Unit Dose Drug Distribution System Research Articles

ASHP Honorary Membership Award.

Clifford Hynniman Kurt Kleinmann Clifford E. Hynniman, MS, FKSHP, and Kurt Kleinmann, MS, were awarded honorary lifetime ASHP memberships in 2022 in recognition of their outstanding contributions to pharmacy practice. Hynniman is associate professor emeritus at the University of Kentucky College of Pharmacy in Lexington. He launched his career at the college as coprincipal investigator of a seminal study demonstrating that hospitalwide deployment of a unit dose drug distribution system reduced medication errors. He was a member of the faculty for 38 years until his retirement in 2006. Throughout his career, Hynniman championed leadership development to support the advancement of pharmacy practice and demonstrate the profession’s contributions to patient care. From 1972 to 1985, Hynniman maintained an appointment as field professor at the University of Kentucky College of Pharmacy while serving as director of pharmacy for Norton Children’s Hospitals (now Norton Healthcare) in Louisville. His many accomplishments at the hospital include establishing the region’s first 24-hour pharmacy service, launching an accredited 24-hour poison control center, and implementing clinical pharmacy services and a pharmacy residency program.

MeDrone- A Smart Drone to Distribute Drugs to Avoid Human Intervention and Social Distancing to Defeat COVID-19 Pandemic for Indian Hospital

Many healthcare centres generally have a centralized unit-dose drug distribution system (CUDD). The in-patient’s drugs are warehoused in a centralized location such as hospital pharmacy. The required or prescribed drugs available in the pharmacy will be distributed to the patient by either the nurse or attendant. The attendant often collects the medicine from the pharmacy. This process is quite time-consuming and in this COVID‘19 pandemic should maintain social distancing by the attendant in the pharmacy. In a field where time is of great importance and can save lives and also, a human intervention which in turn need to maintain social distancing, we can use MeDrones that will dispense medicines to the designated patient(s) location which will avoid human intervention and social distancing to defeat COVID-19 pandemic which is the need of the hour. The drone will be designed to deliver payload (tablets/saline) within/across the hospital premises. Apart from delivering medicines to the respective patients, the drone will be equipped to decide the optimal path to reach patients and prioritize attending to critical patients based on the hospital’s central database. The drones can be customized to return the unused medicines from the patient’s location to the pharmacy. Lightweight secured drugs container kit with authentication enabled will be designed for carrying the medicines to distribute to the respective destination inside the healthcare centre. The drone regulations result from increasing demand in UAV that must be devised to permit adaptation extensively as a logistics solution, to escalate efficacy in the healthcare domain.

Evaluation of Medication Error Reports Sent to Food and Drug Deputy From Hospitals Affiliated to Mazandaran University of Medical Sciences, Mazandaran Province, Iran, 2015-2018

Background: Medical errors are one of the most common threats to patient safety. Medication errors have several consequences, including the increase in patients’ mortality, length of stay, and healthcare costs.
 Objectives: This study was conducted in Food and Drug Deputy of Mazandaran University of Medical Sciences (MAZUMS) to evaluate medication errors.
 Methods: This study was conducted by the Food and Drug Deputy of Mazandaran University on medication errors reported and received from affiliated hospitals during 2015-2018. The analysis was performed based on the cause of the error, the frequency of the drugs, routs of administration, and the type.
 Results: Out of 3033 reported cases, the results of data analysis indicated that the highest percentage of these errors was related to antibiotics (22.84%). According to the results, the most common type of error belonged to the incorrect drug (44.18%), incorrect dose (25.65%), and drug omission (16.68%). The most common cause of the errors was related to neglect and insufficient care by the medical team (38.24%) and no or incorrect mention of the details of prescribed medications (in Kardex, HIS, etc.) by nurses (14.96%).
 Conclusion: Regular in-hospital training for medical staff focused on teaching the standards required for the administration and use of various medications, and identification of common medication errors can prepare guidelines to reduce these errors in hospitals. Besides, providing measures such as electronic prescription and medication systems based on a unit-dose drug distribution system can also help reduce medication errors.

Unit Dose Drug Distribution System at the Department of Cardiac and Transplantation surgery, University Hospital Dubrava

Unit Dose Drug Distribution System at the Department of Cardiac and Transplantation surgery, University Hospital Dubrava

Design of shared unit-dose drug distribution network using multi-level particle swarm optimization.

