Toolkit

One Dose at a Time: Implementing a Unit-Dose Medication Management System (manual and automated, cabinets and robotics)

75% of pharmacies in hospitals utilize a unit dose system for drug distribution for 90% or more of their total beds (Previously Objective 4.7)

The purpose of the toolkit for objective 4.7 is to assist organizations in implementing a unit-dose system. The tool kit includes an introduction describing the typical starting point (the preliminary assessment phase), information about developing a business case, and guidance on planning and implementing such a system, as well as tools and tips for successful implementation. The tool kit also includes case studies from across the country that describes the implementation of unit-dose systems using various levels of technology.

CSHP members from across Canada contributed to the tool kit for objectives 4.7.

There are 5 sections to this tool kit.

Conducting a Preliminary Assessment

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This section describes how to conduct a preliminary assessment that establishes the need for a change in the drug distribution system, such as a unit-dose or automated system. It includes information about searching for evidence, collecting data about the medication-use system, performing a gap analysis, and developing a briefing note.

Soliciting the Organization for Support (the Business Case)

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This section provides high-level information needed to develop the business case for the unit-dose system or automation and how to gain the support of senior leadership for the project.

Developing the Project Plan

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This section highlights the value and components of a project charter, as well as the considerations that are needed for more detailed planning, such the creation of a project team, developing the project budget. It also provides various tools and tips to help with the implementation of the unit-dose or automated distribution system.

Implementing the System

This section provides examples of the implementation plans and success stories shared by various Canadian hospitals.

Implementation plans:

Case studies:

Checking Performance

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This section suggests indicators that a healthcare organization might consider measuring and reporting to assess if the implementation is achieving its desired outcomes.

Why the Objective Matters

What is a Unit-Dose System?

A hospital-based system of drug distribution in which medications for a 24-hour period are dispensed in a ready-to-administer form. As such, no further dosage calculations or manipulations are needed at the point of administration, and no "note strength" labels are required.

Why Use a Unit-Dose System?

  • Improves medication safety
    • Reduces errors due to incorrect selection or preparation of drugs
    • Prevents administration of medications until after they have been checked by a pharmacist
    • In the context of a centralized intravenous admixture program, should result in fewer errors because products are prepared by persons with appropriate training and skills
    • Reduces the risk of recurrence of errors, especially if the error is detected before the next unit dose is administered
    • Frees up pharmacist’s time for patient care activities, thus reducing patient morbidity and mortality
    • Frees up nurse’s time, because nursing staff do not have to select and prepare drug doses
  • Improves overall system efficiency
    • Makes medications available in a ready-to-use form
    • Provides greater security and better inventory management than systems based on common drug stock (i.e., ward stock)
    • Encourages recycling of unused unit doses, which can be returned to the pharmacy (not the case for bulk-issued medications)
  • Improves job satisfaction and ensures effective use of human resources
    • Reduces stress for nursing staff and reduces risks associated with handling biohazardous medications
    • Reduces amount of time that pharmacists spend on dispensing and increases the time they spend on patient care
    • Gives pharmacy technicians ownership over the dispensing process
  • Conforms with requirements of Accreditation Canada: Managing Medications Standard 7.3

Also see CSHP’s Official Publication, Drug Distribution: Statement on Unit-Dose and Intravenous Admixture (2008).

Link to Crosswalk and Supporting Literature

The CSHP 2015 Crosswalk is a document listing the CSHP 2015 goals and objectives in a tabular format, with links to philosophically aligned Canadian health initiatives. Also included are links to supporting literature, such as primary research papers and guidelines. (The CSHP 2015 Crosswalk can be found at: CSHP 2015 Crosswalk)