In an ASHP Midyear 2023 Clinical Meeting & Exhibition Management Case Study titled “Expansion of Medication Tray Check Technology Across Multiple Sites Within a Health System,” Douglas Lasch, PharmD, a PGY2 resident at the University of Wisconsin (UW), and Aaron Steffenhagen, PharmD, BCPS, FASHP, clinical pharmacy manager at UW Health and a clinical instructor with the UW School of Pharmacy, explored the benefits of medication tray technology and key features that ensure process sustainability post implementation, including inventory optimization and cost analysis.

This session covered the maintenance of over 600 medication trays, which were utilized throughout UW Health—a large academic medical center—and over 90 on- and offsite clinics and performed at a central pharmacy (CP) and pharmacy distribution services center. The current process involves inspection by a pharmacy technician and a pharmacist, serving to ensure accurate quantities, appropriate placement, and up-to-date expiration dates during daily tray replenishment and bi-annual tray exchanges. Dr. Lasch added that “[a] manual approach leads to waste and the potential for medication errors.” The case studies presented the implementation of medication tray check technology (TCT), which is poised to revolutionize operations by enhancing efficiency and bolstering patient safety.

Preimplementation tray processing systems were assessed in both the hospital (managed by the CP) and clinics (managed at the offsite pharmacy services distribution center). Time studies were conducted to determine technician and pharmacist workload, and medication error studies were done to understand the type and frequency of errors found in trays. Plans were made to incorporate TCT into the workflow.

Internal and external communication needs were determined. Workflow updates were provided to frontline pharmacy staff, and their feedback was sought during weekly huddles at each site. Monthly status meetings were held with informatics and supplies management leadership teams to ensure success across departments.

Needs for new technologies, supplies, and medications were assessed. Scanners and printers were constructed 2 months in advance of the tray-scanning go-live to allow ample time for labeling medication and supply kits. Scanning kiosks were also constructed to facilitate tray building and workflow piloting.

Staff schedules were modified to accommodate the go-live of tray scanning and tracking. Manufacturer presence was provided for 1 week while trays were removed from storage areas, including medication rooms, code carts, and clinics. They were brought to the pharmacy, modified to accommodate TCT, scanned, and replaced for use. Trays were gradually incorporated into TCT over 1 month, and unlabeled tray inventory was reallocated elsewhere based on usage and appropriateness.

As a result, simultaneous tray scanning go-lives were performed at both the CP and offsite pharmacy distribution services building. An average of 10 trays per day were incorporated at each site, spread among three different tray types—advanced cardiac life support, basic life support, and contrast reaction trays.

On average, pharmacists spent 3.0 minutes per tray before TCT implementation, while technicians spent 9.9 minutes replenishing tray contents. Technicians were also assigned 2 months of project days per year to manage the biannual tray exchange in addition to daily tray replenishment. Dr. Lasch added, “With the implementation of TCT, pharmacists are now removed entirely from the process of checking items within the tray, and instead check medication labels for accuracy on an as-needed basis.” Technician project days were reduced to 14 days per year to manage tray replenishment.

Most preimplementation tray errors included missing medications, expired medications, and missing supplies. On average, 4.8 errors were caught by pharmacists upon tray verification. Supply kit formation and TCT implementation allowed for a reduction in tray errors and patient safety events.

In conclusion, Dr. Lasch noted that medication tray management via TCT has been shown to add efficiency and maximize patient safety. Pharmacist and technician time was reduced, while human-medication errors were minimized. Tray location tracking and catalogued inventory expiration has allowed for the near-complete elimination of the bi-annual tray exchange with plans of greatly reducing the time and cost of the process.

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