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Tracking Multiple Doses of Injectables
How can you ensure all vials are accounted for in your practice?
By Steve Lenier, Contributing Editor |
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Injections play a major role in the retina practice. The drugs dispensed via these injections, as well as other essential medications, are expensive and must be distributed properly, so tracking inventory is crucial. If a single vial is lost, damaged or not properly billed, it's a very costly mistake. Practices must always know what's on hand, so they know when to reorder.
Using a Secure System
Dawn Williams, RN, at the Cole Eye Institute, Cleveland, Ohio, uses the Pyxis system (CareFusion Corp.) to track the medications in her clinic. She says this is a secure system in which a computer is hooked up to a refrigerator, freezer or drawers, depending on which is appropriate for each of the dozen or so drugs kept in their clinic. The system tracks the drugs on hand, how many of each is available and the lot numbers for each. To access the drugs, a nurse must log into the system, using fingerprint verification. The nurse then enters the patient name, the drug name and the amount needed. The system opens the correct compartment, the nurse removes the drugs needed, closes the compartment and exits the computer. The Pyxis system automatically bills and updates the inventory after each usage.
To be sure sufficient inventory is maintained, a par level has been established based on the rate of use. With the Pyxis system tracking the number of vials received and used, it's easy to maintain the correct number based on the par level. The level can be adjusted with their pharmacy, if needed. Ms. Williams says the initial step in the chain is that the pharmacy is "extremely careful to deliver the medications appropriately," which may mean keeping them packed in ice, dry ice, or other special storage conditions.
There may be times when a practice runs across an imperfect vial or has a vial that is accidentally wasted. When this happens, the computer is given the information that the vial was wasted, so the patient isn't charged twice when another vial is taken to replace the first one. The damaged vial is returned to the manufacturer for reimbursement.
The Paper Route
In contrast, Alison Ratliff, MBA, practice administrator at California Retina Consultants in Santa Barbara, Calif., says that although the practice's main office and 10 satellite locations perform a high volume of injections, they use a simple sheet of paper. They log in the number of vials they receive, and then as someone takes a vial, they update the log by subtracting one from the previous number and identify to which patient it was dispensed. Ms. Ratliff says accountability is an important element, so each person initials the log for each entry made. They also put the lot numbers in the log in case of a problem with a particular lot. Although Ms. Ratliff is well aware of the more automated tracking systems, she finds the simple paper approach to be what works best for their practice, and says they've never lost track of a vial.
Their drugs aren't locked up because of the frequency of use. With most drugs, whoever needs a vial gets what they need and updates the log. With ocriplasmin, because of its higher cost, the practice has implemented a system in which either Ms. Ratliff or the billing department must approve each vial before it's taken. She noted that ocriplasmin isn't used as often as other drugs, so it doesn't slow things down to require approval.
These drugs are available by overnight delivery to any of the satellite locations, so keeping enough on hand isn't a problem; they simply track how much they use and order more when needed. If there's ever a need for additional doses, the practice has a separate refrigerator in the main location that holds overflow doses, which can be used in such a situation.
There are several options available for tracking injectables, but each practice must determine works best for it. Implementing and following a system are crucial to track inventory and keep costs down.
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