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
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 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.
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.