Unit-dose drug distribution systems provide optimal choices in terms of medication security and efficiency for organizing the drug-use process in large hospitals. As small hospitals have to share such automatic systems for economic reasons, the structure of their logistic organization becomes a very sensitive issue. In the research reported here, we develop a generalized multi-level optimization method - multi-level particle swarm optimization (MLPSO) - to design a shared unit-dose drug distribution network. Structurally, the problem studied can be considered as a type of capacitated location-routing problem (CLRP) with new constraints related to specific production planning. This kind of problem implies that a multi-level optimization should be performed in order to minimize logistic operating costs. Our results show that with the proposed algorithm, a more suitable modeling framework, as well as computational time savings and better optimization performance are obtained than that reported in the literature on this subject.

The drug logistics process: an innovative experience

Purpose – The purpose of this paper is to present the latest innovations in the drug distribution processes of hospital companies, which are currently dealing with high inventory and storage costs and fragmented organizational responsibilities. Design/methodology/approach – The literature review and the in-depth analysis of a case study support the understanding of the unit dose drug distribution system and the subsequent definition of the practical implications for hospital companies. Findings – Starting from the insights offered by the case study, the analysis shows that the unit dose system allows hospitals to improve the patient care quality and reduce costs. Research limitations/implications – The limitations of the research are those related to the theoretical and exploratory nature of the study, but from a practical point of view, the work provides important indications to the management of healthcare companies, which have to innovate their drug distribution systems. Originality/value – This paper analyzes a new and highly topical issue and provides several insights for the competitive development of a fundamental sector.

Electronic inventory systems and barcode technology: impact on pharmacy technical accuracy and error liability.

To measure the effects associated with sequential implementation of electronic medication storage and inventory systems and product verification devices on pharmacy technical accuracy and rates of potential medication dispensing errors in an academic medical center. During four 28-day periods of observation, pharmacists recorded all technical errors identified at the final visual check of pharmaceuticals prior to dispensing. Technical filling errors involving deviations from order-specific selection of product, dosage form, strength, or quantity were documented when dispensing medications using (a) a conventional unit dose (UD) drug distribution system, (b) an electronic storage and inventory system utilizing automated dispensing cabinets (ADCs) within the pharmacy, (c) ADCs combined with barcode (BC) verification, and (d) ADCs and BC verification utilized with changes in product labeling and individualized personnel training in systems application. Using a conventional UD system, the overall incidence of technical error was 0.157% (24/15,271). Following implementation of ADCs, the comparative overall incidence of technical error was 0.135% (10/7,379; P = .841). Following implementation of BC scanning, the comparative overall incidence of technical error was 0.137% (27/19,708; P = .729). Subsequent changes in product labeling and intensified staff training in the use of BC systems was associated with a decrease in the rate of technical error to 0.050% (13/26,200; P = .002). Pharmacy ADCs and BC systems provide complementary effects that improve technical accuracy and reduce the incidence of potential medication dispensing errors if this technology is used with comprehensive personnel training.

Electronic inventory systems and barcode technology: impact on pharmacy technical accuracy and error liability.

To measure the effects associated with sequential implementation of electronic medication storage and inventory systems and product verification devices on pharmacy technical accuracy and rates of potential medication dispensing errors in an academic medical center. During four 28-day periods of observation, pharmacists recorded all technical errors identified at the final visual check of pharmaceuticals prior to dispensing. Technical filling errors involving deviations from order-specific selection of product, dosage form, strength, or quantity were documented when dispensing medications using (a) a conventional unit dose (UD) drug distribution system, (b) an electronic storage and inventory system utilizing automated dispensing cabinets (ADCs) within the pharmacy, (c) ADCs combined with barcode (BC) verification, and (d) ADCs and BC verification utilized with changes in product labeling and individualized personnel training in systems application. Using a conventional UD system, the overall incidence of technical error was 0.157% (24/15,271). Following implementation of ADCs, the comparative overall incidence of technical error was 0.135% (10/7,379; P = .841). Following implementation of BC scanning, the comparative overall incidence of technical error was 0.137% (27/19,708; P = .729). Subsequent changes in product labeling and intensified staff training in the use of BC systems was associated with a decrease in the rate of technical error to 0.050% (13/26,200; P = .002). Pharmacy ADCs and BC systems provide complementary effects that improve technical accuracy and reduce the incidence of potential medication dispensing errors if this technology is used with comprehensive personnel training.

