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ISMP survey shows drug companies providing fewer unit dose packaged medications

From the March 6, 2002 issue

In our recent survey on pharmaceutical bar coding and unit dose packaging, a small percent of more than 350 respondents told us that they currently use bar code technology throughout the hospital to verify drug selection prior to drug dispensing (8%) or administration (7%). Yet, almost half of the respondents reported that they are actively engaged in discussing possible implementation of bar code technology, or have partially implemented this technology into some part of the drug use process. Thus, it's not unexpected that most felt that the availability of products packaged in unit doses was very important to their organization, especially since bar code technology requires a full unit dose dispensing system. Just as many expressed alarm at the decreasing number of items available in unit dose packaging over the last five years.

According to the survey, three-quarters of respondents reported problems with unit dose packaging of both new and well-established brand oral solid products on the market, including those that had been previously available in unit dose packages. A third reported about 6-10 brand products that have not been available in unit dose packaging in the past year. Another quarter reported problems with 11-20 brand products, and over 6% reported problems with more than 40 different brand medications that were no longer available in unit dose packages last year! Even more experienced problems with generic oral solid products.

When asked to comment on the new government proposal which would require a bar code on packages of all human drug and biological products beginning next year (see our web site for a link to the December 3, 2001, Federal Register), most respondents commented, "It's long overdue." Even so, some expressed concern about the increased risk of errors with internal repackaging of medications, especially if manufacturers continue their downward trend of unit dose packaging. Most respondents who repackaged medications now estimated a 1-10% error rate due in some part to the repackaging process. Many also told us they were worried about the cost of implementing bar code technology, especially in small, rural hospitals, and in pediatric hospitals where so many drugs are not available in unit dose packages. Others felt there was little financial incentive from third party payers, malpractice insurers, or other external sources to help share the costs with implementing bar code technology.

It's clear from the survey that, despite some initial worry about costs, many hospitals are ready to do their part to move this worthwhile technology forward. Almost two-thirds of respondents would be less likely to purchase a product if it were not available in unit dose packaging. About half now consider the availability of unit dose packaging when making decisions about new drugs for the formulary, and two-thirds reported that they would be more likely to select a therapeutically equivalent product if it is available in unit dose packaging. More to the point, 84% felt that a slight increase in cost would not deter them from purchasing a specific vendor's unit dose medication with a bar code. About 62% felt very strongly on this issue. Only 11% felt that a slight cost increase would be a deterrent. On behalf of its members, group purchasing organizations have begun to stipulate the need for bar coded unit dose packaging. The pharmaceutical industry must now do its part and make all products available in unit dose packages with a uniform bar code.
Note: Click here for a table of survey results

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