PhD defence K.H.M. (Karin) Larmené-Beld

Ready to administer parenteral medication produced by the hospital pharmacy: cost, labeling and quality

Medication errors are common in the hospital setting, especially during the preparation and administration of parenteral medication. A solution to improve the safe use of parenteral medication is the use of ready-to-administer (RTA) products. The overall aim of the thesis of Karin Larmené-Beld was to explore cost, labeling and quality of sterilized RTA syringes produced by the hospital pharmacy.Producing RTA syringes in the hospital pharmacy led to significant cost savings of € 4.9 million in the hospital budget (for a 900-beds hospital) when having 50% of the parenteral administrations as RTA syringes and 50% prepared in a clinical environment, mainly due to the reduction in the number of medication errors and contaminations of parenteral medications.A systematic review about strategies to avoid look- alike errors of labels showed only limited evidence for the use of Tall Man lettering to improve readability of labels. A survey of labeling practices in the Netherlands, Germany and the United Kingdom showed that strategies to enhance readability of labels for parenterals were not widely implemented and acknowledged in European hospitals. Cyclic olefin polymer syringes were suitable as primary packaging material for RTA products of water soluble drugs as they had low extractables. We developed a new formulation of a norepinephrine solution without metabisulfite which is chemical stable and sterile during 12 months. In conclusion, RTA sterilized syringes can be produced in hospital pharmacy with a high quality, leading to significant cost savings due to fewer medication errors and reduced contaminations of parenteral medications.

Promotores: Prof.dr. K. Taxis Prof.dr. M.J. Postma and Prof.dr. H.W. Frijlink