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Take the Missteps out of Drug Delivery
Sadly, medical errors continue to make headlines. “An error occurred during the mixing process in our hospital pharmacy” involving heparin, reported Christus Spohn Health System (Corpus Christi, TX) in early July.
Christus Spohn reports that “the error was unrelated to product labeling or packaging.” Without having the details, we won’t speculate otherwise. No general discussion of medical errors would be complete, however, without examining how drug or medication packaging can be used to reduce them.
The American Society of Health-System Pharmacists (ASHP) discussed IV drug safety at last week’s invitation-only summit. Joined by the Institute for Safe Medicine Practices (ISMP), The Joint Commission, United States Pharmacopeia, The National Patient Safety Foundation, and The Infusion Nurses Society, the ASHP used the summit to start developing “recommendations associated with the use of IV products that will positively affect patient safety.”
Hospira was one of the summit’s supporters. One approach by the company to increase the safety of its drug delivery is to minimize the number of preparation steps for intravenous drugs. “Reducing the complexity of medication administration saves manpower and helps eliminate errors,” reports Robert Felicelli, vice president and general manager for specialty pharmaceuticals for the Americas.
Promoting “ready-to-use” products would be one approach, says Felicelli. And Hospira has found through its research that nurses like premixes, he says. But such formats are only designed for drugs that are stable in solutions. In addition, prescribed doses are often based on weight, an additional complexity to drug delivery.
But the problem isn’t that some drugs can be premixed and prepackaged and others cannot. Rather, problems occur when hospital staffs use several different types of delivery systems, Felicelli says. “Nurses get used to one delivery system,” he adds. “Hospitals would like to standardize on one system for a number of drugs.”
Of course, there is no universal system that can meet all needs, Felicelli admits. “But systems with enough similarities between them can work together to minimize error and increase safety.”
Hospira has developed drug delivery systems with these goals in mind. It has worked with nurses to “capture end-user input” and develop “customer-focused design criteria,” says Felicelli. “We partner with customers and hospitals to deliver easy-to-use systems to reduce errors as much as possible.” Hospira has packaged its drugs in FirstChoice Premixes, iSecure prefilled syringes, and ADD-Vantage diluent containers with drug vials designed to fit specifically into them. Hospira also offers other generic and brand-name drugs in some of these systems and is looking to expand that in order to drive standardization, he adds.
The ASHP encourages pharmaceutical manufacturers to “provide all medications used in health systems in unit-dose packages.” It calls upon FDA to “support this goal in the interest of public health and patient safety.”
It is unclear whether premixed, prefilled, or unit-dose packaging could have prevented recent mistakes. But packaging—or the lack of it—does influence drug-delivery procedures. Packaging dictates the series of steps required to prepare drugs for administration. In some cases, prepackaged unit-dose or unit-of-use products may eliminate some mixing steps that are subject to mistakes. As healthcare practitioners and industry look for ways to prevent errors, these packaging formats should be considered.
Humans make mistakes. Unless hospitals start staffing robots to practice medicine, humans will still be responsible for reading labels, opening packages, and mixing and administering drugs.
But simplifying drug delivery through packaging innovation might take some of the missteps out of drug delivery. The fewer the steps, the fewer the chances for human error.
Daphne Allen
Editor
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