The Use of Technology to Ensure the Correct Dosage of Medications in a Hospital in Agreste, Pernambuco

Abstract

Hospital pharmacy aims, in the context of patient safety, to collaborate in the process of healthcare and well-being by ensuring that patients use the prescribed medication in the correct form, time, dosage, posology, and routes, thereby avoiding medication-related errors. An important measure to reduce the occurrence of errors is the unit dose system, which ensures greater safety and efficiency, aiming to guarantee the quality and traceability of the product, thereby reducing associated errors.

Objective

This study aims to analyze the use of medication fractionation technology through the technique of liquid unit dose, from December 1, 2022, to May 31, 2023, in a hospital healthcare service.

Methods

A descriptive study with a quantitative approach was conducted. Data collection was carried out using internal data information from the SoulMV System, from December 2022 to May 2023. Pilot samples of four medications were selected for analysis and comparison of prescribed versus dispensed medications. Data processing was done using charts.

Results

The unit dose system for liquids demonstrated a significant reduction in the total consumption of vials, fewer discrepancies in inventory, and increased patient traceability and safety. Additionally, other improvements in the care aspect were observed. After the implementation of the unit dose system, the dispensed volume balanced with the prescribed volume, despite an approximate 5% loss in the production of sachets.

Conclusion
It was demonstrated that the unit dose system for liquid medications reduces errors associated with the dispensing and administration of these medications, in addition to avoiding costs by reducing losses, waste, and discrepancies, thereby enhancing the efficiency and sustainability of the service.

Abstract
The hospital pharmacy is a healthcare service responsible for the storage, distribution, dispensing, and control of all medications and essential materials in the health recovery process (DALLARMI, 2020). Among its objectives are ensuring the safe and rational use of medications, meeting the needs of hospitalized patients, and guaranteeing that the offered products are of quality. However, to achieve these objectives, an efficient system of information, inventory control, and cost monitoring is necessary (RODRIGUES; PAIVA, 2022).

Moreover, considering the importance of patient safety within healthcare services, which consists of preventing, avoiding, and improving outcomes and harm related to healthcare, the hospital pharmacy aims to collaborate in the process of healthcare and well-being by providing quality assistance (TRAJANO; COMARELLA, 2019). Thus, ensuring that the patient uses the prescribed medication in the correct form, time, dosage, posology, and routes, thereby avoiding medication-related errors; since prescription and medication errors can cause significant harm to patients. It is estimated that in 7.6% of hospitalizations in Brazil, there is an incidence of these medication-related adverse events (MELO; OLIVEIRA, 2021; ALVES; CARVALHO; ALBUQUERQUE, 2020).

The prevention of adverse events stems from adhering to measures that help reduce the possibility of their occurrence (FOGAÇA; GARCIA, 2020). An important measure to reduce the occurrence of errors is the unit dose system for medications and supplies, which ensures greater safety and efficiency by guaranteeing the quality and traceability of the product until its administration to the patient, thereby reducing associated errors. In this process, distribution is carried out from a unit dose packaging with ready forms and dosages for the patient, under pharmaceutical supervision throughout the process (CAMPELO; COSTA; D’AVILA, 2023).

The objectives of fractionation of liquid medications are: to provide prescribed medication doses in an individualized manner, ensure medication identification until it reaches the patient, protect the medication from environmental agents and deterioration caused by handling, and ensure the medication’s quick and safe use for the patient, which is achieved by the combination of the aforementioned factors. Additionally, it contributes to cost reduction, particularly associated with the loss due to the expiration of supplies (RODRIGUES; PAIVA, 2022).

In light of this, this work aims to demonstrate one of the strategies adopted in a private hospital service in the Agreste region of Pernambuco, highlighting the use of technology as a contributing factor to patient safety and as an ally in reducing waste and loss of liquid medications. Additionally, it aims to assess the benefits after the implementation of the liquid unit-dose equipment in the service, ensuring both economic and care efficiency.

Method

This is a descriptive research with a quantitative approach, using statistical methods to demonstrate the results before and after the implementation of the liquid unit-dose machine. Data collection utilized the report of oral liquid medication consumption issued by the Soul MV System, which corresponds to publicly available data, and did not involve the use of user/patient data at any stage, thus exempting it from submission to the Research Ethics Committee. The study period corresponds to the months of December 2022 to May 2023, at the Unimed Caruaru Hospital, Pernambuco. This data collection was based on a comparison of the percentage of mL prescribed versus mL dispensed by the pharmacy before and after the implementation of the liquid medication fractionation service.

