The journey a medication takes through the hospital is far more complex than most people would assume. From sourcing medication to ordering it, to organizing it within the hospital pharmacy and ensuring it gets to the right patient, there are many opportunities for risk and human error throughout the cycle. Pharmacists and other healthcare providers are incredibly busy with tasks related to patient care and clinical services, and it can be an added burden to focus on medication inventory management and ensure that the right medications are in the right place at the right time.
It is especially difficult to track a medication’s path in the supply chain, as there are many phases that require monitoring technology and, sometimes, manual checks to ensure that each drug ordered and dispensed is being used appropriately and safely. Because there are so many touchpoints and so many people throughout a hospital come in contact with each medication, there are instances throughout the cycle where it could be diverted, administered past its expiration date, or otherwise used improperly.
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There are five key points in the medication use cycle where pharmacists and clinicians must make sure that they are properly keeping track of medications: procurement, ordering, transcribing, dispensing and administration. During each of these steps, there are various scenarios where medications could be misplaced or left vulnerable to misuse. Outlined below are some of the threats associated with each phase of the cycle.
Procuring Medications
Before a medication is tracked and administered within an organization, it must first be sourced. The procurement process involves getting specific medications – and the correct amount of them – into the health system, storing them and ensuring they’re of high quality and from a reliable manufacturer. It is during this phase that hospitals must also take into account medication pricing information. Our research shows that 60% of hospital pharmacists have been given a cost savings goal due to budget tightening as a result of Covid-19. For 39% of those pharmacists, their savings goal is as large as $300,000. This makes it critically important for organizations to closely track their budget and ensure that their drug spend is well distributed across the medications they need on both a regular and emergency basis. Hospital pharmacists have the opportunity to utilize different technologies to gain insight into the most cost-effective options for their organization.
Hospitals that utilize RFID technology for inventory management should also examine whether the medications come pre-tagged with RFID labels. Medications tagged at the manufacturer level ensure that there is item-level visibility of drug products throughout their dynamic lifecycle, helping hospitals streamline their tracking processes and reducing the need for manual medication reconciliation.
The procurement phase is also a crucial time to make sure the proper quantity of medication is being accounted for. A hospital staff member engaging in diversion could order the incorrect amount of medication to create an excess from which to divert. Software solutions that reconcile wholesaler medication orders with what is stocked in the central pharmacy are imperative to close this potential diversion gap.
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Ordering and Transcribing
The ordering process is likely what many people equate with prescribing – it’s the step when clinicians select the appropriate medication, dose and time period for a patient to take a specific drug. Although the clinician who orders the medication is not always the one administering it, there is a high risk of misuse during this phase given the power dynamics between doctors and nurses, as well as doctors’ relationships with the pharmacy department and chain of command. In a highly publicized case in Ohio, at least two dozen nurses administered dangerously large doses of fentanyl and other drugs prescribed by one particular doctor, resulting in patient deaths. Investigations later revealed that the alert system to flag when dangerous quantities of medicine were ordered had been overridden, meaning that orders were filled without prior approval from the pharmacy. Nurses and pharmacists had previously questioned the doctor’s prescriptions, but he had used his position and sense of authority to dismiss their concerns.
The transcribing step is more commonly seen among organizations that use a paper system and was far more prevalent before the advent of electronic health records. However, it can still occur at hospitals with electronic records when there is system downtime. It occurs when an administrator takes the information from the prescriber’s order and writes it in the organization’s medication log. It can be a common point for unintended consequences due to the inconsistency of manual transmitting and other issues like handwriting, similarly named medications and a breadth of human errors.
Dispensing, Administration and Reconciling
Dispensing is one of the phases of the medication use cycle where there is a major risk for diversion. This is the point after which a pharmacist must check for drug interactions, verify if a medication is safe, and determine the appropriate amount to dispense. If a pharmacist verifies and dispenses the wrong amount, or diverts medication from a vial or syringe, it can pose a serious threat to them and to the patient. Additionally, there are cases where medications are dispensed but are not used on a patient, leaving them even more vulnerable to diversion.
For example, if a patient comes into the hospital in the midst of a medical emergency and their vitals are crashing, a provider can manually override typical dispense protocols to get morphine or another controlled substance to help manage the patient’s pain. However, if the patient recovers and no longer needs the medication, this creates an opportunity for the provider to maintain possession of that medication if there are no systems in place to identify waste discrepancies. Technological solutions that can reconcile medication dispensing and track whether drugs are administered, returned to the pharmacy or wasted can help identify risk and eliminate the issue of diversion during this phase of the medication use cycle. Some of the solutions on the market even use AI to analyze the behavioral patterns of different clinicians and identify patterns of abuse and potential incidents of diversion.
The final step in the medication use cycle is administration and waste. Often, a full dose of medication is ordered but not used, or there is a small amount of medication left at the bottom of a vial. If this waste is not adequately accounted for, it can subsequently be diverted. Medication waste can also be removed from unsecured waste containers and diverted if it is not secured following administration. Once the process is complete, the cycle restarts, and more medication must be procured or ordered. If hospitals have implemented solutions to help improve their medication purchasing and tracking processes, they can more efficiently move through each step and ensure both patients and providers stay safe.
Streamlining the Medication Use Cycle to Ensure Safety and Efficiency
Pharmacists and clinicians are faced with an overwhelming number of complex tasks on a daily basis. Reducing their workload by implementing advanced technological solutions to help streamline the medication use cycle can take time-consuming burdens off their plates and enable them to focus on patient care and other critical tasks. With options like medication purchasing technology and diversion detection platforms, a well-equipped health system is better prepared to help patients and prevent stress and burnout among providers, leading to better healthcare outcomes for all.
Lauren Forni is the Director of Clinical Solutions for Kit Check, the leader in automated and intelligent medication management solutions. Lauren has 8 years of pharmacy management experience, most recently serving as the Assistant Director of Pharmacy Services at Brigham and Women’s Faulkner Hospital. She is passionate about modernizing health systems through innovation and technology solutions to empower clinicians and improve patient care. Lauren has expertise in improving strategic, operational, and financial performance within a health system and has extensive knowledge of pharmacy supply chain, pharmacy operations, informatics and information systems, 340B, and drug diversion.
