As part of our effort to consolidate pharmacy services, the 1100-bed Greenville Health System, located in Simpsonville, South Carolina, has utilized a centralized compounding and repackaging model for the past 3 years. Operating under 503A, the Greenville Health System Compounding Pharmacy (GCP) supplies seven (soon to be eight) facilities and is staffed by two pharmacists and four pharmacy technicians from 7:00am to 6:30pm.

GCP is conveniently located in the hospital’s warehouse space, which serves to support all centralized functions. In addition to centralizing repackaging and compounding, supplies are managed centrally utilizing a courier system. Fortunately, the warehouse space is adjacent to the central pharmacy, which allows us to easily transfer all compounded and repackaged products to the central pharmacy for courier distribution throughout the health system. The couriers operate under assigned roles; as such, medications are delivered by those couriers who have been trained to maintain product integrity.

Automation to Support Unit Dose Packaging
On a monthly basis, GCP produces about 8000 IV bags via a robotic compounding system for the seven sterile compounds we currently make. In addition, GCP produces 15,000-20,000 oral liquid cups while also repackaging 25,000-35,000 oral tablets and capsules using the Pentapack HP500.

Speed of packaging is important to us given the scope of our operation. We chose Pentapack based on its speed as well as its user-friendly operation and the fact that it is easy to maintain. A new medication can be set up in less than 10 minutes. The technician simply wipes the tray with alcohol, changes the tool set, checks the amber film and label quantities, scans the new drug, and completes the documentation. At that point, the machine takes over and requires little oversight during the packaging process.

The Pentapack software is easy to navigate and creates high-quality labels using pharmaceutical grade materials. Each blister is sealed under aluminum foil, and amber film is available for UV protection. We include the following information on the labels: the generic name, brand name (when applicable), lot number, beyond-use date (BUD), dosage, and drug manufacturer. In addition, we indicate on each label that it was packaged by GCP.

Assigning Products and Staff
Products are assigned for repackaging based on need and the cost effectiveness of repackaging. Over 250 oral tablets and capsules are included on the repackaging order form. The Pharmacy Consolidated Services team regularly reviews the prices and packaging options of our formulary products to determine any changes to repackaging status; they also monitor drug shortages to identify other repackaging opportunities.

Packaging runs begin with all stat orders and then are organized by tool sets. All drugs for repackaging are assigned to one of six tool sets to ensure efficiency. By avoiding multiple tool set changes, the machine can run for longer periods. Likewise, par levels are monitored closely in order to minimize stat orders, which decrease productivity. Using daily par level reports from our carousel, we are able to complete our repackaging 24-48 hours in advance of need.

Every week, one technician is assigned to repackaging, and two pharmacists check the repackaged drugs throughout the day. The process for training staff on the repackaging machine was straightforward; technicians and pharmacists trained together over 2 days, creating intentional redundancies. A policy and procedure was created for the repackaging machine to provide staff with a source document, should any questions arise about the process. Becoming proficient with the system required minimal effort.

Equipment Maintenance
The only maintenance required is the daily cleaning, which takes 10-20 minutes to complete. The manufacturer sends a representative once a year to inspect and fine-tune the machine. We simply keep it clean.

Conclusion
The cost to purchase the Pentapack HP500 system and the necessary supplies is quite reasonable. This system meets our need for a solution that can repackage oral medications quickly and cost effectively. It has been a great addition to our centralized compounding and repackaging pharmacy. We currently use one machine, but should our monthly volume increase to exceed 60,000 oral doses, we would be more than happy to purchase an additional one.

Gary L. Jones, PharmD, serves as the pharmacy supervisor at Greenville Health System’s compounding pharmacy in Simpsonville, South Carolina. He received his BSPharm from the Medical University of South Carolina and his PharmD from the University of Florida. Gary is a member of the American Society of Health-System Pharmacists and Palmetto Medical Dental Pharmaceutical Association. His professional interests include 503B facility registration and board certification in sterile compounding, a status that does not currently exist.