Now that unit dose packaging of medications is acknowledged to be the most economical and efficient method of dispensing in health care settings, hospitals have to make the decision on how best to accomplish this process. In an ideal world, this would be accomplished by finding pharmaceutical manufacturers that offer unit dose packaging with a bar code on each label for bedside verification.

A second option would be to look at companies that repackage bulk medications into unit dose packaging. This scenario would require an in-depth analysis of the cost, transportation, and quality control considerations.

A third alternative is to explore in-house repackaging. This option requires careful consideration of the unit dose equipment to be purchased, and a list of requirements based on the needs of the facility should be drawn up. Optimally, this discussion should involve a cross section of the staff, including pharmacists, technicians, and nursing representatives.

Developing Criteria for Purchasing Equipment

Your team should consider the following:

Cost

• Budget for purchasing the machinery
• Cost of supplies, including work benches
  and tables
• Additional costs for computer hardware that may be needed to operate the machines

Space Requirements

• Space available to isolate the equipment so operators are not easily distracted, but readily accessible for checking by pharmacists before being placed in inventory
• Security, since controlled substances will have to be unit dosed

Staffing

• Availability of sufficient F.T.E.’s to operate the equipment safely
• Designation of employees who are responsible for the operation and for the preventive maintenance, imperative to minimize down time
• Responsibility for writing the policy and procedures for the operation of the machinery

Training and Support

• Training and support offered by equipment manufacturer, including follow-up support and technical advice (inevitably human error will cause problems shortly after the trainers leave)

In addition, develop questions about the specific needs of your institution that can differentiate equipment, for example:

• Is a bar code necessary? Is the facility using a bedside verification process or will it be in the foreseeable future?
• What will be the backup plan if the machine is not functional?
• Is there a need to unit dose other forms of medications like vials, ampoules, syringes, oral liquids? Are there other needs specific to the facility? For example, does the facility have Omnicell cabinets that require a package small enough to be loaded into the cassettes and still drop freely when dispensed?

Finding Equipment to Meet Your Needs
Different brands of unit dose systems may have benefits or drawbacks, depending on the needs you’ve established.

For example, once the scope of the type of drugs to be unit dose packaged has been determined, you will want to consider which equipment is appropriate for your needs. Medical Packaging, Inc. (MPI) has been around for some 30 years, and, if space is critical, its Auto-Print II system has the advantage of being the most compact of the automated systems for packaging oral solid products. The machine packages the oral solids in a perforated single strip that is emitted to the side of the machine. The operator should be alert to keep the strip free from jamming. The optional Autopak MDD Autofeeder is now available for the Auto-PrintII.

Accu-Chart, Inc. (Euclid) also has a wide variety of machines. Its standard Cadet produces a single strip of packaged drugs. The Twin Cadet produces a strip that is two drugs wide, and can be outfitted to accept a smaller sized packaging strip. If you do use the Omnicell automated dispensing system, the smaller size version of the Twin will work with the Omnicell cassettes with a slight modification to the cassette itself. The Cadets discharge the finished packages downward, so the counter must have a hole cut and there needs to be clearance below to capture the finished product. A recommendation would be to secure the machine, so that an inadvertent bump does not affect the alignment of the machine and the hole. If the completed packages back up it will cause the system to jam.

Additionally, both MPI and Accu-Chart, Inc. offer liquid unit dose packagers and overlaypackaging machines to provide a barcode for virtually every other dosage form.

Automed’s tabletop has an optional AutoPac automatic feeding system that allows for continuous packaging. In addition, the feed is horizontal, not vertical, which avoids crushed pills and keeps heat away from gel caps.

You will also want to consider back-up options for that inevitable down time.

One option to consider is a manual packaging system with computer-generated labels. Medi-Dose offers such systems, and the initial cost is extremely low in comparison to the other competitors, making them advantageous as a manual emergency back-up in those facilities with automated machinery, or for institutions that require small quantities to be packaged.

If staffing is a consideration, Pearson’s Intellipack has a feature that allows hands free operation. Once the information is loaded into the computer for the label, the pills are emptied into the hopper and the process begins, leaving the operator free to continue other chores. Pearson is also willing to modify their equipment to meet demands for different size packaging. Another standard feature is their M-print software, which scans the bulk bottle’s bar code, and then using First Data Bank information populates the label screen. This eliminates human error that can occur when manually filling in label screens. This software also allows the customization of the label format to fit your facility’s requirements. The M-print software is also available for use on the other brands of equipment.

Once you have a clear sense of your requirements and have pinpointed equipment that fit these requirements, it is important to evaluate the systems in action. As you can see, the choice of unit dose machinery should not be taken lightly. Both demonstrations at your site and visits to a nearby a facility which has the machinery that you are considering are very beneficial.

Sheldon Lefkowitz, RPh, MS. is Director of Pharmacy Services at St. Mary’s Hospital in West Palm Beach, Florida. Jeffrey Spicer, BS, MBA Is an Adjunct Professor at Indian River Community College in Fort Pierce, Florida.