Duke University Health System includes three hospitals, a homecare and hospice center, a primary care center, and a private diagnostic clinic, among other affiliated programs. At the main Duke facility, medications are routed through a central storeroom where they are distributed to the main and satellite pharmacies, clinics, automated dispensing cabinets, and other entities within the health system. While the bulk of batch produced and compounded medications (including all high-risk drugs) are prepared in the Duke Compounding Facility—an open architecture cleanroom with ISO 4 worktables and an ISO 5 buffer area—there are numerous low- and medium-risk sterile preparation areas within Duke University Hospital where patient specific doses are prepared. The wide dispersal of these compounded medications requires a sound labeling system that can establish a convention that is easily recognized and is not prone to failure.
In 2001, our safety group reported that about 1.5 medication errors per month were attributed to difficult-to-read labels. At that time, we were using paper labels with either dot matrix or direct thermal printing, but these labels tended to be blurry, were not resistant to moisture or wear, and could only be printed with black ink using few font options. As each event in which safety is compromised costs us approximately $5,000, and the safety of our patients is of paramount importance, we needed to find a cost-effective solution for this problem.
Enhancing Information Transfer
The main concern of drug labeling is the proper transfer of vital information. Therefore, to address our original problem back in 2001, we implemented four-color thermal transfer printing technology with a labeling software program that allowed us to use color in order to enhance information transfer. We selected water and wear resistant synthetic media for all drug labels, and developed rules for colors—black for drug name, blue for drug strength, and red for any necessary caution alerts. Advanced printing capabilities made the labels more legible and easier to use, and the addition of specific product information helped address our deficiencies. Although this technology had many advantages, it also had some major drawbacks.
The media we used could get stuck in the printer track or the color ribbons could become creased resulting in blank areas, misprints, or mangled labels. Additionally, we were unable to print bar codes unless they were oriented with the lines in the direction of print. While label-printing speed was fast, it eventually became a cumbersome task to design and print new labels.
Heightened Safety and Output
Last year, as our label production technology neared its life cycle terminus and support for the printer platform was discontinued, we determined we needed a similar, yet more mature version of what we had been using. We sought a printer and software package that was flexible and would allow us to design color labels using different fonts; that could use synthetic, rugged, water- and alcohol-resistant media; and could help us meet all standards for labeling and bar coding our batch prepared and high-risk medications. After reviewing several available products, we chose to implement the Epson SecurColor inkjet printing system in our compounding facility.
We will often print several thousand labels at a time, and the smooth tracking of the SecurColor printer has provided staff the ability to print without constant monitoring, thus allowing our personnel to focus on other important tasks. Additionally, it is quick and easy to change the label and ink cartridges and the addition of the back-feed adaptor allows us to insert larger label rolls, further enhancing our print output. Notably, the small size of the printer makes it very easy to place within the facility, and research showing that placement within the buffer area of the cleanroom does not adversely affect particulate counts has been beneficial to us.
The physical switch to this new system has been effortless requiring only minor adjustments and it has alleviated the imperfections experienced with the older technology. The changeover has allowed us to enhance our labeling and bar coding for all medications, thus furthering our institution’s goals in patient safety. For the end users, the changeover was seamless and largely went unnoticed. In fact, the transition was so well received by our pharmacy staff that we have acquired funding for an additional printer this year. In the future we look forward to the merging of RFID technology with the SecurColor technology to perpetuate the boon to patient safety for our organization.
Kenneth Latta, RPh, received his BS in pharmacy from the University of North Carolina and has been employed by Duke University Hospital for almost 35 years holding many positions, including lead pharmacist on the acute pain service and manager for the Duke Compounding Facility. In 2011, Ken stepped down from management to take on a compounding pharmacist role in order to concentrate on teaching, mentoring, and consulting. Ken is the CEO and president of Health System Consulting Group, LLC, and is a surveyor and ASHP nominated at-large representative on the Standards Committee for the Pharmacy Compounding Accreditation Board.
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