Search

Purpose: Results of a study to quantify rates of identification of expired medications in automated dispensing cabinets (ADCs) are reported., Methods: A pre-post analysis was conducted to determine the effect of various types of ADC audits on rates of finding expired medications in ADCs. For the experimental phase of the study, 4 ADCs at the main campus of an academic medical center were randomly assigned to receive one of 4 interventions: (1) monthly audits of all ADC pockets, (2) monthly audits of matrix (open pocket) drawers only, (3) monthly audits of unassigned pockets only, and (4) no additional intervention., Results: At baseline, rates of finding expired medication doses in the 4 ADCs ranged from 0.4% to 0.7%. During the 3-month experimental period, rates of finding expired medication doses ranged from 0.1% to 0.3%. During a final audit 1 month later, the ADC targeted for monthly audits of all pockets was found to contain no expired doses, with an overall improvement in expired-dose rates for all audited ADCs observed over the course of the 4-month study. The average time to perform a full audit for an ADC with about 340 pockets was 1 hour, or 15 seconds per pocket. The average time to perform matrix drawer-only audits averaged around 45 minutes, or 11 seconds per pocket. The average time to perform audits of unassigned matrix drawers averaged 30 minutes, or 10 seconds per pocket., Conclusion: Auditing of all ADC pockets on a monthly basis appears to be an effective method of reducing the rate of identification of expired medications in ADC pockets., (© American Society of Health-System Pharmacists 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: UF Health's participation in a mentored quality-improvement impact program for health professionals as part of an ASHP initiative-"Strategies for Ensuring the Safe Use of Insulin Pens in the Hospital"-is described., Summary: ASHP invited hospitals to participate in its initiative at a time when UF Health was evaluating the risks and benefits of insulin pen use due to external reports of safety concerns and making a commitment to continue insulin pen use and optimize safeguards. Improvement opportunities in insulin pen best practices and staff education on insulin pen preparation and injection technique were identified and implemented. The storage of insulin pens for patients with contact isolation precautions was identified as a problem in certain patient care areas, and a practical solution was devised. Other process improvements included implementation of barcode medication administration, with scanning of insulin pens designated for specific patients to avoid inadvertent and intentional sharing of pens among multiple patients. Mentored calls with teams at other hospitals conducted as part of the program provided the opportunity to share experiences and solutions to improve insulin pen use., Conclusion: Participating with a knowledgeable mentor and other hospital teams struggling with the same issues and concerns related to safe insulin pen use facilitated problem solving. Discussing challenges and sharing ideas for solutions to safety concerns with other hospitals identified new process enhancements, which have the potential to improve the safety of insulin pen use at UF Health., (Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)

Purpose: Results of a study comparing two methods of optimizing automated dispensing cabinets (ADCs) are reported., Methods: Eight nonprofiled ADCs were optimized over six months. Optimization of each cabinet involved three steps: (1) removal of medications that had not been dispensed for at least 180 days, (2) movement of ADC stock to better suit end-user needs and available space, and (3) adjustment of par levels (desired on-hand inventory levels). The par levels of four ADCs (the Day Supply group) were adjusted according to average daily usage; the par levels of the other four ADCs (the Formula group) were adjusted using a standard inventory formula. The primary outcome was the vend:fill ratio, while secondary outcomes included total inventory, inventory cost, quantity of expired medications, and ADC stockout percentage., Results: The total number of medications stocked in the eight machines was reduced from 1,273 in a designated two-month preoptimization period to 1,182 in a designated two-month postoptimization period, yielding a carrying cost savings of $44,981. The mean vend:fill ratios before and after optimization were 4.43 and 4.46, respectively. The vend:fill ratio for ADCs in the Formula group increased from 4.33 before optimization to 5.2 after optimization; in the Day Supply group, the ratio declined (from 4.52 to 3.90). The postoptimization interaction difference between the Formula and Day Supply groups was found to be significant (p = 0.0477)., Conclusion: ADC optimization via a standard inventory formula had a positive impact on inventory costs, refills, vend:fill ratios, and stockout percentages., (Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)

Objective: To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems., Material and Methods: Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012., Results: Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (<1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (<15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (<15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (<10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (<10%), obtained (10.41%)., Conclusions: Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed., (Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.)

