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Implementing a unit-dose distribution system

Denis Bois
Pharmacy Department
Maisonneuve Rosemont Hospital
Montreal, Canada

Manon Bordeleau
Unit Dose Project Coordinator
Maisonneuve Rosemont Hospital
Montreal, Canada

Maisonneuve Rosemont Hospital (MRH) is a 750-bed teaching hospital that provides both specialised and general services to a large population in Montreal. The health service provided is wide-ranging – encompassing everything from bone marrow transplantation, renal transplantation and extended oncology services, to family care medicine.

The pharmacy department has 30 pharmacists, 25 senior technical assistants and three support staff ­– all dedicated to pharmaceutical care, providing extended clinical services in oncology, bone marrow transplant, renal transplant, intensive care and coronary care units.

Being concerned about potential medication errors in a large hospital, the pharmacy department made the decision to implement a 24-hour-supply unit-dose distribution system with a cart exchange system. The benefits of a unit-dose system are well documented:

  • Decreasing potential medication errors.
  • Increasing efficiency.
  • Decreasing costs in healthcare organisations.

However, this type of distribution system is also well known for increasing the pharmacy staff workload, mainly in the distribution area.

How could we meet the challenge of providing a safe distribution system that increases the time demand for pharmacists in a distribution area without decreasing our clinical services in a period of pharmacist manpower shortage?

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To maintain the integrity of our clinical services, we decided to use an automated distribution device, the JV352 from JV Medi Co Ltd. This is a very flexible machine that dispenses unit-dose medications either individually packaged or, if needed, in multidose packages. In the multidose package a certain number of tablets or capsules for a given administration time during the day are in the same bag. The JV352 contains 352 different medications in calibrated canisters. A universal tray is available for drugs not being calibrated in the machine or for ­fraction tablets.

At MRH, we decided to use the JV352 as a unit-dose dispensing device, both for preparation of 24-hour supply of patient-specific individually wrapped medications, and for bulk prepackaging of drugs intended to be used for dispensing of interim doses (or first doses).

The unit-dose distribution system was, up to this point, implemented in two nursing units, representing approximately 75 beds. The JV352 device was introduced in our department in July 2001. It met our expectations, being accurate and flexible.

Inaccuracies were for the most part caused by misplacement of drugs (eg, two pills in one pack and none in the next). The packaging speed is approximately 60–65 packs per minute in unit-dose mode. The final package is a well-identified medication with generic name, trade name, lot number and expiry date all very clearly marked on the pack. There is almost no human manipulation of the tablet itself.

The 24-hour patient-specific drug distribution is fully automated, therefore decreasing the risk of human errors. The machine dispenses oral solid medications in a patient-specific strip with no human involvement other than transferring computer files to the machine and refilling of empty canisters. Even refilling is secured by using a barcode system in concordance with the barcode on the bottle. Canister placement must be adequate before the machine starts.

The use of automation at MRH clearly benefits the patient as it increases security by decreasing the potential for human error and providing a very neat drug presentation (identification and sterility). It successfully supports the efforts of the pharmacy department to provide a unit-dose distribution system that would otherwise be very time-consuming and therefore increase the distribution workload for the pharmacy staff.

Automation has helped the MRH pharmacy department to meet the challenges of providing a safe drug distribution system without jeopardising our clinical services to patients.

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