Advice from the experts
Advocating for and Implementing IV-WMS By Gina Shaw
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ccording to a recent ASHP national survey of pharmacy practice in hospital settings, IV workflow management systems (IV-WMS) remain underused in U.S. hospitals, particularly at smaller institutions. Overall, 16.4% of hospitals reported having adopted IV-WMS; when broken down by size, 57.6% of the largest hospitals (≥600 staffed beds) are using the technology, versus 4.6% of hospitals with fewer than 50 beds. Only the largest group of hospitals broke the threshold of 50% or more using IV-WMS. However, IV-WMS adoption increased from 6.5% in 2014 to 12.8% in 2017, and the adoption rate of certain key components was higher than that of the systems overall. For example, 31.6% of all hospitals reported barcode scanning to verify the ingredients of sterile compounded IV preparations. (For adoption data from a 2020 ISMP report, see page 8.) “With most institutions having incorporated computerized physician order entry [CPOE] and barcoded medication administration [BCMA], the next area of safety is the pharmacy’s IV room,” said Dennis Killian, PharmD, the vice president of clinical operations for Peninsula Regional Health System, in Maryland. “There is a lot of risk associated with IV room processes; however, no authorities are saying that you have to adopt IV workflow management systems, whereas if you want to obtain incentives under meaningful use, you have to incorporate BCMA and CPOE. IV workflow technology takes effort to implement and costs money; without a mandate, some pharmacy practices just won’t do it. We’ve relied on pharmacy leaders and organizations such as the Institute for Safe Medication Practices to push this technology and say this is what we need to keep patients safe.” IV-WMS advocates are hopeful that calls for its implementation from pharmacy standard-setters will get louder. The THRIV Coalition for IV Accuracy, launched in 2019 to champion the “universal adoption ... of IV-WMS healthsystem pharmacies,” recently succeeded in getting several proposed resolutions accepted by USP for consideration to be adopted into USP’s 2020-2025 objectives and goals. “One proposal argues that IV-WMS should meet or exceed the criteria outlined in the coalition’s Technology Checklist,” said Mark Neuenschwander, THRIV’s founding director. “Another seeks to ensure that all medications, including those used for preparing IVs, have barcodes that include lot number and expiration date. Compounders need to know if the diluents and ingredients have been recalled or are out of date. Humans easily miss these things, but barcode scanners will not, and this is one more layer of safety that IV workflow can bring to the equation.”
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“These resolutions have been incorporated into the formulation process for USP’s next five-year goals,” Mr. Neuenschwander added. “So we’re on their radar, and we are hopeful that we will be able to work with their scientific committees to formulate policy that will achieve those two goals.” A USP spokesperson confirmed that IV-WMS “is very much on the radar of the Compounding Expert Committee.” For more details, see page 6.)
Barriers and Considerations In addition to the often cited issue of cost, many institutions struggle with culture change and adaptation as a barrier to the adoption of IV-WMS. “They say, ‘What is it going to do to my process?’ Things to consider include, how do I have to restructure my room, do I need to change where I store drugs, and how would not having the final label before making a dose change the process?” said Thomas Moniz, PharmD, the director of pharmacy operations at Northern Light Eastern Maine Medical Center, in Bangor. “Yes, initially it will take time to adjust; depending upon the size of your operation, it may take a few weeks or a month. But you do hit your new normal, and there is evidence to suggest it is possible to achieve time savings.” Those increased efficiencies require a full walk-through of how your system will change. “If you slow people down in one area, they will find shortcuts in another, so you have to be careful about your impact on workflow, in the same way we couldn’t just turn on barcoded medication administration in nursing without understanding their workflow,” Dr. Moniz said. “For example, you will no longer have labels printing out that you’re putting on a tray with your vials and bags; in some systems, the labels don’t print until you’re almost done compounding.” Eastern Maine Medical Center designed its new sterile compounding space, which went live in November 2019, with its upcoming acquisition of IV-WMS in mind. “We made sure internet connections were available, and some of our hoods even have USB ports in them,” Dr. Moniz said.
‘The Devil Is in the Details’ Marianne Ivey, PharmD, a professor emeritus at the University of Cincinnati James L. Winkle College of Pharmacy, stressed that hospitals considering IV-WMS need to “look
P H A R M AC Y P R AC T I C E N E WS CO M P O U N D I N G S P E C I A L E D I T I O N • 2 0 2 2
see ADVOCATING, page 12
