With a new medication picking system for the Bowyer Block Pharmacy, which processes more than 20,000 drug items each month, safety is no longer left to chance.

Of the steps involved in processing a single medication prescription, the picking stage is particularly prone to a high frequency of errors and low chance of detection.

In 2012, in a bid to enhance productivity and reduce medication errors, Block 3 Outpatient Pharmacy pioneered the use of Light Emitting Diode (LED)-guided picking.   The system greatly reduced medications errors, but had its limitations. Despite having LED lights to direct the pickers to the correct bins, some preferred to rely on memory and experience to pick drugs from the open bins. This meant that there was a chance they could pick the wrong drug accidentally, especially if they were interrupted in the middle of their work or were harried during peak hours. 
 
“We needed to think out of the box to further improve safety of the drug picking process,” said Wong Jane Ai, Principal Pharmacist.
 
High volume means higher risk

The Outpatient Pharmacy team developed a new and improved Smartbin system with enhanced safeguards for the Bowyer Block Pharmacy.
 
The Bowyer Block Pharmacy (at the Diabetes and Metabolism Centre) processes about 6,000 prescriptions every month. As DMC serves patients with multiple chronic conditions requiring different medications, these prescriptions can add up to a total of more than 20,000 drug items dispensed per month. 
 
“This increases the risk of medication errors,” said Chiong Sieu Hong, Pharmacy Practice Manager. “Getting just one medication wrong can result in adverse outcomes for a patient,” she added.

 
LED lights in different colours – one for each drug pick – light up to indicate that the bin is unlocked and the drug inside is ready for picking.
 
Using technology to ensure correct practice

The Outpatient Pharmacy team worked with technology vendors to design new bins that are closed and locked at all times.   Each bin lights up and can be unlocked only when the picker scans his or her staff card and the drug label, so users will not pick from the wrong/adjacent bins.   The new bins are also fitted with 3D keys to ensure staff will return the correct bin to the correct location after it is removed from the shelf during picking. 
   

The system ensures accountability by requiring the staff to scan his/her staff card at every step of the picking process, thereby capturing the user identity. For drug top-ups and returns, the system tracks that staff will follow a two-person verification process to ensure the correct drug is returned or topped up.

                                                                             
Overcoming resistance to change

The new system was a marked improvement from the earlier one.  In some months, there were even zero errors in drug picks.   It made sure safety is never left to chance, by reducing the risk of errors involving human factors. 
 
However, some staff resisted the change because the new safeguards meant it took longer to pick drugs. “The staffs were used to the traditional method of drug picking,” explained Tan Shu Kuan, Pharmacist. “Our biggest challenge when we first implemented the Smartbin was to bring them out of their comfort zone.”
 
The team chipped away at the problem with frequent discussions with staff about the overwhelmingly positive impact on patient safety.   In addition, they had actively worked with ground staff to implement standardised protocols. “We guided them with a simple step-by-step method, shared with them the benefits of the Smartbin through medication near miss analysis, and conducted periodic surveys for their feedback,” said Shu Kuan.

 Training sessions for staff on the new workflow using Fastrak.
 
As a result, staff became increasingly convinced of the importance of the new workflow. Pharmacy Technician Supervisor Seah Sok Eng recalled: “Initially we were skeptical about the new Smartbin processes as it took a little more time to load and return drugs.   We soon realised that these steps were essential in ensuring safety in our picking process and the extra time taken was minimal in comparison to the benefits.” 
 
“Medication safety is our utmost priority,” declared Pearlyn Tay, Senior Pharmacist.

This story was reproduced from LighterNotes.