In healthcare, hazardous drug safety isn’t just a compliance box to check—it’s a critical responsibility shared across teams. Pharmacists, nurses, and other healthcare professionals all play a role in protecting themselves, their colleagues, and their patients from exposure risks.
We’re happy to have the opportunity to be a part of this story we are sharing with you today.
At the California Society of Health-System Pharmacists (CSHP) Seminar, Erica Bane, Pharm.D., BCPS, Medication Safety Officer at Scripps Health, shared how her team brought pharmacists, nurses, and others together to streamline hazardous drug safety with Rhazdrugs. Scripps’ story is a powerful example of what’s possible when collaboration drives innovation.
About Scripps
Scripps Health is a cornerstone of healthcare in San Diego, California, operating as a not-for-profit integrated health system encompassing five acute care facilities, multiple infusion centers, and ambulatory retail pharmacies. With over 17,000 employees, 3,000 affiliated physicians, and 2,000 dedicated volunteers, Scripps provides comprehensive medical care across four hospitals, including two trauma centers. The organization's reach extends throughout the region with more than 70 outpatient facilities, offering services in over 60 medical and surgical specialties through more than 30 outpatient centers. This extensive network ensures accessible, high-quality healthcare for the San Diego community.
Here are five insights from Erica’s presentation, “Rhazdrugs: Innovative Approach to Hazardous Medication Risk Assessment in Healthcare Organizations,” to inspire your own journey.
1. Involve Your Nurses in the Process
Hazardous drug safety impacts the entire medication use process—from pharmacy to bedside—so Erica and her team made collaboration a priority. They brought together stakeholders from every corner of the healthcare system: nurses, pharmacists, technicians, IS teams, and even buyers. By involving these groups early in the design of Rhazdrugs, Scripps created a user-friendly platform tailored to real-world workflows.
Key Insight: Nurses played a pivotal role by identifying unique challenges, like handling spills on patient bed linens, toileting instructions, and whether consent is required before even administering the drug. Their input ensured the final product addressed concerns that might have been overlooked otherwise.
Erica’s team also conducted demos and surveys to gather feedback. The result? A system so intuitive that extensive training wasn’t necessary, and end users felt a sense of ownership and trust in the program.
Takeaway: Engage all stakeholders early and often. By addressing diverse needs upfront, you’ll build a system that’s not only effective but widely adopted.
2. Centralize Critical Information
Before Rhazdrugs, Scripps relied on spreadsheets to manage hazardous drug lists and administration guidelines. This information was also documented within their EHR, but updates were not always synchronized. This decentralized approach created multiple sources of truth, leading to inconsistencies, delays, and potential confusion. Staff were often left uncertain about whether they were accessing the most current data, which compromised both efficiency and safety.
With Rhazdrugs, Scripps consolidated all hazardous drug safety information into a single, authoritative source. Erica’s team integrated the platform into their EHR, learning dashboards, and pharmacy homepage, ensuring seamless access across the board. This centralization eliminated redundancy and guesswork, empowering staff to trust the information they rely on every day.
Key Insight: By establishing Rhazdrugs as the single source of truth, easily accessible both within and outside the EHR, Scripps ensured clinicians always had access to the most up-to-date information. This eliminated confusion from conflicting sources, reduced cognitive load on busy staff, and reinforced confidence in safety protocols.
Takeaway: A single source of truth doesn’t just save time; it builds trust, reduces risk, and empowers teams to work more effectively.
3. Standardize Risk Assessments
Rhazdrugs provides a consistent checks and balances system for the Assessment of Risk process, covering every dosage form and every step of the medication use process.
When a new medication comes in, Erica and her team look at the risk level or the group, then go through each section and click a button to assign those administration guidelines and patient care activity handling guides. See an example below of how they can assign one set of administration guidelines to multiple drugs.
Another benefit Rhazdrugs offers Scripps is real-time alerts for newly FDA-approved drugs, conveniently displayed on the Rhazdrugs homepage. By staying informed of the latest approvals, Erica and her team can regularly update their risk assessments, avoiding the pressure of an annual review scramble.
