Sun Pharmaceuticals has developed a range of
ready-to-administer (RTA) products, including
intravenous (IV) gemcitabine bags and 50ml
midazolam syringes for use in intensive care
units (ICU). Eight Directors of Pharmacy from six
European countries met in Amsterdam to share
their experience of RTA products and to consider
what the future might hold.
If licensed RTA products were freely available,
most hospital pharmacies across Europe would
be using them, on the grounds that they guarantee
quality and stability, enhance patient safety by
minimising the possibility of compounding and
administration errors and increasing aseptic unit
capacity.
But, of course, they cannot be free, and so their
procurement becomes a trade-off between their
direct cost and their direct and indirect benefits.
Where and how that line is drawn, and the role
of international, European and local guidance in the
decision-making process were the focus of
discussion of this gathering of European Directors
of Pharmacy.
They began with a critical appraisal of RTA 50ml
midazolam syringes.
RTA 50ml midazolam ICU syringes
Who are the stakeholders and what is the
procurement process?
Across the EU, procurement is discussed/decided
between ICU pharmacists and intensive care
departmental medical chiefs (cost), with nurses
playing a crucial advisory role.
In Spain, there is a regional tender for syringes,
with a centralised expert and technical committee
establishing requirements and offering the final
decision, ratified by the regional healthcare
government. A hospital committee proposes,
analyses and decides for devices not included in the
tender.
In the UK, ICU pharmacists and clinicians
(anaesthetists and intensivists) are the major
stakeholders, with pharmacy procurement designing
any framework/contract.
Costs/Benefits
• The benefit is not to minimise the cost, or to save
nurses’ time, but to minimise the risk to the patient
by preventing administration errors; there is
unfortunately no price tag on that, but there was
consensus that this is the only way forward.
• If a company has a licensed RTA product with
a long shelf life that is terminally sterilised, that
would be a winner. As phrased by one delegate: if we
can buy it, then we buy it.
• In the interest of patient safety, it is not possible
to overstate the importance and benefit of proper
labelling and barcoding on syringes and primary
packaging. This is an area in which the benefit of
industry-prepared RTA syringes can easily be sold. As
regards colour coding, this is perceived to be fraught
with danger, unless one can be assured of EU-wide
uniformity.
• Calculations can be deceiving. One of the delegates
from Germany cited the example of 50ml KCl
syringes: his hospital’s ICUs prepare 700 KCl
syringes every day, which, at one minute per
When we are
so pushed for
capacity, why
would you make
something when
there is a
suitable licenced
alternative at a
reasonable cost?
Alison Beaney, UK
DELEGATES
Alain Astier
Formerly Head
of Department of
Pharmacy and currently
Emeritus Professor of
Clinical Pharmacy and
Biotechnology, Henri
Mondor University
Hospital, Paris, France Alison Beaney
Quality Assurance
Specialist Pharmacist
and Visiting Professor,
University of Sunderland,
UK Robert ten Broeke
Head of Pharmacy,
Catharina Hospital,
Eindhoven, Netherlands Martin Hug
Chief Pharmacist,
University Medical Centre
Freiburg, Germany
Antonio Lalli
Director of Pharmacy,
Hospital San Giovanni di
Dio, Naples, Italy David Lopez
Vall d’Hebron University
Hospital, Barcelona, Spain Andrea Machiavelli
Director of Pharmacy,
ASST Cremona, Italy Theresa Saklatvala
Chair, Content Director,
Cogora
Irene Krämer
Director, Pharmacy
Department at the
University Medical Center,
Johannes Gutenberg-
University, Mainz,
Germany
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