The unit-dose and fractionation machine used belongs to the Opuspac Hospital Automatic brand and is manufactured by Ibtek Innovative Solutions, in the MK5 model, with size specifications ranging from 30 x 50 mm to 50 x 250 mm; and promises a production of 1,200 sachet units per hour, with more economy, safety, inventory control, quality, and agility in processes (BASSO, 2021). For the implementation of the liquid unit-dose service, the Hospital Pharmacy team defined the volume and dosage of the selected sachets based on historical analysis of prescriptions, generating packaging with better presentation and sachets with different volumes.

Initially, four medications were selected for analysis and comparison, namely: simethicone 75mg/mL, 15mL bottle; ibuprofen 100mg/mL, 20mL bottle; dipyrone 50mg/mL, 100mL bottle; and lactulose 667mg/mL, 120mL bottle. These medications were chosen based on the observation of high consumption in the service, as they are the most commonly used oral liquid medications in the Hospital, as well as the observation of significant discrepancies in stock accuracy for these items.

Subsequently, reports were issued demonstrating the consumption of these medications in the period prior to the implementation of the service, as described in Table 1, and in the period following the implementation, for comparative purposes, considering that the prescription and database entry in this Hospital are based on milliliters (mL) rather than per unit of medication bottles.

Based on this, and considering the nature of the obtained data, the results were processed using Microsoft Excel 2013 and presented through graphs, employing descriptive rather than inferential statistics, as this study is exploratory in nature and does not aim for statistical generalization of the results. Thus, the prescription and dispensation data were arranged and analyzed according to the discrepancy between these two parameters.

Results and discussion

Prior to the implementation of the unit-dose machine MK5, multidose liquid medication vials were used multiple times by one or more patients. It is known that this type of fractionation poses a risk of contamination between patients, and the use of multidose vials does not guarantee safe administration after the second dose, as the stability and safety of oral solutions are no longer ensured once the vial is opened.

As a result of the implementation of this service, there was a significant reduction in the total consumption of vials, fewer discrepancies in stock, and increased traceability and patient safety. As shown in Graphs 1 and 2, before the unit-dose liquid process, the volume dispensed exceeded the prescribed amount, which could be attributed to inaccuracies in the administered dose, deviations, and losses during the medication administration process. Thus, after the implementation of the unit-dose machine, it is observed that the dispensed volume balances with the prescribed amount, even though there is a loss of approximately 5% in the production of sachets. Table 1 presents the equivalence of each vial to the quantity of sachets.

The discrepancies still observed in Graphs 3 and 4 are mainly justified by the prescription of doses that require fractions of the sachet, such as the example of Lactulose (Graph 3), which is sometimes prescribed and administered only 1mL, but, as demonstrated, the sachet corresponds to 5mL. Therefore, there is a dispensed volume greater than the prescribed amount. However, this type of prescription is not the majority, and there was observed at the Unimed Caruaru Hospital a reduction in the total consumption of vials for these items.

Furthermore, there have been improvements in the care aspect, as it is ensured that the prescribed medication will reach the intended patient according to the medical prescription and better utilization of human resources, as there has been a decrease in the time spent on medication handling, providing more time for patient care. It has also reduced hospital costs associated with medication by increasing stock accuracy, decreased wastage due to loss, deterioration, expiration, and other factors, among other benefits.

Table 1: Equivalence bottles x sachets.

MEDICATION PHARMACEUTICAL FORM SACHET VOLUME BOTTLE/SACHET EQUIVALENCE START OF UNITIZATION
Simethicone 75MG/ML 15ML Oral Emulsion 2ML 1 Bottle/5 Sachets 02/2023
Ibuprofen 100MG/ML 20ML Oral Suspension 2ML 1 Bottle/6 Sachets 02/2023
Lactulose 667MG/ML 120ML Syrup 5ML 1 Bottle/21 Sachets 03/2023
Dipyrone 50MG/ML 100ML Oral Suspension 5ML 1 Bottle/17 Sachets 03/2023
Source: own authorship



Source: own authorship

Conclusion

Given the above, when applying the strategy of liquid medication fractionation described here, a reduction in errors associated with the dispensing and administration of these medications was observed, as well as considerable cost savings through costs avoided by reducing losses, waste, and deviations. The combination of technological innovations, protocols, and other strategies contributes to the efficiency and safety of care and improves the economic approach.

