A unitarization of solid medicines, that is, tablets and capsules, is one of the most critical and essential steps within the supply chain process in an institution and one of the most important for organization and reducing medication errors. The objective of this phase of the process is to preserve the information contained in the medicine's primary packaging, which is essential for it to be administered safely. Some of the information present on the packaging is: name, expiration date, dosage, barcode/Datamatrix, batch, manufacturer, as well as warnings related to the medicines, such as risk of falls, do not administer to pregnant women, High Surveillance Medication (MAV ) and others, which can be customized according to the characteristics of the institution.
Improvements in this process are essential for quality assurance and patient safety and provide some advantages such as: immediate entry of the medicine into the patients' account and automatic stock write-off, traceability and differentiation of medicines that may cause harm to patients at the time of administration, such as controlled medicines, high surveillance medicines, chemotherapy drugs, cytostatics, medicines with similar names and sounds (LASA), among other classes; in addition to providing nurses, at the time of administration, with a clear and effective reading of all necessary information about the medication in the unitary packaging, to guarantee safety in the bedside process, providing easy usability by the care team and reducing stock levels in the hospitals, compared to those that do not carry out unitarization, a number that currently approaches 60%.
To guarantee a safe and efficient process, we must meet the minimum requirements:
- perform the hygiene of hands and equipment to be used before starting the process.
- Have an exclusive room dedicated to this activity, with facilities suitable for compliance with legislation, with appropriate space, easy to clean, with sufficient lighting, sink for hand hygiene, controlled temperature and humidity, ergonomic furniture and, if possible, close to the reception area, to avoid movement unnecessary.
- At the time of unitarization of the medicine, Unitarize only one product at a time, in order to avoid the risk of mixing medications, causing serious harm to patients. Start by checking the batch and the information to be printed on the unitized packaging, comparing it with the information on the medicine's primary box. If possible, at this point, read the medication's barcode in order to enter the information into the machine and carry out the verification. After the end of the process in unitizing machine, carry out an inspection of the equipment to check that no medication remains; carry out visual inspection and counting of unitarized medicines; seal this medicine in plastic boxes with the name and quantity of the unitary medicine, duly identified, for later sending to the central pharmacy.
- Separate medications by respective batches, that is, if at this moment the medicine has more than one batch, work with one batch at a time, comparing it with the respective primary packaging. It is also recommended to organize high-cost or specific medications in a serialized manner.
- The pharmaceutical professional, together with the Quality and Patient Safety team, you must create control indicators for the process, with the aim of ensuring that after the unitarization of each medicine, the necessary safety is achieved and that there are no failures in the process. A computerized spreadsheet can be created with all the unitary medication data and, after each product is finished, a physical check is carried out to avoid errors in the process.
- Carry out training for everyone involved in the unitarization process and avoid staff turnover when using the equipment, to avoid possible damage and lack of unitary medicines intended for patients. The ideal is to have a reference collaborator on duty to operate the equipment.
It is important to remember what not must be done in this process, that is, it is strictly prohibited:
- Work without barcode (CB): It is essential that the entire medication unitization process is carried out using the Bar Code (CB) system. This will guarantee traceability and safety, minimizing errors and ensuring that each medicine is properly identified and unitized before any procedure.
- Unlist medications: Medicines in tablets, capsules and dragees must always be packaged in their respective blisters, to preserve their physiochemical properties, guaranteed by the pharmaceutical industry, in addition to continually following the safety standards established in the process and avoiding any risk to patients' health.
- Mix batches in the unitization room: As previously recommended, batches must be properly separated and you must always work with one batch at a time, so that there is no confusion or mixing of different medicines. This practice promotes traceability and avoids potential errors when dispensing medications to patients.
- Work with multiple operators in the room: Ideally, only one operator should work at a time, and not work with several employees in the same room. Each operator must be duly authorized and trained to perform their functions in accordance with established procedures. The unitarization of medicines must only be carried out by designated and properly trained operators, avoiding any errors in the process.
- Split incoming batches: The fractionation of batches of medicines must not be carried out in the unitarization process, it must be strictly following the established protocols and guidelines. It is important to ensure that each batch is correctly identified and that there is no risk of errors or improper mixing during the process.
- Not having a separate room for unitarization: It is essential that the unitarization of medicines is carried out in a specific room duly designated for this purpose. This measure aims to avoid any possibility of errors in the process and guarantees a controlled and suitable environment for safe unitarization.
A dispensing of medicines is another essential activity within the Hospital Pharmacy, which is why we mention it here, as it is the stage that follows the unitarization process. Therefore, it is necessary to pay special attention to the choice of the distribution system, appropriate to the characteristics of the institution, with the use of technologies, automated intelligent cabinets, barcode reading and separation of High Surveillance Medicines and psychotropic drugs, duly identified. and separated from other items and delivered personally to the nursing stations.
The work of the pharmaceutical professional in these processes mentioned must be guided by the following objectives: having an organized and safe unitarization system; a rationalized distribution system to ensure compliance with medical prescriptions; correctly administer medications to patients, mitigating errors; reduce the nursing team's time with activities that should be carried out by the technical-administrative team; and enhance its role in the multidisciplinary team, providing the institution with active and economically efficient management, reducing costs and waste, and providing safe, effective and rational drug therapy for patients.
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