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How patient safety made Baxa’s fortune


Carole Mongin-Bulewski
Hospital Pharmacy Europe

The official opening of Baxa’s new European headquarters in Bracknell (UK) on 17 May 2006 was a good opportunity for Hospital Pharmacy Europe to ask Managing Director Terry Aston why, in his opinion, Baxa has trebled its number of employees and has gone from a turnover of £2.6m to £10m since 2000, with a European turnover forecast for 2010 of £19m (£108m worldwide). The reason for this, according to him, is threefold: patient safety, commitment to the pharmaceutical industry and innovation.

First and foremost is patient safety, which can be achieved through innovation. Baxa was founded in 1975 with an oral liquid medication dispenser, a modified syringe that provides safe and effective dosing and administration of oral liquid medications. This product is still in Baxa’s line today. During the 31 years since the company was founded, various systems and products, as well as software and services, have been developed to facilitate hospital (as well as retail) pharmacists’ work and enable them to deliver medications safely and efficiently. During those years, Baxa has developed electronic hardware, and in particular a product called the total parenteral nutrition (TPN) compounder (see image). This compounder can take the hospital doctor’s prescription for a patient’s specific medication under aseptic conditions and, through a series of software and hardware products, can select up to 24 different ingredients, dose the exact amount (no matter what unit is being entered in the system) and put them into one single-source container. The formulation is then delivered to the patient. “If you look at our mantra within this company,” says Terry Aston, “the number one priority is patient safety.” The TPN compounder enables clinicians, pharmacists and any deliverer of pharmaceutical services to determine accurately the drug dosage. Indeed, statistics in terms of medication errors show that a large percentage of these errors are due to the dosing part of the process, with incorrect amounts being delivered. This is where the fact that Baxa is, and has always been, an innovator comes to play. Says Aston, “If one can automate the whole process, putting it through validated software control, you have a much greater opportunity for safety than if you rely on an individual who might get distracted at the point of delivery. And that is what our machines do.” Along with this electronic equipment, which is one of the keys to Baxa’s success and growth, the company also provides a range of disposables, consumables, bags and various components that are all sterile and can be used to fill and deliver the drug to the patient. As patient litigation becomes more important in Europe, hospitals are looking into ways of reducing this risk, by having validation and documentation of the procedures, which, in addition to the high level of training in pharmacy departments, reduces the risk of something happening. Baxa’s automated systems provide all of this documentation, so not only do these systems give pharmacists the means of accurately dispensing the liquid drug under sterile conditions (thus reducing the risk of touch contamination, which is a major source of infection), but they also provide the backup documentation to prove to pharmacists that what is in the bag or the container is actually what was prescribed. Furthermore, a lot of the work that is currently being done at ward level by nurses is migrating down to the pharmacy department, and this will help to reduce medication errors. According to Aston, “Nurses and clinicians are extremely busy people, they have a lot of distractions and there are now many documented cases where someone fills a syringe, puts it on a table, does something else, and another person picks it up and thinks that the content of the syringe has to be delivered by IV route.” This can – and has – led to tragic, fatal cases. Thus, the more the pharmacy department can get involved, with its cleanroom conditions and highly-trained staff, as well as its equipment that can automate the process of formulating, mixing and filling the containers and provide the documentation, the more the risk of medication error is reduced. Automation also gives pharmacists the possibility to go on the wards. “There are a lot more pharmacists at ward level in the USA than in Europe,” says Aston, “and we can learn from them. Conversely, there is a lot that the USA can learn from aseptic drug procedures from Europe.”

Finally, Baxa is dedicated to the pharmacy and to providing automation within the pharmacy, because it recognises that one of the problems within this department is dedicated staff, and if one can take away the drudge, repetitive jobs from the pharmacy technicians, there is a better chance of keeping those technicians. One of the major reasons for technicians leaving is that they get bored with certain parts of their job. “They are highly trained,” Aston explains, “and will say that they didn’t come to this career to be sitting there filling 200 syringes. With automation we remove these repetitive tasks from their job, enabling them to do some more value-added operations within the pharmacy department. So retention within the pharmacy departments tends to go up.” The other benefit of automating repetitive actions is a reduction in the number of strain injuries. For example, if a particularly small, generally female technician is repetitively pulling on syringes, reports show that, due to strain injuries, she will be off work for three to six months while she recovers. By using the automated pumps that Baxa provides, that risk is removed.

A needleless valve developed by Baxa that will be on the market next year is set to greatly reduce the number of needlestick injuries experienced by healthcare staff. Aston explains, “We still have some needle products, and the reason for that is that the containers which need to be accessed are small valves, and the only way that one can access those containers is by using a needle-type device.” Together with pharmaceutical manufacturers, companies are trying to come up with a container that will give access to users ­without having to use a needle. The initiative, however, is coming from the designers of the packaging of the drugs rather than the companies that are providing access to it.

Baxa’s commitment to the pharmaceutical industry can also be illustrated by its highly efficient customer service. When new equipment, such as the TPN compounder, is being installed, the installation training is a one-week process. Baxa’s engineers and technicians install the equipment, enter the formulary of all the drugs that are being used by that particular customer, which takes about two days, and then the following three days are spent intensively training the staff, with a possibility for the ­trainers to come back, if need be. “In the USA,” Aston tells us, “they are setting up a model of a pharmacy production department within the company itself, so that pharmacists can come and train not just on our products, but also on aseptic techniques, cleanroom conditions, and that is a value-added that we bring. What we bring to the customers is not just a product; we bring them the expertise that we have within the company. We also adapt to each pharmacy, because they all have their different way of working, and because of that, they have different validation processes. This slows matters down but that’s something we have to live with and we have technicians who will go and work with them.”

Another point made by Aston regarding Baxa’s commitment to the industry is that the company is helping in the process of centralisation. There are still a lot of pharmacies in the UK and around Europe that are in fact mini production units making small amounts of many different products. Currently, big hospital groups believe that, rather than having five hospitals all doing their own thing, the way forward is to consolidate and have one big production unit. By doing that, the number of products that are being produced (individual syringes, IV bags, etc) justifies the automation of the pharmacy.

Another reason that Aston gives to explain Baxa’s growth over the past few years is its staff. Baxa is a family-owned company, and it is unusual in the way it looks after its staff. “The company really believes that if you motivate the staff, pay them well and give them good working conditions, you get very good, motivated people,” smiles Aston. “We have a very low staff turnover, and with facilities like this [the new Bracknell headquarters], we can now recruit good staff because they see us as a growing company.”

With highly-trained staff, Baxa can also increase distribution. A few years ago, most of the European distribution was through independent distributors. Baxa would sell the products to them; they would then value the product and make an offer to the hospital pharmacy department. Over the last few years, Baxa has been moving towards direct operations, so the company now has direct sales in the UK, France, Germany, Benelux and in some Scandinavian countries, and is making a move so that most European countries use direct sales ­distribution in the next few years.

“The final component of our success,” says Aston, “is the message that we give across, our marketing message. I will admit that a few years ago, we weren’t very good at marketing. We now have a good ­marketing team. You’ve seen an example of that in the materials we produce, in the message that we send to people. We’ve got a much clearer message that we are now giving to the industry.”

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