for the entire staff, as well as other patients, we chose to treat all patients as if they were presumed COVID-19 positive.”

The hospital worked with the vendor to design a designated workstation complete with a small RFID scanning station to ensure all of the tagged medications and prefilled syringes used within the OR remained in the OR, meaning none of the potentially contaminated medications used returned to the pharmacy department.

“All tagged medications and replacement trays were stocked in the OR with a label of special ‘restrict access’ designation, which prohibits access among non-pharmacy staff,” Tayon explained. “Essentially, we collaborated to reconfigure the technology to allow our staff to isolate all the activity involved with medication management in operating rooms to avoid the potential spread of the virus.”

As confirmed cases and infections of COVID-19 continue to fluctuate, the team is able to adapt and pivot the technology to meet varying needs related to elective surgeries, COVID-19 medical units and infection-control protocols, he added.

Additionally, the technology works in tandem with Codonics, OR technology that creates safe labels for prepared medication to prevent adverse events or medication errors during surgical procedures. This technology is built within the hospital’s Omnicell anesthesia workstation, which houses and secures medications within the operating room.

All of these technologies help ensure that the right medication makes it to the right patient at the right time and decreases the likelihood of human error, Tayon said.

RESULTS

By leveraging Kit Check’s new offerings and coming up with creative ways to rework the tool to meet Coral Gables Hospital’s needs as an organization, the hospital has been able to navigate major drug shortages, keep constant tabs on inventory and determine when it needed to activate alternative treatment options for COVID-19, Tayon reported.

“The technology also has enabled us to protect our hospital staff and other patients in the hospital who were not COVID-19 positive and to continue to protect them as we ramp up our elective surgeries,” he said.

“We also use ASHP’s and the FDA’s website to keep a pulse on shortages. In addition, our vendor AmeriSource Bergen notifies us at the point of order entry of medications, what their on-hand quantities are, the availability of medication for more than 100 products, the ETA of any back-ordered medication, and if we are entitled to an allocation quantity. This level of insight is very beneficial when it comes to inventory planning.”

Drug shortages were a serious concern during the onset of the pandemic. Pain management and intubation drugs were in danger of a shortage, so having the ability to see where those drugs were going at all times, how much was being used per patient and when the hospital was in the “red zone” in terms of supply was tremendously beneficial, he added.

“There is no denying that our medical professionals have their hands full throughout the COVID-19 pandemic and having reliable technology that provides accurate and real-time insight into critical medications is pivotal to our success,” he said.

Further, the hospital has been able to uphold the safety of its staff and patients who it presumed were not COVID-19 positive, which it considers to be a major success, he said. The technology helped the hospital accomplish this through the Sanitation Check feature, which kept sanitation top of mind for employees throughout the COVID-19 turbulence, he added.

“Additionally, the Kit Check team worked with us step-by-step to create OR-specific scanning stations and inventory systems, allowing us to isolate all the activity involved with medication management for patients who opted for elective surgeries, as well as disposable kits for all medications involved with the management of COVID-19,” Tayon said. “Using the in-OR scanning station and designated area, we have greatly streamlined the process and the time allocated to replenishing our OR trays.”

The hospital has reduced the total time spent from approximately 2-3 hours to 30-45 minutes each processing day. Additionally, it has greatly mitigated the risk of exposure of presumed COVID-19-positive patients to pharmacy staff and other hospital staff who are exposed to the OR trays and the medications contained within the trays and kits, for which the team – including RNs, CRNs, anesthesiologists and surgeons – is very appreciative.

All of these adjustments allowed the hospital to keep frontline medical workers, pharmacists and every patient that walked through the doors of the facility safe, the value of which can’t be overstated, Tayon said.

ADVICE FOR OTHERS

“For other healthcare provider organizations considering medication management technology, I would say go all in,” Tayon advised. “We’re in a period where medical professionals and pharmacists are more time-starved than ever before, and having insight into the chain of custody of medications is integral to successful treatment and safety.”

It also is extremely beneficial when it comes to operational efficiency, he added.

“COVID-19 most likely will continue to impact the pharma supply chain for years to come by way of increased demand and drug shortages, and having technology that provides unit-level visibility can help healthcare organizations be better prepared,” he suggested. “Additionally, I would tell healthcare providers to ensure that your vendor is flexible and willing to work with you.”

If the pandemic has revealed anything, he concluded, it’s that healthcare is unpredictable and ever-changing. Having a partner that is willing to listen to your hospital’s challenges and work hard to help you address them is invaluable.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.