Things That Make You Go Hmmm... include IntelliGuard® Pharmacy where RFID Tags are not required.
In the spirit of education and transparency, this blog post focuses on a new approach in the field of medication IntelliGuard® Pharmacy. It features 2D barcode imaging and states to effectively solve the pharmacy operations challenges currently addressed by RFID-enabled IntelliGuard® Pharmacy.
The newly released 2D barcode imaging approach is simple in concept. By taking a high resolution image of the contents of a medication tray, the system “reads” 2D bar codes on medications in the tray and compares that against the approved, pre-defined template for that tray as well as specific item level detail (expiration date, lot #). Any discrepancies are noted and the pharmacy technician operator refills the tray based on the medication picklist provided.
7 Challenges Associated with 2D Barcode Imaging for IntelliGuard® Pharmacy Instead of RFID Tags
We are always curious about new developments in the pharmacy operations field and in this case, especially interested, as it pronounces itself as a sound alternative to RFID-enabled solutions. This blog post explores some of the claims of this approach and offers challenges to consider:
1. Human intervention
All products in the tray must have a secondary 2D barcode label applied and this step alone requires human intervention.
Even if you discount that requirement as not part of the actual replenishment workflow, the fact is, the 2D barcode imaging system requires all medication vials be properly oriented (facing up) in order to be imaged. Consider this:
Your trays may leave the pharmacy looking like this,
but …They likely come back to the pharmacy looking like this
There’s undoubtedly a couple of reasons for this: the trays are moved and handled multiple times during their clinical use, so inevitably, even if the vials were “properly” oriented when they left the pharmacy, they surely don’t return the same way.
Thus, a human operator in the pharmacy will always be required to re-set the tray configuration so that these 2D bar codes can actually be captured by the imaging system.
>> See RFID vs Barcode: Why Errors Happen in Barcode Processing
2. Medication vial configuration in the tray
Consider the actual tray set up in your hospital. Have you designed your tray configuration with some vials arranged on their sides? Many do, as shown in this actual tray configuration example.
Note how many pockets include medications that are arranged on their side
And, although the vial cap is the most visible part of the vial, it typically contains no information about the vial contents. Vials may purposely be positioned in a way that the manufacturer label is visible so that anesthesiologists and clinicians may get a view of medications.
How do you ensure that cylindrical containers, arranged on their sides, all stay properly oriented to be collectively imaged?
3. Space constraints on medication containers
Think over the space constraints on the top of the vial:
- Do other labels go across the top of lids such as warning and tamper proof labels?
- Does your hospital policy mandate auxiliary labeling?
- If so, will this create a conflict of space?
- In addition, how would you apply a 2D barcode label to very small vials (where the vial cap is actually smaller than the 2D barcode) and/or to glass ampules?
No additional label can be applied that would cover over, block or obscure the manufacture’s label.
Even if there is an acceptable space on the actual vial for an additional 2D barcode, again consider the workflow impact to reset the tray and assure nothing rolls out of position as the tray is placed in the TraySafe system for scanning - each and every time it is processed in the pharmacy.
4. Barcodes are sensitive
Our specific RFID-enabled Intelliguard® IntelliGuard® Pharmacy is designed to read each item multiple times and this is critical to achieve 100% read accuracy for items arranged in any orientation. Barcode systems read each item a single time. Additionally, barcodes are sensitive (to position, print quality, etc.) to accurately reading at all times.
Consider how many times you have to rotate a vial to get a scanner to read? Accurately reading every item in the tray is critical to the accuracy of the tray replenishment process. With 2D barcodes, you can’t guarantee 100% accurate read rates; therefore, you introduce the potential for additional medication errors.
To be fair, in the case of damaged codes, where a traditional barcode laser can’t read them, a barcode imager may be smart enough to still extract information from the code as long as it can be read somewhere in it.
5. Non-standard medication carriers
Procedural and emergency medication kits are prepared and transported in all types of containers: med trays, code trays/kits/boxes/bags, transport trays/kits/boxes/bags, intubation kits, C-section trays, anesthesia trays, anesthesia fanny packs and many other “non-standard” carriers.
Many times these are configured with multiple layers (as with a tackle box) or there is no standard, predefined template (medications in multiple pockets of an anesthesiologist’s fanny pack or an emergency transport bag). So, how does 2D barcode imaging support these non-standard medication carriers? It doesn’t!
The need for accurate replenishment, with nothing missing, nothing expired and nothing unexpected, certainly extends to all types of kit and tray configurations for which the pharmacy is responsible and 2D barcode imaging simply cannot support these “non-standard” form factors.
6. The 2D Barcode is a relabeling process – a big medication safety concern
We’ve been very vocal about the safety issues of relabeling.
>> See Patient safety driving increased RFID use in hospitals
The system will not be able to use the 2D barcode on the product label (if there even is one as it’s not required…. until 2017 at the earliest). It requires secondary labeling and again, the labels MUST BE positioned in direct line of sight for the imager to work.
There is no human readable information on a 2D barcode, or on our own RFID Smart Tag for that matter, and that’s a good thing. Duplicate human readable information on a secondary medication label can cause a whole host of additional medication error potential in the clinical setting. However, the application of a secondary 2D barcode requires pharmacy staff to print a label (in this case, just with a barcode) and then affix it to the appropriate vial. So, in the case of the 2D barcode relabeling process, how do you ensure the right tag is being applied to the right drug when a visual check isn’t possible?
MEPS Real-Time, Inc. has solved that issue with our RFID Smart Batch Encoding™ process.
>> Scroll mid-page to see Compare RFID Tag Processing Workflows.
With the alternative 2D barcode relabeling process, the risk of medication mislabeling is of significant patient safety concern. Even with applicable double-checks in place, the fact is this would not be a task that is easy and/or pleasant for a pharmacist to do and it adds significant staff time to the process of secondary 2D barcoding. Consequently, they may not do it consistently or very well.
7. No Costly RFID Tags
2D barcode labels are less expensive than RFID tags. But what is the cost of human error and wasted time?
RFID–enabled IntelliGuard® Pharmacy systems have proven ongoing safety and efficiency benefits and are the gold standard for pharmacyIntelliGuard® Pharmacy replenishment processes.
>> See Intelliguard® RFID and Impinj – Setting the Standard with RAIN RFID
RFID technology automates manual processes prone to human error while saving thousands of pharmacy staff hours annually. By automating the replenishment process for all medication kits and trays, you can assure the right drugs in the right doses are available when and where they are needed.
The Last Word on Medication Inventory Management
For most pharmacies, significant costs, regulatory pressures, patient care and safety challenges are often associated with medication inventory management. Inconsistent medication management processes create momentous risk when you consider that at the end of every procedural or emergency medication tray, there’s a patient waiting for that product.
We are always excited when pharmacy leaders look to technology to support safety and efficiency goals. However, not all solutions are created equally. We recognize that budget constraints are a real concern, but these seven reasons explain why that could cost you more (in both dollars and risk), if you decide to go the economy route.
Don’t compromise: We’d rather see you forego a technology solution in favor of your current manual processes versus introducing reliance on, and frustration with, an undependable, incomplete and potentially dangerous solution.
If you’d like to discuss or challenge these conclusions, we’d love to hear from you. Email info@mepsrealtime.com