I read with interest a recent article from Pharmacy Purchasing and Products Magazine entitled “Develop an Effective Unit Dose Packaging Strategy” that describes the best practice of how our customer Lakeland Regional Medical Center in Lakeland, Florida relies on automated packaging systems to improve patient safety in their hospital.
The primary driver behind repackaging is Lakeland’s commitment to bar code medication administration (BCMA) – that is all medications administered to a patient will be scanned by the nurse to ensure that the right medication is being delivered to right patient at the right time. Lakeland has set up an alert system so if the medication is recognized for the patient, an alert is issued. BCMA has been proven to increases patient safety! Another benefit of the Lakeland implementation is the integration from the BCMA system to the billing system ensuring that medications are only charged to the patient if they are actually administered. While it is difficult to achieve 100% BCMA in a pharmacy, Lakeland reports “about 40% of all mediations administered in the facility are scannable”.
The best practice process followed by Lakeland is a great one for hospitals pharmacies to benchmark their own processes:
All medications that arrive in the pharmacy are scanned into the CPOE system before they are stored to ensure that drugs will scan correctly at the patient’s bedside. This allows the technicians to add bar code labels as needed and ensures that inventory is correctly mapped within the system.
Similarly, every medication that leaves the pharmacy is required to have a bar code. If an item lacks a bar code and one must be created, a technician enters the information into the repackaging computer system and a pharmacist verifies that this information is correct. Information that must appear on the new label includes the institution’s name, brand and generic drug names, manufacturer, strength of the drug, technician’s initials, pharmacist’s initials, a bar code, and an expiration date. Our policy is to never place an expiration date on a product that is more than 1 year from the date the product was packaged. All repackaged items are recorded in a log, which details who prepared and checked the drug, and also includes a label of the final product.
The bar code on the label is then scanned for mapping into the CPOE system. A single drug may have multiple bar codes mapped to it denoting medications from different manufacturers or packages of different sizes. If the bar code on the package is unscannable, the nurse must contact the pharmacy for a replacement, which can cause a delay in patient care. Following the same process every time a drug is repackaged helps ensure that bar codes scan correctly and contributes to nursing’s confidence in the scanning process.
To get a barcode on every dose of medication can be a difficult and challenging process. The article states that “Repackaging medications in the pharmacy demands accuracy and attention to detail every time the process is executed, as even a single mistake can result in a patient receiving the incorrect medication with potentially deadly consequences. Having the right equipment and training all staff on its use are crucial to ensuring a safe, efficient process.” Lakeland relies on automation to assist in the process – using 3 different technologies:
The pharmacy’s primary repackaging machine repacks oral solids that arrive in bulk form. It can be used to auto-pack or manually repack items, holds up to 350 products, and interfaces with the carousel in our central pharmacy. This feature is particularly efficient as the carousel sends a message to the packager when a refill is required, be it for an ADC refill or for a patient-specific fill.
The tabletop unit repackages tablets and pills and also is used as a backup to the primary repackager. In addition, this unit serves to repackage medications that are light sensitive. One side of the packaging has the drug information printed on it, while the backside is tinted amber to block certain light waves and protect the medication. The tabletop unit also is used for oral medications that cannot be repackaged in the primary unit.
The liquid repackaging machine is used to repackage liquids that arrive in bulk form, such as oral prednisolone. The machine utilizes an external peristaltic repeater pump that allows the user to repackage liquids in multiple quantities, including 5 mL, 10 mL, 15 mL, 25 mL, and 35 mL cup amounts, with an information label and a bar code. This process is much easier than drawing up items individually in syringes.
Lakeland has achieved significant benefits from their investment in automation. The article states:
A decade ago, the hospital operated with a single repackaging machine. One technician was designated solely to repackaging and accomplished little else over the course of an entire shift. Today, that same technician loads up to 350 drugs in our primary unit and the items are repacked in about a quarter of the time.
The repackaging machines used at our facility are simple to operate, require little more than general maintenance and cleaning, and significantly improve efficiency. Because Lakeland requires a high volume of repackaged products and must run batch fills day and night, were we to operate without in-house repackaging machines, a significant amount of time would be required for the staff to manually repackage all needed medications. Instead, the carousel batch fills are sourced directly from the primary packager, complete with an accurate bar code, thus eliminating the need for manual handpicking by the technician. Moreover, because medication scanning is linked to billing, an efficient repackaging process ensures equally efficient billing.
The article also shares the following conclusion:
Because medication availability and the number of bar codes are constantly increasing, repackaging technology must keep up with demand. Embracing this technology helps ensure that medications are repackaged correctly, reduces the amount of time required to repackage medications, and improves pharmacy workflow.
I applaud Lakeland’s commitment to excellence in repackaging to improve their pharmacy workflow, facilitate hospital billing practices, and most importantly driving better patient safety through BCMA.