Automated and Closed Loop Oncology Agent Compounding and Administration; Gains in Safety and Efficiency. (Preprint)

BACKGROUND The forms of automation available to the oncology pharmacy range from compounding robotic solutions, through to combination workflow software which can scale up to cover the entire workflow from prescribing to administration. A solution that offers entire workflow management for oncology is desirable because in terms of cytotoxic delivery of a regimen to a patient the chain, which starts with prescription and the assay of the patient’s laboratory results and ends with administration, has multiple potential chokepoints. OBJECTIVE To show how incremental change to a core compounding workflow software solution has helped an organization meet goals of improved patient safety, increasing the number of oncology treatments, improving documentation and improving communication between oncologists, pharmacists and nurses. And to illustrate how using this technology flow beyond the pharmacy has extended medication safety to the patient’s bedside through the deployment of a connected solution for confirming, and documenting, right patient-right medication transactions. METHODS A compounding workflow software solution was introduced for both preparation and documentation, with pharmacist verification of the order, gravimetric checks, and step-by-step on-screen instructions displayed in the work area for the technician. The software supported the technician during compounding by proposing required drug vial size, diluents and consumables. Out of tolerance concentrations were auto-alerted via an integrated gravimetric scale. A patient-medication label was created. Integration was undertaken between a prescribing module and the compounding module to reduce the risk of transcription errors. The deployment of wireless connected handheld barcode scanners was then made to allow nurses to use the patient-medication label on each compounded product and to scan patient ID bands to ensure right patient-right prescription. RESULTS Despite an increase in compounding, with a growth of 12% per annum and no increase in pharmacy headcount we doubled our output to 14,000 medications per annum through application of the compounding solution. There was also an overall reduction in compounding time of 35%. We also saw improved management of remnants and reduced costs overall. The use of handheld barcode scanning for nurses reduced the time for medication administration from ≈ 6 minutes per item to 41 seconds, with a mean average saving of 5 minutes and 19 seconds (5.303 minutes) per item. When calculated against our throughput of 14,000 items per annum (current production rate via pharmacy) this gives a saving of 3 Hours and 24 minutes of nursing time per day, equivalent to 0.425 full-time nurses per annum. CONCLUSIONS The addition of prescribing, compounding and administration software solutions to our oncology mediation chain has increased detection and decreased the risk of error at each stage of the process. The double-checks that the system has built in by virtue of its own systems and through the flow of control of drugs and dosages from physician to pharmacist to nurse allows it to integrate fully with our human systems of risk management. CLINICALTRIAL Nil

Pharmacists’ perspectives on the value of reason for use information

Background: The indication for a particular medication, or its reason for use (RFU), is important information for prescribers, pharmacists and patients but is not often communicated in writing from prescribers to pharmacists. Adding RFU to a prescription and a medication label would ensure that pharmacists are confident that they are providing high-quality, accurate patient care. This study aims to describe the perspectives of pharmacists on how receiving RFU from prescribers would affect their practice and how pharmacists putting this information on prescriptions would affect patients. Methods: Semi-structured qualitative interviews were conducted with 20 pharmacists in Southwestern Ontario. Thematic analysis was used to analyze the interview transcripts, leading to 4 major themes. Results: Pharmacists expressed that RFU should be formatted to ensure that it is of clinical utility via the use of written text and noted that either medical or lay (also known as plain) language would be appropriate for use. Pharmacists indicated that patient privacy should be considered when writing RFU on labels and that patient preference with respect to the addition of RFU should dictate its inclusion on a medication label. Pharmacist access to RFU was universally acknowledged to improve patient safety by providing pharmacists with more information to determine whether the given medication was indicated. Conclusions: This study provides further information about the impact that having access to RFU would have on pharmacy practice and can be used to advocate for the inclusion of RFU information with prescriptions to improve patient outcomes. Can Pharm J (Ott) 2020;153:xx-xx.

