ISMP survey shows drug companies
providing fewer unit dose packaged medications
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.
here for a table of survey results