In the entertainment world, a showstopper is a good thing. In the pharmacy world, they are a source of anxiety and can negatively impact patient safety!
In situations where the dose preparation process is complex, the staff maybe unfamiliar with the process, or the time to prepare is urgent we can easily find ourselves in a showstopper situation.
Example: Brain Attack Protocol — Alteplase
Activase® (alteplase) is indicated for treating patients with acute ischemic stroke (AIS), which is caused by a blood clot in the brain’s blood vessels. Patients can receive Activase® (alteplase) only if they begin treatment within 3 hours after stroke symptoms start and only after bleeding in the brain has been ruled out.
When a patient arrives in the ER with symptoms of a stroke, everyone involved is working against the time window to administer this life saving drug. When the call comes in, pharmacy may have as little as 15 minutes to dose, check calculations, and prepare the drug for administration.
Administration of alteplase for this indication requires the preparation of 2 dosing units: a syringe and infusion.
The recommended dose for this indication is 0.9 mg/kg (not to exceed 90 mg total dose), with 10% of the total dose administered as an initial intravenous bolus over 1 minute and the remainder infused over 60 minutes. This requires pharmacy to prepare a syringe containing 10% of the dose and an IV bag with the balance of the dose.
The information from the package insert on the dose preparation states:
“Slight foaming is not unusual; let stand undisturbed for several minutes to allow large bubbles to dissipate. Inspect parenteral drug products for particulate matter and discoloration prior to administration whenever solution and container permit.
Alteplase may be administered as reconstituted at 1 mg/mL or further diluted immediately before administration in an equal volume of 0.9% Sodium Chloride Injection, USP, or 5% Dextrose Injection, USP, to yield a concentration of 0.5 mg/mL, using either polyvinyl chloride bags or glass vials.
Avoid excessive agitation during dilution; mix by gently swirling and/or slow inversion.”
When the call comes in and the pharmacy technician realizes that the empty Intravia bag needed to dispense the infusion solution is not available in the pharmacy, that’s a showstopper!
When the pharmacy technician preparing the dose hasn’t done so in several months, is unsure of how to proceed, or shakes the vial during preparation, that’s a showstopper!
After observing showstopper scenarios firsthand, RxTOOLKIT® developed Dose Preparation Kits to finally stop the showstoppers. Dose Preparation Kits help your staff establish a well‐defined process to prepare, distribute, and document dose preparation.
RxTOOLKIT’s Dose Preparation Kits also include on the spot competency checks designed to help pharmacy staff familiarize themselves with both the process and the drug therapy. These competency checks can include on the spot quizzes and feedback, educational resources, and live links. Competency checks can also report data back to an organization’s Competency Tracking Program, provided by RxTOOLKIT eLEARNING™.
Dose Preparation Kits are batch prepared in advance and contain all the ingredients, devices, sets, bags, labels—everything needed to prepare the dose.
We recommend that Dose Preparation Kits be stored in tamper evident bags inside a bin dedicated to the individual drug or scenario. Alternately, kits can be dispensed in ADCs (automated dispensing cabinets) or dispensed as a patient specific item.
Two labels are included with every Dose Preparation Kit – a bin label and a kit label.
The bin label aids with inventory management and restocking. The bin label can be scanned into RxTOOLKIT to reference the kit components (including ingredients and labels), kit assembly instructions, and stocking process—a big time saver!
The kit label includes step‐by‐step instructions for dose preparation as well as any appropriate warnings. Having this information right on the kit itself increases efficiency, consistency, and accuracy. It also includes a competency check (barcode) your staff can scan to ensure they understand the preparation process. Scanning the barcode connects staff to quiz questions with feedback, provides reference material, or links to more information.
The kit label also has a built‐in feature to help manage inventory and documentation when paired with RxPACK™, RxTOOLKIT’s bulk labeling, repackaging, and inventory solution. The label can be scanned right into RxPACK™ easily documenting ALL the information required for inventory management including expiration dates, source ingredients, and staff involved in preparation. The expiration date of the kit is automatically calculated based on the source ingredient information.
Our Dose Preparation Kit for Alteplase has helped one hospital so consistently prepare the dose within the 15‐minute window they were able to increase the percentage of patients receiving the Brain Attack Kit within the first hour by over 70%! They even received the ELITE Target Stroke Achievement Award as well as recognition from the Joint Commission for the accomplishment.
We have developed over a dozen different Dose Preparation Kits for diverse and specific situations—for physician’s use, when ingredient needs are unique, for nursing when bed‐side dose preparation is necessary, to manage high‐alert drugs, and for use in emergency (code blue) situations. We can design a custom Dose Preparation Kit to meet the demands of any situation or set of parameters. All Dose Preparation Kits contain: preparation and administration instructions, necessary ingredients or diluent information, storage/disposal information, and appropriate labels.
The use of Dose Preparation Kits provides the following advantages:
- Consolidation of necessary ingredients to be utilized in an emergent situation
- Standardized and streamlined dose preparation procedures
- Provides administration/preparation/storage/disposal information for nursing staff
- Inventory control support to ensure availability of ingredients
- Integration with Omnicell providing inventory management under a single menu
- Integration with RxPACK™ for batch preparation electronic record keeping
- On the spot staff Competency Check, references, and integration with Competency Tracking