Many pharmacies are challenged to establish safe handling practices for cytotoxic medications, and this holds true for oral chemotherapies, particularly those not available from the manufacturer in unit dose. The additional safety realized from bar code scanning upon administration is key to avoiding medication errors with oral chemotherapy. Although many medications can now be purchased prepackaged in unit-dose, bar-coded form, some oral cytotoxic medications are available only in bulk bottles. Packaging and bar coding these medications can be problematic in the pharmacy.
The Erlanger Health System is a five-hospital health system, with the largest of its facilities in downtown Chattanooga, Tennessee. That facility, which is licensed for approximately 800 beds, distributes the majority of its doses from a central pharmacy via cart fill.
Many repackaging machine manufacturers recommend either not using their product with cytotoxic medications (or certain antibiotics) or thoroughly cleaning the machine after packaging these agents; such medications may be crushed while moving through the machine or leave residue on the surfaces they touch. However, cleaning the machines can be time-consuming, as it requires at least 10 to 15 minutes to thoroughly clean all the surfaces that the drugs pass over.
An excellent alternative is to repackage these drugs using a manual press-and-seal, or blister pack, system. Most press-and-seal systems are simple to use and require very little training for technicians to master. Our system consists of rectangular trays of cups that technicians set on a board to fill. After a tablet is placed into each cup, an adhesive sheet is rolled over the top, sealing each dose in place. Lastly, labels are placed on each dose. Given the simplicity of this approach, medications can be packaged quickly and safely, once the labels are set up, with little cleanup required. Another advantage of adopting this process is that it can serve as a backup for those times when the pharmacy’s automated packager is down.
Packaging oral chemotherapy doses in this manner increases safety, reduces the time required for repackaging, and decreases costs. Given that most institutions will use this system for a small volume of doses, the cost is quite manageable. Our pharmacy packages approximately 300 doses per year using the manual press-and-seal system. We have found that the packaging costs are offset by the safety benefits and time savings we have experienced.
Allen Broome, PharmD, is the director of pharmacy for the Erlanger Health System in Chattanooga, Tennessee.
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