By automating drug updates and AoRs within Rhazdrugs, Scripps added an extra layer of checks and balances to ensure no steps were missed when introducing a new medication. This systematic electronic verification process replaced outdated spreadsheets and ensured all hazardous drug entries and administration instructions were accurate, accessible, and complete.
Key Insight: Standardizing risk assessments with Rhazdrugs ensured consistency and reliability throughout the medication management process. This approach transformed risk evaluations from a manual, error-prone task into a streamlined, repeatable process that any team member could perform confidently. A bonus was eliminating a spreadsheet listing administration instructions and hazardous levels.
Takeaway: Standardization simplifies processes and ensures safety, freeing up time to focus on patient care.
4. Leverage Reporting for Compliance and Change Management
Rhazdrugs has become an indispensable tool for Scripps’ compliance audits and change management processes. The Approvals Report provides a list of all the medications within the facility formulary. With 5 acute care facilities, Erica and her team use the approvals report to track the following for each drug: approval date, the last date it was updated, and the individual who has updated it, along with their title. This ensures no medication is missed and provides an audit trail of who approved the drug and at which site it was approved.
Erica and her team also use Rhazdrugs to track updates, logs changes, and provides a clear audit trail, making inspections smoother and more transparent. They run change audit reports to show a side by side view of what was changed on a drug, avoiding the headache of remembering which line and what about it was changed on a spreadsheet.
Scripps went live in Epic with Rhazdrugs in July, and Joint Commission inspected one of their sites in August. Scripps received high praise for their use of Rhazdrugs, namely due to Scripps's work to provide easy-to-access and easy-to-understand safety information to ALL employees. Not only that, but Erica said the entire Scripps team was able to speak to their workflow and how they protect themselves from hazardous drug exposure using Rhazdrugs. She said that everyone - not only in the pharmacy, but the nursing staff and more - really shined in this area. Inspectors even recommended it as a best practice for hazardous drug management.
Key Insight: Robust reporting capabilities don’t just ensure compliance—they also empower teams to continuously improve their workflows.
Takeaway: A well-documented program not only impresses inspectors but also fosters ongoing accountability and improvement.
5. Build a Comprehensive Program, Not a One-Person Solution
We can paraphrase here, but honestly Erica says it best: “Now I can sleep at night, and I don’t have to worry about what is on that Excel document, where did I leave off? We have a streamlined process, now it’s a program.”
“You want it to be something that anybody can do. If you’re a specialist, you are special. That means there is one person who can do this job, but why is it one person? This should be such a comprehensive program that anyone can do it.”
Erica and her team at Scripps are pioneers and thought leaders. Being the USP <800> “designated person” is a huge responsibility, but Erica and her team at Scripps have taken it upon themselves to go beyond the pharmacy with the compassion to care about the safety of ALL employees in their health systems. As a result, the level of satisfaction with the program is very high. She says, “We want to protect ourselves (from hazardous drug exposure), but by protecting ourselves, we protect our patients. So just keeping that in mind, that yes, it is about employee safety, but if the employee's safe, the patient's safe.”
Erica says Rhazdrugs is the “superhero that comes in and helps manage hazardous drugs for you. With a few clicks, you can automate and centralize all those pesky tasks we are working on.” Now, they can focus their energy on other programs and projects.
Key Insight: By involving multiple stakeholders and streamlining processes, Scripps built a sustainable program that anyone on the team could manage confidently.
Takeaway: A comprehensive, team-driven approach ensures longevity and resilience in hazardous drug safety management.
If you have questions about Rhazdrugs or the Scripps implementation, please email us at info@rpharmy.com. We are here to help you with your unique hazardous drug safety and compliance needs.
Also, check out other Safety First blogs on inspectors' questions, where our passion for patient and healthcare worker safety comes from, what to expect in Joint Commission inspections and much more.
