The capacity to safely and reliably package and label bulk medications is critical in the pharmacy. Moreover, with a significant number of drug recalls and shortages to address, it has become necessary to repackage an increasing number of medications in-house. These concerns, as well as the desire to realize the safety benefits of bar code scanning, make it crucial to identify a robust repackaging solution that addresses these needs. 

The Iowa Lutheran Hospital (ILH), located in Des Moines, Iowa, has 224 staffed beds and specializes in maternity services, emergency and trauma treatment, chemical dependency treatment, behavioral medicine, general surgery, critical care, transitional and skilled care services, and home health care. It is part of UnityPoint Health—Des Moines, and is the first hospital in Iowa to be ISO-9001-2008 certified by Det Norske Veritas (DNV). 

ILH began using Medi-Dose/EPS MILT labeling and bar coding software several years ago to repackage medications that could not be purchased in unit dose. Recently, we upgraded our product to its newest version, MILT 4.0, a multi-purpose labeling and repackaging system that utilizes both physical packaging supplies and a bar code-generating computer program to enable the hospital to reliably package and track medications. The system is installed on all of the PC workstations in the hospital and it is linked to a common network drive. Since the software is site-licensed, it can be used on as many computers as necessary. No additional hardware is required.

System Benefits
FDA NDC Lookup Function
One of MILT’s most useful tools is the FDA NDC database look-up function. When a user searches for an NDC code, the database retrieves the information and the program automatically generates the data directly onto the drug label. A user also can search the NDC database by scanning the drug package’s bar code. 

Bar Coding
The program enables medication bar coding and integrates with our existing automation, including the ADCs, the picking and checking system, and the bar code medication administration (BCMA) system. This version supports bar coding capabilities. Because ILH recently upgraded to Windows 7.0, any chosen software needed to be 64-bit compatible to support bar coding. Version 4.0 is 32-bit, 64-bit, and Windows 7 compatible. With MILT 4.0, we are confident that each medication leaving the pharmacy has the correct bar code.



Customization
The program includes prebuilt, highly customizable medication repackaging templates and customizable medication labels. Multiple preloaded warning placards and symbols are available, and all templates can be modified to display any necessary alerts. The hospital can use the labels in a number of ways. The most common is to repackage tablets or capsules with the packaging trays with the lid label. Other packaging options include unit dose cups, liquid medications, and syringes. 

Labels can be printed from any PC to any network printer, and the data are updated in the shared database. Pharmacists can then access the program on any computer and approve or reject the packaging and labeling. This creates documentation that serves as a searchable, sortable electronic record. Prior to utilizing MILT, the hospital kept paper repackaging logs, which ensured activities were documented but did not allow data mining. 

Repackaging 
The Medi-Cup blisters and lid-label covers used in the system offer UV protection; are cold-sealed, tamper-evident, and moisture-resistant; and ensure beyond-use date stability of up to 1 year. Repackaging can be conducted anywhere, including the chemotherapy hood, which ensures hazardous medications will not create contamination risks. 

Cost-Effectiveness
The software, template, and Roll-E-ZY press-piece are necessary to use the system, and are a one-time purchase. Thereafter, labels and additional supplies can be purchased as needed, making the system cost effective. 

Ease of Use
Finally, one of the most important benefits of MILT 4.0 is that the program is intuitive to install and use, and if questions arise, Medi-Dose/EPS’s robust customer support quickly addresses any concerns. 

Conclusion
Upgrading our MILT software to version 4.0 has streamlined our labeling process and ensured that each medication leaving the pharmacy has the correct bar code. The system’s ease of use, cost-effectiveness, and customization flexibility were integral to our decision to continue utilizing this valuable tool.

Jacob Wheeler, CPhT, is a senior pharmacy technician at Iowa Lutheran Hospital Pharmacy. Chemo certified by PTCB, Jacob is a 15-year employee of UnityPoint Health. He works to improve IT integration, automation of pharmacy practices and services, and IV room procedures.