Patient safety is at the centre of many discussions surrounding health care. Medication error is one very important concern linked to the role hospitals must play in their focus to ensure high quality drug-related patient care at the lowest possible cost.
Unit dose distribution systems (UDDS) have long been established as the safest form of drug distribution. A UDDS system applies to oral medication. The equivalent for intravenous medications is a CIVA (Central Intravenous Admixture) system.
The Ontario Hospital Association (OHA), in its submission to the Pharmaceutical Inquiry of Ontario, recognized UDDS as the system of choice. Virtually every new hospital built in Canada over the past 10 years has a UDDS system. Manual unit dose distribution systems are labour intensive and require physical space and staffing which can be prohibitive; an automated UDDS does not significantly increase staff and greatly reduces the possibility of human error.
Joseph Brant Memorial Hospital was the first community hospital in its LHIN (Local Health Integration Network) to introduce automated unit dose distribution of oral patient medications. “When I started at Joseph Brant 11 years ago, the goal, as the highest standard of care, was always to implement a fully functioning unit dose system,” says Nancy Giovinazzo, Director of Pharmacy.
That goal came within reach with newer, more efficient technologies available in automated unit dose distribution.
After intensive research and several site visits, the hospital purchased a McKesson PACMED machine. Although the system cost $250,000, Giovinazzo says, “Increased patient safety justified the investment.” She also added that it saves money in the long term because of lower drug inventories, less waste, and a more efficient use of pharmacy and nursing personnel.
The automated UDDS went live October 2005 on the medical units; by March 2006 the whole hospital was incorporated.
The PACMED machine is fully automated holding 400 medications plus an STS tray (special tablet system). It dispenses a long, transparent strip of individually packaged doses of 24 hours’ worth of medication for individual patients. Each strip starts with a label showing the patient’s name, room number, unique ID number, and the date and time to administer the medication. This information is followed by individual packages of each medication for that dosing time which are labelled with generic name, strength and lot number. The strip of medications ends with a footer label that contains the same information as the header label. Each patient’s medication strip is separated by a blank label.
When a medication bin in the machine requires refilling, the contents are checked and double checked by a pharmacy technician via bar code identification.
The process for generating a patient’s medications using the PACMED (a series of checks and double checks) is rigorous with patient safety always the top priority. A pharmacist receives the physician’s orders for a patient’s medications for that day, verifies it against the patient’s MAR (Medication Administration Record), then enters the medication orders into the Meditech computer. (Every medication is profiled, ensuring the pharmacist has a complete record of the patient’s medications for checking interactions and reviewing dosages). This system is interfaced to the PACMED machine which dispenses and packages the oral medications based on the profile for each patient.
A pharmacy technician verifies the medications as they are dispensed from the PACMED. These are put into individual patient bins in a medication cart based on a refill list that has been generated from the Meditech system. The refill list is initialled by the filling technician. The bins are then double checked by a technician who has been certified as a checker or by a pharmacist if necessary.
The final check, prior to administration, is by the nurse who compares the medication against the MAR and the patient’s armband to ensure the correct patient receives the medication. When bar code readers are implemented on the nursing units, the nurse will be able to call up the patient’s MAR on the Meditech screen, scan the patient’s armband, the medication and her own ID.
In the past, medication carts were stocked with three to seven days of medications for individual patients as well as floorstock medications. The nurse would select medications from the multi-day packages or from floorstock prior to administration. Floorstock had to be checked manually by the nurse or a pharmacy technician and then replenished from the pharmacy stock. It was also necessary to check for expired medications on a routine basis. Because of the large quantities in the bins, it was often difficult to find medications.
With the current system, a patient’s medication is prepared by the pharmacy department and dispensed in a ready-to-administer form for a 24-hour period. There is less waste and everything is in the same patient bin (unless refrigerated). In accordance with Accreditation standards, the pharmacist reviews every order against the patient’s profile and relevant laboratory information.
Although some medications are prepared using a manual distribution system, the automated UDDS represents a profound improvement in drug distribution and more importantly, the patient care process. It also represents another way Joseph Brant Memorial Hospital lives its vision: Best People. Best Care. Healthiest Community.