The Ups and Downs of Unit-Dose Packaging

Lidding Inspection Optical Head

In the United States, it is estimated that on average a hospital patient is subject to at least one medication error per day, and most of these medication errors occur at the drug prescribing or administrating stages.¹ How prevalent are drug administration errors? In a 2002 study, 36 different healthcare facilities were observed, and it was found that the percentage of drug administration errors was 11% excluding doses administered outside of scheduled time (ie., wrong-time errors).² Given these results, it should come as no surprise that several groups and agencies are focusing their efforts on reducing or eliminating steps that can contribute to the error rate in the drug administration process.

Presently in the US, most solid oral dosage drugs destined for pharmacies are packaged in 100 count bottles.³ These medications are then repackaged by the pharmacies into smaller containers and are finally dispensed to patients. Therefore, part of the drug administering process in healthcare facilities requires the repackaging of drugs onsite.

Obviously the task of repackaging numerous medications on a daily basis is time consuming, but this type of activity also opens the door to medication labeling errors and/or packaging errors. Therefore, eliminating the need for the repackaging of drugs through providing healthcare facilities’ pharmacies medications in unit-of-use and unit-dose packaging would undoubtedly improve the safety of the drug administration process.

As much as this “ready-to-use” form of drug packaging brings direct benefits to the drug administration process, this type of packaging clearly displays information relating to the medications, and therefore, makes the information easier to verify. However, manufacturing companies that switch to unit-dose packaging can also benefit from a number of advantages.

As previously stated, most solid oral dosage drugs destined for pharmacies in the US are packaged in 100 count bottles. These bottles then enter the supply chain and proceed through a series of hands before they reach a pharmacy.⁴ First, providing drugs in secure, tamper resistant packaging such as unit-dose packages reduces the likelihood of counterfeit drugs being introduced into the market. Secondly, this form of packaging also protects drugs from:

• atmospheric exposure (humidity)
• dispensing errors due to repackaging
• handling of drugs by anyone other than the manufacturer and patient.⁵

Providing drugs in unit-dose packaging allows companies to design labeling that not only complies with current FDA regulations such as the bar code rule, but it also provides companies the opportunity to brand company and product names throughout the supply chain.

Even though these factors represent true benefits to manufacturers, in the past there has been a clear reluctance to adopt unit-dose packaging as the standard. According to a 2002 survey on pharmaceutical bar coding and unit-dose packaging in hospitals, over 55% of respondents saw a reduction in the number of items available in unit-dose packaging over the 5 previous years.⁶ This could be due in part to the cost associated with implementing a change in packaging; however, transferring some of these costs onto the costs of drugs themselves would partially solve this problem, wouldn’t it?

One question on the survey concerned this exact issue. Eighty-four percent of the respondents felt that a slight increase in cost would not deter them from purchasing unit-dose medications with a bar code. Furthermore, over 2/3 of respondents agreed that they would likely select a therapeutic equivalent product that is available in unit-dose packaging when considering therapeutic substitution policies.

Another survey question focused on the importance of unit-dose formats. In the survey 88% of the respondents believed that the availability of products packaged in unit-dose format is important to the institution. Given these results and the bar code requirements on all medications for hospitals and certain OTC’s, not to mention the fact that this form of packaging decreases the likelihood of dispensing errors, the company and product branding opportunities and the securing of the supply chain, why haven’t more companies made the move to unit-dose packaging?

First, for companies to introduce unit-dose packaging an investment is required. Secondly, new packaging and labeling must also be designed and manufactured. Thirdly, new packaging machinery right down to new vision inspection equipment must be purchased.

If you are currently using or you are thinking about implementing unit-dose packaging on your lines’ and need to update your vision inspection for blisters and/or lidding, click here to request information on Optel Vision’s Blister Inspector and Lidding Inspector.

Optel Vision can also easily customize solutions by combining various inspection capabilities. For example, Optel Vision recently supplied a specially designed a unit-dose pouch inspection system, which combines complete information verification of printed lidding information (OCV, bar code verification, bar code grading, presence and etc.), with simultaneous tablet verification (integrity, presence, color and etc.). This flexible solution was built as an off-line system but can also be easily installed on-line.

¹ Preventing Medication Errors: Quality Chasm Series, 2006, accessed 22 August, 2006,
http://www.nap.edu/catalog/11623.html.
² Barker et al. 2002b. ‘Medication errors observed in 36 health care facilities’, Archives of Internal Medicine 162, 2002, pp.1897.
³ Peter G. Mayberry, ‘Current Trends in Pharmaceutical Packaging and Distribution Practices – US Versus the EU’, US Pharmacy Review, 2004, pp. 1.
⁴ Peter G. Mayberry, ‘Current Trends in Pharmaceutical Packaging and Distribution Practices – US Versus the EU’, US Pharmacy Review, 2004, pp. 1.
⁵ Peter G. Mayberry, ‘Current Trends in Pharmaceutical Packaging and Distribution Practices – US Versus the EU’, US Pharmacy Review, 2004, pp. 1-2.
⁶ Institute for Safe Medication Practices, Results of survey on Pharmaceutical Bar Coding and Unit Dose Packaging in Hospitals, 2002, accessed 18 August, 2006,
http://www.ismp.org/Survey/NewsLetter/Survey12122001Results.asp?ptr=y.