Develop a Do Not Tube List

March 2021 - Vol.18 No. 3 - Page #34
Categories: Manual Unit Dose Packaging Systems, Unit Dose Pharmaceuticals

Pneumatic tube systems can be a vital part of product flow within a health care facility. These systems provide nursing areas with patient specific medications in a timely manner, ensuring efficient medication access. In addition, they simultaneously improve the workflow within the pharmacy by reducing the required number of delivery runs throughout the day. This allows the pharmacy staff, both technicians and pharmacists, to focus on other critical aspects of their jobs within the department.

Identifying Inappropriate Products

Nevertheless, it is not appropriate for all medications to be transported via the tube system. For some medications, it is simply unsafe to tube them as the motion can impact the integrity of the product. In addition, it is important to consider those medications that would have an outsized financial impact should they be “lost” or damaged during transport in the tube system. At Doylestown Hospital in Doylestown, Pennsylvania, we have established seven points of consideration to determine whether a medication should be added to the institution’s Do Not Tube list.

The following criteria are used to assess if an item is unsuitable for tubing:

  1. Potential for alteration of active ingredient/vehicle, including products that may foam if shaken
  2. Chemotherapy/hazardous/cytotoxic medications and radiopharmaceuticals
  3. Risk of breakage, including glass bottles or ampules that cannot be secured or padded during transport
  4. Substantial monetary or labor loss if the medication is “lost” during transport
  5. Flammable/explosive/aerosol containers and volatile liquids
  6. “High Alert” or controlled substances that require a signature upon receipt
  7. Living therapeutic modalities or creatures (eg, leeches, maggots)

The Do Not Tube list is reviewed annually; in addition, any time a new medication is added to the formulary, it is assessed against these seven criteria (see TABLE 1).

Ensure List Accessibility

The Do Not Tube list is posted above the pharmacy’s tube station and sent to each nursing area for posting near their respective tube stations. In addition, it is uploaded to our hospital intranet so it is easily accessible for all associates from any computer in the hospital. It is key that the list remains user-friendly; as such, we maintain it as a one-page document in an easy-to-read format for any associate accessing the tube. This is especially helpful during critical, emergent situations.

It is important to track tubing directions within the pharmacy’s information systems as well. Tubing instructions can be placed in the comments section on the patient label; this data also appears in the electronic health record (EHR) in a space reserved for important administration instructions for nursing. For products on the Do Not Tube list, brightly colored auxiliary labels are placed on the patient label to serve as a back-up safety measure, in the event that the message is overlooked in the EHR.

Interdepartmental Policies

The pharmacy’s Do Not Tube list does not reference products from other departments that should not be tubed, such as pathology specimens or respiratory specimens. Both nursing and the laboratory have established their own department-specific policy and procedures for items requiring transport.


A pneumatic tube system is an important tool for increasing the efficiency and timeliness of medication transport within a health care facility. However, it is critical that hospital staff recognize those items that are not appropriate for use in the system. A Do Not Tube list that is accessible, clear, and consistently updated will help ensure that all staff can effectively manage those medications that are unsuitable for tubing.

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.

Christina Schnell, CPhT, is the lead pharmacy technician at Doylestown Health in Philadelphia. In addition, she supports the medication reconciliation program, leading the team and training staff on how to conduct a quality interview. During the COVID-19 pandemic, Christina became the point person for Bioquell technology and she and her team decontaminated over 9000 respirators.

Where to Find Unit Dose Packaging

For a full list of vendors offering unit dose packaging go to:

Manual Unit Dose Packaging Systems
Medi-Dose, Inc / EPS, Inc
Medical Packaging Inc, LLC

Unit Dose Pharmaceuticals
Euclid Medical Products

Unit Dose Packaging Machines
American Health Packaging


Like what you've read? Please log in or create a free account to enjoy more of what has to offer.

Current Issue