Providing as many medications as possible in unit of use is a goal for hospital pharmacies, but because organizational needs differ, each health system must devise its own strategy to reach this objective. Good Samaritan Hospital Medical Center (GSHMC) in West Islip, New York, is a 435-bed, not-for-profit facility and one of the largest providers of emergency services in the area. Three years ago, the hospital implemented computerized prescriber order entry (CPOE), which requires that the hospital pharmacy provide all oral medications in bar-coded, unit-dose packages. The integration of CPOE significantly increased the importance of providing medications in unit-dose form with scannable bar codes.
The GSHMC pharmacy had been providing medications in unit dose for many years, but the process for repackaging and labeling these products was labor-intensive and time-consuming for staff. The hospital purchases approximately 75% of its oral solids in unit-dose packages; the remaining 25% are not available in unit dose, and therefore must be repackaged in-house. In an effort to improve workflow while ensuring all products leave the pharmacy in bar-coded, unit-of-use form, pharmacy began evaluating repackaging machines that would allow us to more efficiently repackage these medications.
Selecting a Repackaging Machine
A few fundamental factors were considered during the evaluation process:
After evaluating several repackaging machines, we identified a unit that best suited our requirements. The machine we chose is extremely efficient, with the capacity to repackage 120 medications per minute using a dual repackaging wheel, which doubles the packaging rate of single-feed machines. In addition, it is versatile, featuring a larger package size that accommodates a variety of oral solid sizes. Tall-Man lettering, which is recommended by ISMP,1 is incorporated into the labeling process. The software package includes a bar-code scanner, ensuring that each patient receives the correct medication and that each product will scan correctly. Moreover, the machine we purchased enables robust reporting functionality. Should a recall occur, the pharmacist can run a report to locate an item and easily remove it from stock.
The Repackaging Process
When a medication enters GSHMC, it is scanned by a pharmacy technician to verify that it appears in the database, and then the pharmacist signs off and the technician repackages the product. Next, the medication is given to the inventory manager to ensure the bar code scans in the CPOE system. A technician runs a report at the end of each shift of all the medications that have been repackaged, and the pharmacist signs off on the log and files the report for our records.
Maintenance plays a critical role in the efficiency and functioning of the repackager. Technicians clean the machine prior to unit dosing, between each batch, and at the end of each shift. The machine is serviced annually, at which time components are replaced if necessary.
All staff members must participate in training and pass a competency exam before being permitted to prepare unit-dose products.
The Need for Manual Repackaging
Although the repackaging machine has increased the safety and efficiency of the repackaging process, the need for manual repackaging remains. Certain medications, including antibiotics, sulfur-containing medications, oral chemotherapy agents, androgen inhibitors (eg, Proscar), and anti-androgen medications (eg, Casodex), cannot be repackaged using the machine due to the potential for contamination. GSHMC repackages these drugs using a manual system, wherein the technician places each tablet into an individual blister cup, which is then labeled.
While many organizations endeavor to increase the number of medications purchased in unit-of-use form, purchasing 100% of the pharmacy inventory in bar-coded unit of use remains an impossible goal. As such, every pharmacy needs a plan for managing in-house unit-dose repackaging. Selecting a repackaging machine can be challenging, but a thorough evaluation of the machines’ attributes can help identify the machine that best suits the facility’s workflow.
James Alfiero, RPh, is the pharmacy director at Good Samaritan Hospital Medical Center in West Islip, New York. He received his BS in pharmacy at Arnold and Marie Schwartz College of Pharmacy in Brooklyn, New York.
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