Christine Clark, BSc, MSc, PhD, FRPharmS, FCPP(Hon)
Approximately 1000 participants attended the German hospital pharmacists’ association (ADKA) congress in Mainz in May. The presentations covered a variety of topics of current interest and brought into sharp focus some of the questions that pharmacists across Europe are facing. (See our full report in HPE63.) Three of the big questions were:
Are unit-dose systems the best way for hospital pharmacists to improve medication safety?
Can robotic preparation of cytotoxic injections be efficient?
When will the industry answer pharmacists’ demands for ready-to-use or ready‑to‑administer injections?
In recent years the ADKA has embraced patient safety, and in particular, medication safety as one of the principal purposes of the organisation. Among discussions of many measures designed to improve medication safety, the question of unit-dose packaging for medications looms large. In Europe, unlike the USA, manufacturers do not provide individually-labelled unit doses. Some pharmacies have resorted to repackaging strip-packed doses in individual sachets. Some ‘deblister’ the tablets or capsules first and some cut the strip but leave the blisters intact. Intact blisters can have sharp edges and can be difficult to open. Furthermore, in Germany there have already been reports of oesophageal injury when patients have swallowed the doses in the intact blisters. So – a measure intended to improve accurate dosing has led to the unintended consequence of patient injury. The provision of individually packed, barcoded, solid oral doses by the industry would do much to enhance patient safety.
The preparation of injectable doses continues to be a topic of interest and concern to pharmacists and at the ADKA congress many posters were devoted to aspects of this theme. Few areas are quite as complex as the preparation of cytotoxic injections and the prospect of automated preparation has long seemed attractive. However, the goal remains elusive because some big problems have yet to be solved, such as how to keep the working area free of cytotoxic contamination and making the process fast enough to be useful in a busy hospital. Ongoing development of the robots appears to be overcoming the problem of slow operation.
However, many questions remain around the matter of cytotoxic contamination resulting from aerosols, droplets or breakages that could be spread to the exterior of compounded doses and then be taken out into the pharmacy and wards.
The problems here are numerous and the best solution could be for the pharmaceutical industry to provide ready-to-administer doses of cytotoxic agents. This would, of course, call for dose-banding – another topic on which debate rages. One thing that there seems to be no doubt about is the provision of ready-to-use or ready-to-administer injections in general. One hospital in Germany that produces a range of ready-to-use injections demonstrated clearly that in every case, the ready-to-use product had a lower risk score than the product that had been used previously.
The authors called on the pharmaceutical industry to make the products available for purchase. When several countries are asking for standardised, ready-to-use injections, consensus cannot be far off and then such products should become a realistic possibility.
The application of pharmaceutical expertise to the management of medicines in the widest sense can only improve patient safety. Now that German pharmacy minds are focused on this topic we can hope for developments that will parallel the quality of German cars and domestic appliances. This is indeed ‘getting ahead through science’ or ‘Vorsprung durch Technik’, as the Audi adverts used to say.