OHP-014 Clinical and Financial Effects of the Use of a Therapeutic Equivalence Programme in a Tertiary Hospital

BackgroundA Therapeutic Equivalence Program (TEP) assembles clinically equivalent drugs and defines the best therapeutic alternative included in the hospital’s pharmacotherapeutic guide to drugs not included (DNI).Purpose To measure the clinical...

Bayesian networks as decision-making tools to help pharmacists evaluate and optimise hospital drug supply chain

BackgroundThe drug supply chain is a cross-disciplinary process involving numerous actors. This can create difficulties in attempts to successfully analyse and manage its execution.ObjectiveTo produce a tool allowing easy evaluation...

Hospital pharmacy practice in Saudi Arabia: Dispensing and administration in the Riyadh region

BackgroundThere is very little published data assessing hospital pharmacy practice in Saudi Arabia. Hence, a comprehensive survey has been undertaken to evaluate hospital pharmacy services of the Kingdom of Saudi Arabia. Recently, we published the survey results on the prescribing and transcribing steps of the medication use process. This paper focuses on dispensing and administration. MethodsA modified-American Society of Health-System Pharmacists (ASHP) survey questionnaire was personally delivered to the pharmacy directors of 48 hospitals in the Riyadh region. Three attempted follow-ups were made within 3months to non-responders and the surveys were collected upon completion. The survey was conducted using similar methods to those of the ASHP surveys. ResultsTwenty-nine hospitals participated in the survey with a response rate of 60.4%. Centralized distribution (74%) is the most commonly used model for inpatient pharmacies. Overall, 21% of hospitals routinely use bar coding technology in medication dispensing. None of the hospitals are using a robotic distribution system to automate the dispensing of unit doses. Automated dispensing cabinets (ADCs) are used by 21% of hospitals as part of their decentralized distribution model. Sixty-one percent of hospital pharmacies have IV admixture preparation area in their facility. In the use of safety technology for medication administration, only one third of hospitals are using electronic medication administration records (eMARs), 7.4% had bar-code-assisted medication administration (BCMA) and 12% had smart infusion pumps. ConclusionHospital pharmacies in the Riyadh region are fairly well developed in providing dispensing and administration services. Further improvement can be achieved by increasing the use of new technologies such as bar-code technology, unit dose drug distribution systems, pharmacy-based IV admixture services, smart infusion pumps, and automated medication distribution.

Automatisation de la dispensation nominative au sein d’une pharmacie à usage intérieur. Expérience du centre hospitalier Le Vinatier

Nominative drug dispensation significantly reduces the incidence of medication errors. Computerized automated unit dose drug distribution system could be a safest hospital drug distribution system and allows an improvement of drug distribution in clinical ward. In 2005, at the Vinatier Hospital, an automated ward dispensing device was acquired. This report describes the implementation of this system and the experience of the pharmacy department. The implementation of an automated unit dose system includes expanding computerized order entry system, physicians' training and nurses to use the software, pharmaceutic staff's training to use the new dispensing system and setting under quality assurance the dispensation process.

The uptake of technologies designed to influence medication safety in Canadian hospitals

There are many technologies designed to improve medication safety. Although limited evidence supports their use, there are pressures to implement them. To determine the uptake of technologies designed to improve medication safety, plans for adopting technologies, attitudes towards technology use, and perceptions of medication error. Methods We performed a cross-sectional survey of pharmacy directors at Canada's 100 largest acute-care hospitals. Seventy-eight per cent of surveyed hospitals responded. Responding hospitals averaged 499 beds and 29% were teaching facilities. Hospital frequently used clinical pharmacy services (97% of hospitals), pharmacy-based intravenous admixture services (81%), computerized decision support modules for pharmacy order entry systems (77%), unit-dose drug distribution systems (75%) and computerized medication administration records (67%). Hospitals infrequently used bar-coding (9% of hospitals) and computerized physician order entry (9%). A majority of respondents and hospitals favoured expanded use of new technologies and planned for increased uptake. Respondents chose as their hospital's next investment: automated dispensing (33%), bar-coding (25%) and computerized physician order entry (12%). Canadian hospitals appear poised to make sizeable investments in poorly evaluated technologies that address medication safety.

