In recent years, the pharmacy team at Our Lady of the Lake Regional Medical Center identified a recurring challenge with operating room inventory: after medications were stocked in the anesthesia workstations (AWS), visibility of that inventory diminished.
By implementing RFID technology into OR inventory management in 2023, we were able to resolve this challenge, save 17 hours of staff time every week, reduce stockouts, increase patient safety, enhance regulatory readiness, and improve employee satisfaction.
Opportunity For Improved Operations
Located in Baton Rouge, Louisiana, Our Lady of the Lake Regional Medical Center is an 800-bed acute care hospital with an average annual volume of 30,000 surgical cases and 10,000 endoscopy cases. All of the medications in our 42 procedural rooms are stored in anesthesia workstations (AWS), and over 90% of these medications are located in the top two drawers of each station.
Prior to implementing RFID in the OR, the utilization of medications from each AWS was difficult to quantify, which created challenges in managing expiry and restocking inventory. We had developed several tedious processes to work around these challenges – including a twice-weekly full inventory of each station. However, the lack of consistent visibility into the unit-level inventory left room for error. For example, one audit of 17% of our workstations demonstrated several restocking errors in each AWS. The most common errors noted during the audit were medications located in incorrect pockets, expiration date mismatches, and inaccurate medication counts.
Measuring the Pre-RFID Workflow
Before the implementation of an RFID inventory management solution, we performed a time-in-motion study on our established workflow. This was done to ensure that any results from adopting a vendor solution could be measured against the previous standard. Our original restocking process began at 3:30 pm each day. At this time, our inventory management software was scheduled to send a pick list to our medication carousels for all medications whose counts in the AWS fell below our established minimum par levels. Next, our pharmacy technicians would pull the medications from the carousel (60 minutes) and sort them into bags for each AWS (63 minutes). Once sorted, these bags were placed on a cart to transport to each operating room. At each AWS, our designated operating room pharmacy technician would methodically refill each drawer, manually updating the count and earliest expiration date of each medication stocked.
Figure 1: The Pre-RFID Process
Making the Decision to Implement RFID
While it is common for hospitals to use manual processes to track and stock medications for the operating rooms, our pharmacy team was determined to streamline the workflow and reduce the staff burden surrounding restocking the AWS. We identified RFID as our preferred method, after concluding that it would be more accurate, scalable, and efficient compared to a barcode-only approach. Additionally, industry literature demonstrates that RFID use in the OR significantly reduces restocking errors and eliminates instances of expired and missing medications1. After reviewing several vendors, we chose KitCheck primarily due to their commitment to innovation in the space and their ongoing opportunities for us to provide feedback and request product updates. We were already in the process of evaluating KitCheck for use in our crash carts at the time but decided to pivot to implement RFID in the OR first because we anticipated a higher return on investment in this area.
By automating workflows, implementing an RFID technology gave us a simple way to track unit-level inventory after it leaves the pharmacy – ultimately reducing the risk of errors and waste. RFID tags on every unit of inventory allow for detailed tracking of each item, down to NDC, expiration date, lot number, and location. Our staff can access the cloud-based record of the medication inventory in real time, which is especially valuable during recalls and shortages. Using both the tagged inventory and an RFID scanning box, we can quickly and accurately compare the actual contents of used OR trays to pre-selected par levels – identifying discrepancies such as missing doses, extra doses, expired medications, and units expiring soon (based on our predetermined warning window).
Implementing a New Process
During the implementation period, we modified the drawer liners in the AWS to create removable trays and developed a process for exchanging the used trays with fully restocked trays each weekday. Our first step was sourcing and preparing transport carts and building replacement trays. We also spent time training our pharmacists and technicians, tagging medications, updating affected standard operating procedures, and staging our workspace. The final step before going live was loading the trays into each AWS.
We knew that securing buy-in from front-line staff would be key to a successful implementation. Our initial tray template was the pre-existing AWS drawer configuration, and the pharmacy team had planned on uniform trays for all procedural rooms. However, after meeting with our anesthesia team lead, we decided to build a specialized bottom tray for our eight cardiovascular operating rooms. This move helped garner the support of the anesthesia team, reduced inventory carrying costs for the remaining 34 procedural rooms, and greatly decreased the number of medications we needed to purchase and tag during implementation. To gain the support of our pharmacists and technicians, we held a contest during the implementation period to see who could tag the most items. It was a great opportunity to get our team members excited about the new workflow.
We also made sure to build quality assurance checks into the new workflow from the beginning. We minimized the opportunity for a tray to be placed in an incorrect location using barcode scanning and visual indicators. We assigned a barcode to each tray type and affixed the appropriate barcode to each tray. During the exchange process, technicians must scan the barcode on the tray to open the appropriate AWS drawer. We also obtained cleanroom floor marking tape and repurposed it to visually differentiate each tray type (See Figure 2). Each shelf in our tray storage area was equipped with a flag system to designate trays as Clean, Ready to Check, or Dirty to ensure staff do not inadvertently stock an incomplete tray back into an AWS machine. Upon final check of each tray, team members place green “Clean” tape on the corner of the tray to confirm that the tray is ready to be deployed.
