Continuous improvement to the quality of life and well-being of the patients we serve is the goal at Doylestown Health, a 240-bed, not-for-profit hospital in Bucks County, Pennsylvania. A highly automated facility, the hospital’s pharmacy operation leverages and seeks to maximize the utility of the facility EHR, an automated medication storage and retrieval system, an automated dispensing cabinet (ADC) network, RFID inventory control technology, a high-volume unit dose repackaging machine, and solid and liquid manual repackaging systems, all of which are essential to the ongoing success of our pharmacy operation.
Our Unit-Dose Packaging Approach
The provision of bar coded, unit-of-use medications is a general goal for our pharmacy operation as it is for many others, and so we seek to acquire as many medications pre-packaged in unit dose as we can; however, not all medications are available in this format and some that are available in this format can be price prohibitive compared to bulk purchasing. The advantages of products manufactured with a bar code and in unit dose are somewhat obvious (eg, built-in safety measures, simple-to-no preparation, convenience in tracking and loading into automated medication storage and retrieval systems), but Doylestown’s unit-dose provisioning strategy includes purchasing some medications in bulk and repackaging them into unit dose in-house, using a combination of high-volume repackaging machines and manual repackaging systems.
The majority of bulk, non-liquids are repackaged using the high-volume unit dose repackaging machine. However, in certain situations—eg, if the medication contains an allergen or if the tablet is especially brittle or too large for the machine—our manual repackaging system is especially advantageous. We use the manual system to repackage controlled substances and hazardous drugs, as well as oral liquids, and this system is particularly helpful when dealing with the significant number of manufacturer backorders. For example, sometimes, due to backorders, we can only obtain pints of liquid medications, so we are able to address these repacking needs using our manual liquid unit dose packaging system to unit dose.
Staffing and Training
As medication back orders have been common lately, a technician repackages medications for an average of 4 hours each day. Our technicians are also responsible for properly loading repackaged medications into the automated medication storage and retrieval system. Typically, 15 to 20 different types of medications are repackaged each day.
Given the inherent need for skilled attention to detail when performing any manual task, an effective staff training program is integral to a successful unit dose packaging strategy. Doylestown Health has implemented a robust program to teach pharmacy technicians how to correctly use the repackaging machines and the manual unit dose packaging system. Technicians are trained full time for 2 weeks and this didactic and experiential training includes the use of handouts we designed in-house, as well as a competency assessment after the training is completed. Thereafter, the competency assessment is administered annually to ensure continued competency.
Cost savings is a significant benefit of in-house repackaging of medications into unit dose, using the high-volume repackaging machines or the manual repackaging systems. Speed, versatility, and convenience are the primary benefits; if a medication is not available in a certain dose—eg, 12.5 mg are needed for a patient, but tablets are only available in 25 mg strength—we simply utilize our manual processes to split the tablet and repackage and label the doses in the pharmacy.
Although Doylestown Health strives to purchase as many medications as possible in bar coded unit of use, this is not always possible, and a supplemental repackaging system is necessary. Given that both cost and availability can be prohibitive factors, the combined system we have employed thus far has maximized our ability to ultimately provide safe, bar coded, unit-of-use medications to our patients.
Kathryn Schwartz, RPh, is the pharmacy operations manager at Doylestown Health in Philadelphia. She received her pharmacy degree from the University of the Sciences in Philadelphia and is a member of the American Society of Health-System Pharmacists.