During a recent deployment of Kit Check, the pharmacy staff and Kit Check deployment manager were surprised when the system alerted them to the presence of a recalled drug before they were even done with the implementation (this was all thanks to our unique Network Recall capability). This particular recall was issued months before the Kit Check implementation which means whatever processes the hospital had in place for dealing with recalls had failed. As I reflected on this incident, I began to fully appreciate the monumental challenge hospital pharmacies face when it comes to recalls.
Hospital pharmacies are bombarded with information
FDA recall notifications, state board of pharmacy listservs and wholesaler notifications are just a few of the sources pharmacy staff have to monitor. On top of that, much of the information is irrelevant (the FDA recall notification service is mainly filled with food-related recalls). Beyond filtering through non-drug recalls, hospitals have to figure out if they ever received the specific lot and, if they did, whether or not that inventory is still present. Lastly, there are usually 1 or 2 people in pharmacy responsible for monitoring these services. As a result, vacations, sick days and competing demands often mean those recall notifications can go unnoticed for long periods of time. This has become more of an issue as the FDA has increased the frequency with which they are auditing how effectively hospitals are handling recalls.
Finding recalled inventory is like finding a needle in a haystack
Even if a pharmacy can confirm that they had at one point received inventory included in the recall, the really painful step is still ahead of them. Pharmacy has to reference multiple formularies to identify where that drug is used and inspect every impacted inventory location in the hospital. In the case of crash carts, that means opening up every single cart, inspecting every vial, replacing any impacted inventory, re-sealing the cart and updating any requisite paperwork. And those efforts only apply to the “official” inventory storage locations. Recalled inventory present in “unofficial” hoards often has a bad habit of showing up months after pharmacy thinks they had the recall under control.
Recommendations for easing the pains associated with recalls
Although there is no silver bullet out there for dealing with the challenges of recalls, there are actions pharmacies can take to address many of the issues articulated above.
1. Consider adoption tracking tools and alert services to reduce the noise
Obviously self-serving, but a solution like Kit Check makes it really easy to understand whether or not you have any recalled items in your inventory. With our unique Network Recall functionality, we also alert you if you have impacted inventory (and only if you have impacted inventory) even if you were otherwise unaware of the recall. Lastly, solutions like Kit Check will help catch any recalled inventory that was overlooked during the initial processing of the recall.
There are plenty of other services out there, that monitor drug recalls and proactively alert pharmacy that you can also consider. Keep in mind, however, that although those services can filter out non-drug recall alerts, filtering alerts down to only those NDC/lots your hospital received requires that you maintain accurate shipping information in those systems. Kit Check tracks each individual package so that NDC/Lot visibility comes along for free.
2. Leverage tools and establish processes to more effectively disseminate information internally
Make sure you have a clearly defined backup plan for when the staff normally responsible for monitoring recalls is out of the office. If you are the person responsible for monitoring, consider setting up a rule in your email service that forwards emails from certain people (e.g. firstname.lastname@example.org) or with the keyword “recall” while you are out (here is how to do this in Gmail). This will keep your backup from developing alert fatigue. Lastly, consider using collaboration tools like Slack or Yammer to set up a group for all of those responsible for helping with recalls to make sure there is a clear understanding of what has or has not been done in response to a particular recall.
3. Engage your providers in an open dialog
When providers hoard inventory, it is usually because they find the current access to meds inconvenient for themselves and their patients. Establish a regular dialog with providers to better understand their workflows and where the current arrangements fail to meet their needs. A while back, we shared the story of how one of our customers was able to address the issue of unofficial drug caches in L&D by creating a new process that better met the needs of Nursing while increasing compliance for Pharmacy. At the end of the day, you can’t keep a provider from hoarding but the more you can make med access efficient and safe, they will be less motivated to do so.
Interested in how Kit Check can help your pharmacy get a better handle on medication management in your hospital? Contact us.