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Wendy Jordan, Pharm.D.Inpatient Pharmacy ManagerSt. Bernards Medical Center
St. Bernards Timeline• Hospital Committee Approval of Policies &
Procedures– March 2015
• Selection and training of TCT Technicians– March 2015 to August 2015
• Random Audits– September 2015 (1 Technician)• Two batch runs were selected• Total doses checked = 169• Accuracy Rate = 100%
TCT Education• Five technicians identified as possible
candidates per policy– Three technicians selected for training– Two technicians completed training• One Technician did not complete training due to:
» Staffing restraints» Change in positions of pharmacist trainers
– Didactic Exam (N=3)• Average score = 94%
– There was no re-training required
Validated Doses with Artificial Errors
Tech A Tech B480
500
520
540
560
580
600
519
588
Total doses checked
Total errors introduced
Total errors discovered
Percentage Found
Tech A 519 10 10 100%
Tech B 588 12 12 100%
Introduced Errors
Introduced Error Types
5
12
4
1
Name ErrorDose ErrorDosage Form ErrorOther
Tech-Check-Tech Pilot Updates
Jackie Acuña, Pharm DClinical Pharmacist I
Baptist Health North Little Rock
8
Timeline of Pilot Implementation
• Pilot approval of TCT by ABoP– February 2015
• Selection and training of VPT– February 2015- April 2015
• Policies and Procedures reviewed and approved by QRC– April 2015
• TCT Pilot implemented in central pharmacy – May 4, 2015
• TCT Random Audits– August 2015– October 2015 (6 months of data)
9
Training Overview
• Technician selection- policy based• Technician re-education– Didactic education• Self-learning• Important sections emphasized by TCTPC
– Didactic exam (n=4)• Average score 96% (+/- 3.26)
10
Re-education
• Four technicians qualified for training per policy– Two technicians completed training process– Two technicians required re-education• Review and discuss training packet• Additional 500 line items checked
– One technician did not complete the validation process
11
Total Doses Checked
A B C0
200
400
600
800
1000
1200
Total doses checked
12
VPT Validation Process
Total doses checked
Total Errors introduced
Total Errors discovered
Percentage found
A 589 58 58 100%
B 511 57 57 100%
C 1011 109 107 99.80%
13
Total Randomized Errors
57
72
63
30
Name Error (A)Dose Error (B)Expired Medication (C ) Dosage Form Error (D)
14
Introduced Errors vs Errors Discovered
1
2
3
0 20 40 60 80 100 120
58
57
109
58
57
107
Total Errors discovered Total Errors introduced
15
August Random Audit
• Student intern/APPE– Randomized nursing unit selection process• Three nursing units verified per random day
– Verified after the medications had been pulled for distribution
– VPT blinded to the auditing process and dates audits were to be conducted
• No mistakes were found during this review
16
October Quality Assurance Audit
• Per policy- Audit will consist of at least 10 % of ADC batch runs– Each VPT checked an average of 232 doses (3 batch runs)
• Errors were introduced at a rate of 1%
– The accuracy rate for each technician was 100%
17
Next Steps
• Present to ABoP final results of year-long pilot– March 2016
• AAHP Hospital Advisory Committee– Currently drafting recommended regulations– Will be reviewed by the AAHP Board of Directors
• Review of proposed regulations by ABoP