Errores de medicación asociados al sistema de distribución de medicamentos en dosis unitarias. Concordancia entre observadores

Objective To evaluate the quality of the unit-dose drug distribution system by quantifying errors and evaluating concordance between observers in their classification. Material and method We performed an observational study to evaluate filling and transcription errors. Six medical units were analyzed 5 days per week, in different weeks, with random selection of the unit evaluated on the first day. Two observers (A and B) classified transcription errors according to the taxonomy of the modified Ruiz-Jarabo group classification 2000. Concordance was assessed using the Kappa index. Results A total of 1.9% filling errors and 12.01% transcription errors were detected. Among the errors, 74.2% of the drugs were used in the nervous system, digestive tract and cardiovascular diseases. The professionals most frequently involved in errors were pharmacists and nurses (κ = 0.793), and the most critical phase was transcription (κ = 0.766). The commonest errors for A and B were dose or drug omission (29.6%, 31.2%), incorrect dosage interval (25.0%, 22.6%) and incorrect duration of therapy according to the original medical prescription (21.5%, 27.8%) (κ = 0.701). The main causes of error were human factors (71.2%, 96.3%) and incorrect interpretation of the medical prescription (26.5%, 2.3%) (κ = 0.55). Conclusions The indicators used allowed the quality of the activity of the pharmacy service to be evaluated, and will serve as a reference for future evaluations. Human factors were the main cause of errors made during transcription. Consequently, new strategies with demonstrated effectiveness in reducing this kind of error, such as electronic prescription, should be introduced.

Control of antibiotic use by a unit-dose drug distribution system

Abstract The aim of the study was to test a new model of drug distribution known as unit-dose drug distribution including the effects of implementing this system on total drug consumption, especially in curbing antimicrobial use. The study was carried out in the Department of Surgery at the University Clinical Center in Nis, Serbia. During the first six months of the study (comparative period), drugs were delivered directly from the pharmacy to the urology and orthopedic wards in the traditional way (ward stock system). During the next six months (study period), drugs were delivered directly from the pharmacy to the patients (unit-dose drug distribution system). Drug consumption was measured using the statistical unit defined daily dose (DDD) per 100 bed days according to the anatomical-therapeutic-chemical classification of drugs. Following implementation of the unit-dose drug distribution system, total drug consumption was reduced by 24.34% in the urology ward and by 21.43% in the orthopedic ward. During the comparative period, in the urology and orthopedic wards, systemic antiinfectives (group J) comprised 263.54 and 227.61 DDD/100 bed days or 43.05% and 25.52% of total drug consumption respectively, whereas, during the pilot study period this group of drugs comprised 191.63 and 173.52 DDD/100 bed days or 41.37% and 24.96% of total drug consumption respectively. The unit-dose distribution system of drugs in hospitals leads to a control of drug consumption and substantial savings. Also, the pharmacist-physician interaction began to emerge as an important factor as a direct result of the changes in the drug distribution system.

Análisis de los problemas, relacionados con medicamentos, detectados en un hospital general

Background Drug-related problems (DRP) can arise between the time a drug is prescribed until it has an effect on the patient. The present study describes the methodology used in our hospital to identify, prevent and resolve DRP. The main objective of this study was to determine the prevalence and characteristics of the DRP detected and the results of the pharmaceutical interventions performed to resolve these events. Material and methods DRP were analyzed during a 1-year period in a general 450-bed hospital with a unit-dose drug distribution system (UDDDS) in all beds. A pharmacist reviewed all drugs processed in the UDDDS daily. When a DRP was identified, the therapeutic recommendation was communicated in writing through standard form, and the response obtained after 48 hours was registered. Results During the study period, there were 17180 admissions and 4859 DRP were detected. The highest percentage of DRP (54%) corresponded to drugs not included in the drug formulary and 88% of these DRP were due to drugs that could have been substituted for drugs included in the drug formulary. Another important group of pharmaceutical interventions corresponded to drug interactions, recommendations on drug administration, allergy alerts, and indications for pharmacotherapeutic monitoring. The most frequently involved drugs were those acting on the cardiovascular system. A total of 41.7% of pharmaceutical interventions were accepted. Conclusions The application of the program proposed was useful for detecting, preventing and resolving DRP. Given the repercussions of DRP, a standardized system that would allow follow-up of drug treatment is required.

