Part 1: From Drug Supply to Staffing, the Benefits of RFID Integrated into Vial Labels

In this Q&A, a manager of pharmacy operations explains why RFID-embedded vial labels just may change the world of inventory management and dispensing.

Automated inventory management solutions are used for a variety of different products, including medications and equipment. Their popularity continues to grow in tracking drugs for efficiency benefits across health systems.

We talked with Eric Schaefer, PharmD, manager of pharmacy operations at Allegheny Health Network, about how using label systems from Kit Check and CCL Healthcare has opened doors, increased efficiency, and more.

Before we get into the benefits—and Schaefer explains there are many—we’ll go over the technology that makes this possible. Kit Check and CCL Healthcare have partnered to deliver labels embedded with RFID tags to pharmaceutical manufacturers.

RFID inlay for small vials

Until recently, flag labels with RFID tags were manually applied to individual vials at the hospital system. The labels could not be applied at the manufacturer due to the time-consuming nature of the process. “Additionally, pharmaceutical companies use specific adhesives which are tested against migration and anything that can affect the drug,” says Karl Hoelper, director of marketing at CCL.

CCL has integrated the RFID inlay into the existing vial label that they print for the manufacturer. Vials then arrive at the hospital pre-tagged, eliminating the flag-application workflow at the hospital.

“Because we're producing the label already, we can take a transfer tape and match that adhesive so there are no qualification issues for the pharmaceutical company, which is a pretty big hurdle—it could be a year or two years to qualify,” explains Hoelper. “This mitigates the risks of any chemical migrating off the label and into the drug.”

Glass, liquid, and small vial/syringe sizes—including the traditional 2 mL vial—all pose challenges for RFID functionality. In addition to these challenges, the RFID inlay needs to be rotated 90 degrees in order for the antenna to fit properly on the 2 mL vial.

To make integrated RFID labels a reality on small vials, CCL custom-built a machine to orient inlays so that manufacturers wouldn’t have to change any aspects of their label artwork. The machinery allows them to remove each RFID inlay from the reel, pick it up, rotate it, and space it properly.

To make integrated RFID labels a reality on small vials, CCL custom-built a machine to orient inlays so that manufacturers wouldn’t have to change any aspects of their label artwork.To make integrated RFID labels a reality on small vials, CCL custom-built a machine to orient inlays so that manufacturers wouldn’t have to change any aspects of their label artwork.

The process requires extreme precision with multiple sensors and camera systems on the line to ensure the tag fits behind the label. The labels undergo numerous quality checks before they are released.

The result is that manufacturers receive labels with RFID inlay that appear identical to their existing label—and don’t require artwork changes and new FDA approval—and do not affect packaging lines. “We're working within the constraint of the current label, which is key for that 2 mL vial,” says Hoelper. “We wanted to make sure we made this work with their current adhesive and current label so that adding RFID is as painless as possible.” 

DoseID 

With the goal of ensuring the quality, performance, and interoperability of RFID tagged drug products as they move through the supply chain, DoseID launched in August 2020. CCL and Kit Check are founding members of this self-governing consortium established to unify the industry around an approach to serialized, RFID-tagged pharmaceutical products. “Creating pharma specific RFID labels is irrelevant unless there is an interoperable supply chain that sees the value of RFID. DoseID substantiates that value,” says the consortium.

They report that they take serialization beyond DSCSA, from the unit of sale to the unit of use. DoseID uniquely serializes every dose, container, or device to track every action taken upon it during its entire lifecycle.

The consortium takes a practical approach to ensure that the system works in the rigors of the real world. DoseID drugs and hardware devices are compliant with existing standards like RAIN and GS1. They are tested to ensure (1) performance (the best inlay is chosen for the application), (2) interoperability so that the drug will read in real-world scenarios, and (3) complete and accurate data in which the evolving record of a drug's attributes and event history is stored in the cloud and accessible to all parties.

“In recent years a variety of different RFID solutions have come into the healthcare market to track drug products, instruments, and supplies without any industry-wide standards having been established to ensure quality, performance, and interoperability between them," says the consortium. "With industry-wide support of a comprehensive set of RFID standards for healthcare, players along the pharmaceutical supply chain can work together to solve these issues proactively rather than reactively.”

With that explanation in mind, we sat down with Dr. Schaefer to hear about how the end users at heath systems have gained efficiency from RFID solutions adopted by pharmaceutical manufacturers.

Healthcare Packaging (HCP): To start, how are you using automated inventory management for drugs at your facility? I understand companies are transitioning away from flags into seamless systems with embedded tags. 

Eric Schaefer: What we choose to tag is going to depend on where we're utilizing this technology. When you look at how people select automated inventory management, there's one mindset of “I'm going to use it to check this tray or this kit.”

