DVx™ for On-site Drug Verification

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Reducing Costs and Improving Consistency, Patient Safety, and Staff Training with the 4th-Generation DVx

The fourth generation DVxTM, DYNALABS LLC DVx – 04, provides the means to create a significant improvement to hospital quality assurance procedures, staff training, and patient safety. This case study describes four common issues faced by hospitals and how the DVx has been used at all phases of the medication lifecycle to address and resolve those issues for a sample hospital (Hospital A).

Hospital A faced four main issues related to medication use and misuse within their systems and staff. These issues could potentially lead to reduction in patient safety, costing the hospital both money and reputation.

The issues were:

This paper will show how Hospital A used the DVx to reduce costs and improve consistency, patient safety, and staff training.

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Figure 1: How using the DVx in the pharmacy and hospital floor fits into the hospital medication lifecycle

Inconsistent Quality Assurance and Medication Labelling Practices

National Patient Safety Goal 03.04.01 states a hospital must “label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings”. Unfortunately, Hospital A staff was not following NPSG 03.04.01 and had no standard method to perform quality assurance on the inconsistently labelled contents. The following should always be on the container label:

Because inconsistent labelling is also an indicator for inconsistent contents, patient safety issues were an ongoing problem for Hospital A.

Figure 2:Inconsistent content labeling
Figure 2: Inconsistent content labeling
Figure 3:Actual results of the DVx chemical analysis of multiple samples of Fentanyl injection from a hospital with inconsistent quality assurance and labelling practices.
Figure 3: Actual results of the DVx chemical analysis of multiple samples of Fentanyl injection from a hospital with inconsistent quality assurance and labelling practices.
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Figure 4: Actual results of the DVx chemical analysis of multiple samples of Fentanyl injection from a hospital with well managed quality assurance and standard labelling practices.

By adding the DVx to the pharmacy and hospital floor, Hospital A was able to perform immediate and consistent quality assurance on medications received, created, used, and discarded. With the DVx, within seconds, Hospital A staff can now confirm the medication within a container matches the label:

With the DVx, Hospital A can easily manage their quality assurance and enforce standard labelling practices. Patient safety is improved and consistent labelling now helps to ensure consistent container contents.

Verifying Staff Training

Staff training is an important piece of maintaining standard labelling practices and well managed quality assurance programs. When Hospital A recognized their issues with inconsistent quality assurance and medication labelling practices, they realized they needed a way to verify that their staff was getting complete training and following best practices.

By using the results of the DVx analyses, Hospital A was able to pinpoint staff training needs. This led to a revamping of their staff training to use the DVx, which helped address several issues, including medication labelling practices.

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Figure 5: Sample DVx staff training analysis pinpointing staff training needs

Diversion

Diversion can be an issue in any hospital. In general, random samples of containers are sent to the DYNALABS core lab for testing. This helps to address diversion, but does not ensure the compromised containers will be tested and diversion confirmed.

With the DVx, any suspect container, or even every container can be tested, ensuring that diversion will be discovered.

Hospital A discovered they had a problem, when the Director of Pharmacy noticed that a supposedly unused vial of morphine had too much liquid in the vial, and the tamper-resistant cap was removed.

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Figure 6: Control sample (left) and diverted sample (right)

By using the DVx, the Director of Pharmacy was able to compare the contents of a control sample against the suspected diverted sample. Within seconds diversion was confirmed.

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Figure 7: DVx chemical analysis of the samples in Figure 6: confirming diversion

There was no need for the expense and time of sending multiple samples offsite for confirmation of diversion. Only the compromised container need be sent to the DYNALABS core lab for a documented test result that will hold up in a court of law. The Director of Pharmacy can quickly follow-up by checking other medications and containers for diversion, and begin the process of finding the culprit.

Waste Verification

Discarding unused medication increases hospital costs. It can also be a source of diversion. Hospital A had no way to confirm whether the medication discarded matched the medication used (was diverted).

With the DVx, Hospital A was able to confirm the contents of the medication discarded matched the medication dispensed and used. In addition, Hospital A could confirm the percentage of medication wasted versus what was drawn into the syringe.

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Figure 8: DVx chemical analysis of waste indicates Hospital A discarded the correct percentage compared to the medication dispensed.

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