Mejora de la calidad del proceso de llenado de carros de medicación en un sistema de distribución de medicamentos en dosis unitarias

To assess the quality of filling medication trolleys process for an unit-dose drug distribution system, after the implantation of a protocol. Five criteria were defined: four were related to the medication given to the patient, and one criterion was related to the patient's identification. At the same time, it was designed a standardized protocol of filling medication trolleys process and it was evaluated the degree of compliance with the criteria on all the hospitalized patients medication drawers in two clinical units. The fulfilment of the criteria was measured both before and after the implantation of the protocol, for fourteen and seven days respectively. In the first evaluation the number of errors was 0.84/medication drawer. After the implantation of the protocol, the total number of errors after correction for sample size decreased at 0.22/medication drawer. The degree of compliance improved for all the criteria, and differences were statistically significant for the criteria with most errors. The implantation of a protocol significantly improved two of the five quality criteria studied in the filling medication trolleys process. The patient's identification has been revealed as a fundamental aspect of intervention in the dispensation quality.

Medication errors: who is responsible?

New diagnostic and therapeutic technologies are used with growing frequency, improving the quality of medical assistance and increasing life expectancy. Health care, however, is becoming progressively more expensive and complex. Adverse events related to medical assistance, particularly errors, are becoming public, being debated and judged in courts. Given their training, health workers are not prepared to deal with errors, which are associated with shame, fear and punishment. The approach to errors in the health system is usually individualistic, considering such events as acts of insecurity performed by careless, non-motivated and ill-trained persons. The tendency is to hide errors when they occur, with the result that an important learning opportunity is lost. There is another way to deal with errors, a systemic view that has obtained positive results in sectors such as aviation, anesthesiology and unit-dose drug distribution systems. These systems have varied degrees of safety and should take into account human limitations when designed and applied. A change in paradigm is needed when dealing with drugs, as it is not enough for a drug to have quality assurance, but the complete process of drug use should be safe. Medication errors, avoidable by definition, are at present a serious public health issue, leading to loss of lives and significant financial losses. A systemic approach to medication errors may disclose failures in the process as a whole, and improvements can be implemented to reduce their occurrence.

Economic evaluation of Viaflex with vial adapter in a unit-dose drug distribution system.

The cost of parenteral admixtures has an important impact on the hospital budget. Recently, a Viaflex with vial adapter (named 'minibag plus' in some countries) has been commercialized in order to facilitate parenteral admixture preparation. In the present study a preparation using Viaflex with a vial adapter has been economically compared with a preparation with a traditional Viaflex (without adapter) in a centralized unit or in nursing wards in a unit-dose drug distribution system. A cost-analysis was conducted from the hospital point of view. Direct costs were considered: these included supplies and human resources. Differences in the whole process between the two types of Viaflex were analysed. The process included: purchasing, reception, storage, medical order record, preparation in the Pharmacy Service (PS), delivery from the PS to the nursing unit, preparation by the nurse, return of unused material to the PS. Human resource costs were estimated by time counting and multiplying by the average salary. To estimate wasted material, drug and supplies delivered from the PS and returned to the PS were counted during 26 days. With the new Viaflex costs are reduced by 30% in comparison with drug dilution using the traditional Viaflex in a centralized unit of the PS, and by 13.4% in comparison with preparation with the traditional Viaflex in the nursing ward. In addition it can be estimated that contamination risk with the new Viaflex is lower than preparation in the nursing ward with the traditional Viaflex. Therefore, owing to its lower cost we recommend the use of Viaflex with vial adapter for drug dilution for those vials that are compatible with the system.

Missed Doses An Evaluation in Two Drug Distribution Systems

To compare the rates and causes of missed doses in a modified unit dose drug distribution system versus an imprest system. A secondary aim was to seek the views of nurses and pharmacists on how the systems could be improved.