Figure 2: Flags are used both on shelves and individual trays to specify whether a tray is ready to be restocked, checked, or deployed.
The New Way of Managing OR Inventory
Each morning, there is a set of used trays waiting in the central pharmacy for a technician to scan with the RFID scanning station. After scanning, the technician restocks the trays as directed by the software and prepares them for delivery to the OR suites. In the evening, carts are used to transport the trays to the operating rooms. Once logged into the AWS, the technician removes the used tray and replaces it with the appropriate fully stocked tray. The used trays are placed onto the carts and brought down to the pharmacy to be restocked the next morning.
To maintain a consistent supply of tagged medication, a pharmacy technician is assigned to review bins with low stock levels each weekday. If additional tagged inventory is needed, the pharmacy technician removes the medications from the carousel and tags them. A pharmacist checks that the information encoded in the RFID tag is correct and places the tagged inventory into the appropriate bin (See Figure 4). This replaces the pulling, bagging, and sorting processes present in our previous workflow.
Figure 3: The New RFID Process
Figure 4: The bin refill area specifically for tray restocking contains RFID-tagged medications.
Results
When we implemented the new AWS restocking process, Our Lady of the Lake Regional Medical Center significantly reduced the number of stockouts in the AWS and the amount of inventory wasted due to expiry. Most notably, we documented significant time savings.
A time-in-motion study was conducted to evaluate the process both before and 90 days after implementing the RFID tray-swap process. The study shows that on an average day, time dedicated to restocking the AWS decreased from seven hours to just under two and a half hours. Tagging the inventory and associating the RFID tags with data in the software requires an additional 6 hours of work per week. Despite the extra time dedicated to tagging inventory, the total time savings with the new process is over 17 hours of staff time per week.
Figure 5: Time in Motion Study. Time measured in mm:ss.
Our technicians and pharmacists have provided positive feedback, specifically around time savings, ease of identifying expiring medications, reduction of stockouts, and overall simplicity of the process. “The physicians no longer complain about running out of medications mid-case, because our stocking is always accurate now” is a testament shared by one staff member.
A recent nationwide recall of one of the emergency syringes kept in our AWS was far easier to manage utilizing the new software. We were able to quickly find and sequester the affected inventory within hours of receiving the recall notice. We have also found it easier to manage shortages of items in the trays because we can easily reduce PAR levels in all trays simultaneously and rotate the remaining stock to high-use areas.
Conclusion
As predicted, after implementing RFID in the OR we achieved a more automated inventory management workflow and significantly reduced staff burden. Reflecting on the implementation process, we believe two components were critical to our positive outcomes:
- The involvement and support of front-line team members were essential to the success of the project.
- The integration of quality assurance steps into the process reduced the risk of drawer-tray mismatches.
Following the implementation of this process for operating rooms, we introduced RFID into the process for crash cart tray management. Establishing this workflow in the OR first laid the groundwork for RFID to be efficiently implemented for crash carts – enabling us to convert our backup crash carts in only two days. Given the rapid and meaningful success documented with the new inventory tracking workflows across both the OR and crash carts, we next plan to incorporate RFID into the rapid-sequence intubation kits as well as other ancillary kits.
Author biographies
Jennifer Jones, PharmD, BCPS, is the pharmacy informatics specialist for the Baton Rouge market of the Franciscan Missionaries of Our Lady Health System. Jennifer is responsible for coordinating, implementing, and maintaining technology services for the pharmacy departments at both the system and market levels. Jennifer received her Doctor of Pharmacy degree from the University of Florida College of Pharmacy and completed her PGY-1 pharmacy residency at Our Lady of the Lake Regional Medical Center.
Amber Broussard, PharmD. is the Director of Integrated Operations for the inpatient pharmacy at Our Lady of the Lake Regional Medical Center, having previously served as the inpatient pharmacy Business and Operations Manager. She is proud to lead a team of pharmacists and technicians who are dedicated to the constant pursuit of excellence in patient care and medication management. Amber received her Doctor of Pharmacy degree from the University of Louisiana Monroe.
Rosanna Dastoori, PharmD, BCPS, BCCCS is the pharmacy operations supervisor for Our Lady of the Lake Regional Medical Center. Rose is responsible for inpatient pharmacy operations, and assisted in implementation of this project, along with maintaining continual oversight. She received her Doctor of Pharmacy at Xavier University of Louisiana and completed her PGY1 pharmacy residency at OLOLRMC.
Reference
Carlie Wilke, Ashley Bowden, Tom Sanders, Nancy A Nickman, Payson Ashmead, Implementation of radio-frequency identification technology to optimize medication inventory management in the intraoperative setting, American Journal of Health-System Pharmacy, Volume 80, Issue 6, 15 March 2023, Pages 384–389, https://doi.org/10.1093/ajhp/zxac367