Background: In Thailand there is no regulation and standard guideline to control the quality of drug transportation, including cold storage drugs., Objective: To explore the condition of cold storage drugs transportation and delivery to general public hospitals, community hospitals and private hospitals., Material and Method: This is a cross-sectional survey research. There were 301 questionnaires returned from 720 questionnaires sent (41.8% response rate), Results: The serious problems of cold storage drugs on delivery were (1) Cold storage drugs (2 degrees C - 8 degrees C) were delivered to the hospitals without controlled temperature boxes, was found in private, public and community hospitals at the rate of 46.7%, 48.3% and 72.9% respectively. (2) Cold storage drugs (-20 "C), i.e., polio vaccine came to the hospitals with a temperature higher than 8C or ice melting in the box, was found in private, public and community hospitals at the rate of 22.9%, 12.7% and 35.0% respectively., Conclusion: There are differences in quality of cold storage drug transportation and delivery among types of hospitals. It is highly recommended that Thai FDA should develop a standard and implement the control system for logistics management of cold storage drugs.

Purpose: Recommendations of the interdisciplinary Safe Medication Use Expert Committee of the United States Pharmacopeia (USP) to assist health care professionals, manufacturers, and organizations in handling neuromuscular blocking agents (NMBAs) safely and effectively are discussed., Summary: Review and analysis of the USP Medication Errors Reporting Program and MEDMARX program databases showed a continuing risk of patient harm or death due to errors with NMBAs. Medication errors involving wrong concentrations, wrong doses, wrong drugs, look-alike packaging, and sound-alike names, combined with lack of monitoring and communication, have been associated with the use of NMBAs in health care institutions. Serious adverse events occur when NMBAs are used without adequate safeguards. Recommendations for improving safety were developed through review and discussion of root causes and areas of concern with these medications., Conclusion: Medical errors with NMBAs continue to result in patient morbidity and mortality. Increased awareness and action on the part of all parties involved are needed to improve the safety of this class of medications.

Objectives: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences., Design: Multi-method study involving interviews and a physical inspection of clinical areas., Setting: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003., Participants: Senior managers and ward based medical and nursing staff., Main Outcome Measures: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation., Results: All trusts required that potassium chloride concentrate be stored in a separate locked cup-board from common injectable diluents (100% compliance). Unauthorized stocks of potassium chloride were found in five clinical areas not authorized by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert., Conclusions: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes.

A national survey was conducted to determine the policies of hospital pharmacies regarding expiration dates for repackaged pharmaceuticals. A cover letter, questionnaire, and self-addressed stamped envelope were mailed to the directors of pharmacy of 360 randomly selected hospitals. Definitions of bulk and extemporaneous repackaging were provided. The response rate was 57%. Less than one third of the responding institutions followed the current FDA recommendations for dating oral solids repackaged in bulk. Almost one quarter used the manufacturer's date. Only 5.6% of the hospitals used more conservative dating. Similar percentages were found for the dating of oral liquids. One third of the hospitals used 30-90 days to date repackaged injectables ; however, a large range of expiration dates was reported. Almost one third of the hospitals applied the current FDA bulk repackaging dating recommendations to extemporaneous repackaging . A large percentage (29% for oral solids and 31% for oral liquids) used the manufacturer's date. A wide variety of arbitrarily assigned expiration dates are being used by hospital pharmacists in the bulk and extemporaneous repackaging of oral solids, liquids, and injections.

Expiry date guidelines for a centralized pharmacy-based IV admixture program are documented. These guidelines form part of an overall quality assurance program for the IV admixture service. Factors affecting IV admixture expiry times include drug compatibility with the vehicle(s) and container, microbiological parameters, and established standards of practice for pharmacy-based IV admixture programs.