Generic packaging changes could improve efficiency

Changing medicines packaging to have prominent placement of active substances and strengths could help reduce prep time without increasing errors

A study published in the BMJ by Norwegian researchers has examined the differences in how nurses and pharmacy technicians handled medicines with two different types of packing.

The first phase of the study used original labelling, while Phase II used new generic labelling.

Nurses and pharmacy technicians were asked to prepare medications in accordance with medication charts, place packages on a desk and document the package prepared. The operation was timed and participants were asked to prepare medications in advance, with as many charts as possible within 30 minutes.

While nurses prepared significantly more medication charts with the generic labelling compared with the original, pharmacy technicians were significantly faster than nurses in both phases.

The number of errors was low and not significantly different between the two labellings.

However the authors highlighted the risk of medication errors (MEs), citing European data that show 23% of EU citizens claim to have been directly affected by MEs, with 18% claiming to have experienced a serious ME in hospital.

The authors also discussed the dangers posed by “lookalike/sound-alike” health products, which refer to “names of health products that have orthographic similarities and/or similar phonetics i.e. similar when written or spoken”.

“These similarities may cause MEs in relation to prescribing, dispensing or administration of a product. In USA, confusion between LA/SA medication names is attributed to 25% of MEs, according to MEs reported to the US Pharmacopoeia.

“In a study of 400 deaths caused by MEs, the US Food and Drug Administration (FDA) found that 5% of deaths were attributed to proprietary name confusion and 4% to generic name confusion.”

The authors say that due to the low error rate in their study, more investigation is needed.

In Phase I, nine errors were made in 99 medication charts, seven of which were made by nurses; in Phase II, eight errors were made in 124 medication charts (four by nurses and four by pharmacy technicians).

“A new labelling of medication packages with prominent placement of the active substance(s) and strength(s) may reduce time for nurses when preparing medications without increasing MEs,” the authors concluded.

“We do however suggest adding information about drug formulation to the label to further minimise risk of confusion. Due to pharmacy technicians’ efficiency and knowledge about medications, innovative collaboration structures between pharmacy technicians and nurses should be investigated.”

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