Located in western Pennsylvania, UPMC Shadyside is 521-bed tertiary-care hospital and one of the flagship hospitals of the renowned UPMC Health System. UPMC Shadyside has been serving the residents of Pittsburgh and the surrounding area since 1866, offers a broad range of advanced clinical specialties, and is a recognized leader in the fields of cardiology and cardiothoracic surgery, oncology, surgical oncology, orthopedics, geriatrics, vascular medicine, and primary care medicine. The use of bar coded medication administration (BCMA) is just one of the many health information technology initiatives being implemented across the UPMC Health System to assure patient safety.

The pharmacy at UPMC Shadyside dispenses approximately 4.2 million doses per year, each of which needs a package that protects the integrity of the product, is clearly labeled, and has a bar code that can be read with the scanners used by nursing for positive patient identification during medication administration. For over 20 years, we used Euclid’s unit dose packaging products. In anticipation of our BCMA implementation, we reevaluated our packaging needs, and after considering multiple vendors, we chose to continue using the Euclid product line. Specifically, we chose the Cadet Twin 2x2 and Speedy Wet Cadet packaging systems, which we have found to be reliable and easy to operate. Both packagers require only a few hours of hands-on user training.

Packaging Oral Solids
The user manually feeds the tablets or capsules into the Cadet Twin 2x2 by placing them into twin slots cut into a rotating acrylic disk. The slots can double the packaging rate of single-feed devices, and eight different disk sizes can be used to accommodate various sized tablets and capsules. Finished packages feed out of the bottom of the machine in side-by-side, heat-sealed, tamper-evident unit dose packages. The packager is capable of producing 90 to 120 packages per minute, depending upon the desired package length, and the materials cost for packaging a 100-count bottle is approximately $0.52. In the last six months, the Cadet Twin 2x2 has completed over 1,900 packaging runs of nearly 170,000 solid doses at our facility – an average of more than 320 runs and 28,000 bar code-readable doses per month.

Packaging Oral Liquids 
The Speedy Wet Cadet, an automated liquid unit dose packaging machine, operates in combination with a Baxa Repeater Pump, which is included in the Wet Cadet system and can be used for other fluid transfer and filling applications. After calibration, the pump delivers the appropriate dose directly to the unit dose cup with a high degree of precision. A legible, bar coded top seal is applied to the unit dose cup, making a tamperand leak-resistant unit. In the last six months, the Speedy Wet Cadet has completed nearly 300 packaging runs of over 22,000 liquid doses at our facility, for an average of 46 runs and 3,800 bar code-readable doses per month.

Label Considerations
Both devices’ thermal printing mechanisms are sharp and consistent, and produce highly readable text and accurately scanned bar codes. Font sizes and text appearance can be formatted using the packagers’ Windows-based software. Each dose’s label is large enough to designate the drug’s generic and trade name, manufacturer, expiration date, and lot number, as well as the type of medication (i.e., controlled substance). Tall-man lettering can also be utilized to aid in the quick recognition and distinction of look-alike, sound-like drug names. Depending upon the packager, multiple print colors may also
be available.

The software’s electronic database also helps us maintain compliance with Department of Health and Joint Commission documentation requirements. We can query the database to retrieve records of the quantities and types of medications packaged, packaging dates, and lot numbers for the identification of recalled products.

Conclusion
There is no single technological answer to all of the issues surrounding patient safety, but we have found Euclid’s packaging systems to be important tools in our BCMA program.  ■

Brian Tuttle, PharmD, MBA, is a pharmacy operations manager at UPMC Presbyterian Shadyside, where he was worked since 1984. He has held numerous positions during his tenure, including clinical pharmacist, IV room supervisor, and interim director. He received his BS from the University of Pittsburgh School of Pharmacy, his PharmD from the University of Arkansas for Medical Sciences, and his MBA from the University of Pittsburgh’s Joseph M. Katz Graduate School of Business.

Dennis Schilling, PharmD, currently serves as a pharmacy operations manager at UPMC Presbyterian Shadyside. Prior to his current post, he was the coordinator for the regional cardiac registry at the Pittsburgh Regional Healthcare Initiative, a role he took after serving as a clinical pharmacist and medication specialist in the informatics and process improvement department at UPMC Shadyside. He received his BS from Duquesne University’s Mylan School of Pharmacy and his PharmD from the University of Arkansas for Medical Sciences.