In Brazil, the use of automation for the fractionation of oral liquid medications is not widely adopted by hospitals, thus representing a technological innovation for healthcare services. Medications account for a significant portion of hospitals’ budgets and are the primary therapeutic resource in the treatment of many diseases, justifying the implementation of measures to ensure their rational use.

It is also stated that the investment in technology and machinery is justified and compensated in the medium and long term, since the avoided costs increase over time, and the differentiated dispensing of standard doses per patient and for a 24-hour period will naturally decrease the cost of inventory, expenses with excess doses, and improve inventory control and billing.

References

ALVES, M. F. T.; CARVALHO, D. S.; ALBUQUERQUE, G. S. C. Motivos para a não notificação de incidentes de segurança do paciente por profissionais de saúde: revisão integrativa. Ciência & Saúde Coletiva, Curitiba, v. 24, p. 2895-2908, 2019.

BASSO, V. Opus MK5 – a máquina de fracionamento automatizado de líquidos orais. Grupo Unihealth. Disponível em: https://www.opuspac.com/br/artigos/opus-mk5-a-maquina-de-fracionamento-automatizado-de-liquidos-orais/. Acesso em: 08 jun. 2023.

CAMPELO, L. M. A.; COSTA, T. D.; D’AVILA, R. V. Implantação de rastreabilidade em um hospital geral, avaliação a partir dos processos de trabalho. Brazilian Journal of Health Review, Curitiba, v. 6, n. 2, p. 7750-7764, mar./apr., 2023.

DALLARMI, L. Gestão de suprimentos na farmácia hospitalar pública. Visão Acadêmica, Curitiba, v. 11, n. 1, jan./jun., 2020.

FOGAÇA, F. C.; GARCIA, M. A. T. Segurança do paciente no ambiente hospitalar: Os avanços na prevenção de eventos adversos no sistema de medicação. Revista científica eletrônica de ciências aplicadas da FAIT, São Paulo, n. 2. Maio, 2020.

MELO, E. L.; OLIVEIRA, L. S. Farmácia hospitalar e o papel do farmacêutico no âmbito da assistência farmacêutica. Revista JRG de estudos acadêmicos, São Paulo,v. 4, n. 8, jan/jun., 2021.

RODRIGUES, C. A. O.; PAIVA, V. S. Redução de custos hospitalares após implementação de ferramentas informatizadas na logística de um serviço de farmácia hospitalar. Jornal Bras Econ Saúde, Natal, RN, v.14, n.3, p210-216, 2022.

TRAJANO, L. C. N.; COMARELLA, L. Gestão farmacêutica na farmácia hospitalar: aumento da qualidade e segurança ao paciente e racionalização de recursos. Revista da FAESF, Floriano, PI, v. 3, n. 2, p. 4-8, abr./jun., 2019.

Authors:

Juciara Jucelia de França¹; Thamiris Silva Bezerra de Sousa²; Thais Ribeiro de Moura³;. Hugo Leonardo de Vidal Neves⁴.

Hospital Pharmacist, Unimed Caruaru Hospital, post-graduate in Clinical Pharmacy (IDE) and Public Health (FAVENI); 2. Hospital Pharmacist, Unimed Caruaru Hospital, post-graduate in Mental Health (FCM-UPE) and Hospital and Clinical Pharmacy (FAVENI); 3. Clinical Pharmacist, Unimed Caruaru Hospital, post-graduate in Public Health (ESPPE), Hospital Pharmacy (FARMART), and Clinical Pharmacy (UniAmérica); 4. Hospital Supply Manager, Unimed Caruaru Hospital.

Authors’ emails:

juciara.franca@hospitalunimedcaruaru.com.br¹;

thamiris.sousa@hospitalunimedcaruaru.com.br²;

thais.moura@hospitalunimedcaruaru.com.br³;

hugo.neves@hospitalunimedcaruaru.com.br⁴