Central to enabling point-of-care medication distribution is the guarantee of accurate unit dose packaging. Peninsula Regional Medical Center (PRMC) in Salisbury, Maryland, a 363-bed tertiary care facility, is in the latter stages of a large-scale project to switch from a centralized to a point-of-care (POC) medication distribution model (as detailed in the September issue of Pharmacy Purchasing & Products). A key component of this project was the decision to incorporate new high-speed, unit dose packagers to enable fast and efficient packaging in support of the POC model.
Take Advantage of Current Technology
Our previous process for unit dose packaging—a pieced together system consisting of an overwrap device, a bulk packager, and a tadpole-labeling machine—required manual intervention throughout the process, thereby introducing considerable risk of double doses, omitted doses, and/or incorrect product packaging. When we approached our administration with the proposal for medication distribution change, we emphasized that a fully automated packaging system was critical to the entire medication system overhaul. We found it beneficial to stress that the previous packaging system was considerably outdated and dismissing this stage as non-essential to the success of distribution change would be irresponsible. Accounting for timeliness and accuracy during unit dose packaging is as vital as any other phase in the process.
Technology Selection, Features, and Functions
After reviewing several options, we chose the Pearson IP128 Automated Packaging System based on several factors, including the system’s small footprint, scalability, and medication safety features. Likewise, the improved accuracy rate would allow for just-in-time packaging, which was key to the LEAN nature of the overall project. Additional features, such as biometrics
to identify users and the ability to continue packaging while restocking canisters, while not essential, were favorable to our streamlined vision.
Given the size of our medication inventory and our turnover rates, we decided to purchase two units, which can be linked together to function as one large packaging system. Each IP128APS unit holds 128 medication canisters, with each canister calibrated specifically for a particular medication. In addition, each canister can only be placed in its designated slot in the machine, serving as a fail-safe mechanism to prevent wrong medication errors. The user interacts with the process via a computer linked to both units in order to package medications, control the mapping and replenishment of canisters, and monitor job status. To run a packaging job for an existing medication held in one of the packagers, the user selects the medication from a list, indicates the quantity of medication required, and submits the request to the proper packaging device. Based upon priority, the designated packager will automate the remainder of the job. The end result is a strip (or a single package) of unit dose medications labeled with the medication name, strength, NDC, facility name, lot number, BUD, and bar code. Given that some medications cannot be run through any type of automated packager—such as large or oddly shaped items—or require special handling —such as controlled substances or slow moving products that do not need to be permanently stored in the devices—these medications are packaged using a manual tablet unit (MTU) tray that is integrated into the packagers. Through either fully automated packaging, or via the MTU tray, we are able to unit dose package 100% of our medications in the same manner.
While designing the new pharmacy layout to support POC distribution, we focused on allocating sufficient space to accommodate the new workflows. Fortunately, both IP128APS units and their accompanying control computer have a small footprint—just under four square feet each—and a buffer space is not required next to or behind the units. Thus, they fit easily into our existing space. System maintenance is fairly straightforward wherein we replenish the consumables, such as ink, packaging material, and journal paper used to print any internal error messages, and establish a cleaning schedule according to the manufacturer’s specifications. We designated a single pharmacy technician as the primary system operator, but there are several pharmacists available to check medications during canister replenishment to ensure accuracy at that critical stage.
As we move to complete the redesign of our distribution system, plans are being developed to monitor packaging utilization for each medication, which will be enabled through the system’s reporting function. Pearson provided us with a set of report templates to assist in managing inventory and reviewing productivity, and will continue to work with us to create any custom reports as needed.
As an administrator, I am confident that the accuracy of this new process will be far superior to the previous system, which relied heavily on human interaction. Based on this implementation, we were able to reduce our packaging staff requirement from 1 FTE to less than 0.2 FTE. When considering a new unit dose packaging system, it is important to factor in how the system will mitigate common activities for pharmacists, allowing them to focus on clinical and patient care issues. Eliminating human manipulation of processes also will ensure better risk management and a more streamlined distribution model.
Dennis Killian, PharmD, PhD, received his graduate degrees from the University of Maryland-Baltimore School of Pharmacy in 1999 and 2001, respectively. He currently serves as director of pharmacy services at Peninsula Regional Medical Center in Salisbury, Maryland, and also as an associate professor of pharmaceutical sciences at the University of Maryland Eastern Shore School of Pharmacy.
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