Then there's also the mindset of “I'm going use this to check those items and reduce the time it takes to check or use pharmacy time. However, I also see the other benefits that are available: the analytics, the inventory pieces, the recall pieces, and shortage management options with the tray.”

At my prior facility, I did a major implementation for two systems. We converted part of the facility to Kit Check for crash cart trays and for anesthesia trays where they do a tray drop, in which they take the used tray out, place a new tray into that drawer, and then it's 100% stocked. Those are going to be items that are usually higher value vials—they lend themselves well to this use. 

Most facilities that implement this are probably going to start with a crash cart because turnover in that cart isn't daily, so it's something where if you have an option to know electronically where stock is, and what's expiring, you're able to manage those and rotate those out rather than opening every cart every month.

That was the case here at Allegheny General Hospital, and at the previous facility I worked at. We started with crash cars and then expanded into other areas, but really you're looking at those kitted items for emergency kits, trays, and operating room (OR) based items.

HCP: What is the importance of the ability to scan vials without a direct line of sight?

ES: There’s a big time difference between scanning RFID versus 2D codes. If I needed a line of sight to scan a 2D barcode for a box or a bagged kit of drugs, if the label is on the side, I have to stand all those vials up or twist them so that the barcode is showing.

With Kit Check the nice thing is that I'm confirming that this drug is inside using RFID, without necessarily having the line of sight. I can use it to scan trays and scan boxes, such as radiology reaction boxes, without physically having to look at each item.

With 2D barcoding, I'm still going to have to physically look at every vial in that area. Many places will spend about one day every six months doing outdates and pulling drugs for the next six months. With an RFID system, I can now scan my bins once a week, or it may even be more frequent. I can eliminate scenarios where I have six months of a drug in limbo that I could be using up. 

The 2D barcode is usually going to end up being on the vial cap. What I had found is when they pop that off, it's still attached and the lid will sometimes fall back down, so it looks like it's an unopened vial. Whereas with RFID, the tag is attached to the side and I can tell when that top is off or when it's used.

HCP: Why did you end up selecting the Kit Check as opposed to other competitors?

ES: I am in the camp that the capabilities of Kit Check allow for a broader use of the system.

Speaking from my pharmacy manager experience in my previous facility, I looked at the options available. As I mentioned previously, there are the subset that look at it as a way to scan a tray, then there are the groups that look at it for fuller functionality.

When you're going to implement any technology, you have to pitch the benefits to the people who are going to be providing you the funds. If you're going in and you're saying, “I scan a tray” and you don't explain the benefits, they're probably going to want to lean towards the cheaper route.

However, I saw that as technology advances, there would be opportunities to use RFID to scan the products for inventory. 

In the past, we would make medication kits for the OR nurses with a 2D barcoding system. Their kit functionality was a laptop with a handheld scanner and scanning each vial. That takes more time than me putting a kit into a scanner and reading in seconds compared minutes.

When I used 2D versus Kit Check, the scan times vary greatly because you have a camera trying to assess the location of those barcodes. So it's something where being able to place it into the reader, have it recognized, not having to stand all the vials up to make sure that perfect make it up there in there with kind of that savings. 

And for me, I don't necessarily assume it as a time savings in the aspect of cutting people or hours. It's about what can I now do that's more value-added with that pharmacist hour. How can I elevate a technician's level of involvement to helping with the dispensing portion rather than just filling the tray and waiting for a pharmacist to check.

Even for pharmacists, other than having them check each of the hundred items that are in a tray manually for expiration, I can have a technician dispatch it, and I can now use that pharmacist’s time for providing clinical information, interacting more with the provider, and being more involved in patient care versus them having to check a tray for 10 minutes at 40 trays per day.

HCP: One feature is that information associated with an RFID tag isn’t static. Can you provide an example of additional or updated information being sent to RFID tags?

ES: We have a prime example of syringe shortages. For several years, there’s been an ongoing shortage of emergency syringes and even FDA updates to their expiration dates. The nice thing is I can validate that information on the FDA website, log into the system, and update the expiration on that lot number.

I can see the history of the tracking. I can see that for some of the syringes, I had to update the lot numbers two or three times because they were performing testing and allowing extended dating due to shortage. We can update expiration dates automatically without having to replace the tag.

HCP: So it's both a patient benefit, a cost benefit, and a sustainability benefit because you're not necessarily getting rid of something that's already in short supply? If an expiration date has been updated, then somebody isn’t mistakenly thinking it’s expired and tossing it? 

ES: Right. So a user looking at the vial doesn't see the old expiration printed on the tag (maybe they do on the carton) but we know that when we're releasing that drug, it has had an updated expiration in the system.


This is part 1 of a two-part series. Click here for Part 2 to read about KPIs, COVID-19 effects, and more.

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