Development of a 3D-printed Medication Label for the Blind and Visually Impaired

This study explored the potential of three-dimensional printing (3DP) technology in producing a three-dimensional (3D) medication label for blind and visually impaired (BVI) patients to ease their drug administration. Different variations of label wordings, dosing instructions, and medication identifiers were designed with reference to guidelines by the American Foundation for the Blind. Shapes and symbols were used as dosing instructions and medication identifiers to the patient’s medical conditions. Prototype designs were created with common graphics computer-assisted drafting software and 3D-printed using acrylonitrile butadiene styrene as the polymer filament. Feedback was then obtained from five people with normal vision and four BVI persons. The initial prototype comprised four components, namely, medication name and strength, patient’s name, dosing instruction, and medication identifier. A revised label comprising the latter two components was developed after feedback by BVI persons. Words were in all uppercase and regular font type, with a 5-mm center-to-center letter spacing. Elevation heights of the letters alternated between 1 mm and 1.5 mm. A half sphere represented the medication dose unit, while vertical lines and a horizontal center line with alternating elevation of arrowheads represented the frequency of administration and the medication’s consumption in relation to food, respectively. Symbols based on target organs were used as medication identifiers. With rapid advancements in 3DP technologies, there is tremendous potential for producing 3D labels in patients’ medication management.

Assessment of literacy and numeracy skills related to non-steroidal anti-inflammatory drug labels

Background: Non-steroidal anti-inflammatory drugs are widely used and have a potential for over-the-counter misuse. Limited health literacy is associated with poor health outcomes. Identification of new strategies to assess literacy and numeracy could be useful in targeting effective education initiatives. Objective: To characterize numeracy and literacy skills related to non-steroidal anti-inflammatory drug labels in primary care patients. Methods: Patients were recruited and consented over an 8-month period after their regular primary care visit. Demographic information was collected and two instruments were administered to assess literacy and numeracy skills: (1) a medication label literacy instrument focused on non-steroidal anti-inflammatory drugs (MedLit-NSAID) and (2) a general healthy literacy-screening tool, the Newest Vital Sign. Two questions on the MedLit-NSAID instrument evaluated understanding of the Food and Drug Administration medication guide for non-steroidal anti-inflammatory drugs and the Food and Drug Administration approved over-the-counter label. Results: A total of 145 patients were enrolled. Mean MedLit-NSAID and Newest Vital Sign scores were 6.8 (scale range 0–8) and 4.2 (scale range 0–6), respectively. Higher education level was associated with higher scores for both tools (p ⩽ 0.05). Total MedLit-NSAID scores on average were higher in females compared with males (6.5 vs 6, p = 0.05). Patients with decreased kidney function (n = 18) had significantly lower MedLit-NSAID scores (p ⩽ 0.05). Test–retest scores were not significantly different for MedLit-NSAID (p = 0.32). The correlation between the tools was 0.54 and internal consistency MedLit-NSAID was 0.61. Conclusion: A medication information focused instrument provided specific information to assess health literacy related to non-steroidal anti-inflammatory drug labels. This information could be utilized to develop patient education initiatives for medication label comprehension.

Factors influencing medication label viewing in Malaysia

The misuse of medicine is a serious public health issue worldwide. An important factor that contributes to the misuse of medicine is the lack of medication label viewing by consumers. The objective of the present study is to examine the socio-economic, demographic and lifestyle factors associated with medication label viewing among Malaysian adults. The empirical analysis is based on a nationally representative data set of 30,992 respondents. An ordered probit model is used to examine different types of medication label viewers. The results of this study suggest that socio-economic (i.e. age, income level, education level, location of residence), demographic (i.e. gender, ethnicity, marital status) and lifestyle factors (i.e. physical activity, smoking) have significant effects on medication label viewing. It is found that age, low-income and low-education level reduce the likelihood of viewing medication label. Based on these findings, several policy implications are suggested. The present study provides policy makers with baseline information regarding which cohorts of individuals to focus on in efforts to increase the frequency of medication label viewing.