FENTANYL PATCHES
Wrapper ripped from the bar code
On the wrapper for Mallinckrodt fentaNYL transdermal patches, the tear-open slit area on the back of the outer wrapper is positioned next to the product bar code, as shown below. Tearing the package open to remove the patch may destroy the bar code, making scanning impossible. A bar code on the front of the wrapper (not pictured) does not include the national drug code. Consequently, scanning that bar code instead of the one on the back of the wrapper usually will not work, causing confusion.
This example underscores the importance of scanning medication bar codes before, not after, drug administration. Sometimes busy clinicians perform bar code scanning after the fact to speed up the drug administration process; however, doing so increases the risk of errors.
LEGACY ENTERAL CONNECTORS
Phase-out schedule has been modified
Given that healthcare systems are experiencing a surge in patient needs and an increase in the demand for critical supplies during the pandemic, the Global Enteral Device Supplier Association and its members have revised the production phase-out dates for legacy enteral connectors and conversion to ENFit in the US and Canada. Widely adopted in Europe, ENFit devices are designed to prevent medical tubing misconnections and improve patient safety.
Manufacturing of legacy enteral devices was planned to be phased out beginning July 1, 2020, with transition adapters no longer manufactured after January 1, 2021. Those dates are being pushed back by 1 year. Now, legacy enteral devices will be phased out on July 1, 2021, and transition sets and adapters will no longer be manufactured after January 1, 2022.
DEPO-PROVERA
Pick a date
MedroxyPROGESTERone (Depo-Provera) is a hormonal contraceptive given by I.M. injection. The expiration date printed on a prefilled syringe of Depo-Provera (shown below) does not match the expiration date on the outer carton containing the syringe; the expiration date on the outer carton is an earlier date. A representative for the manufacturer explains that the product has two separate components-a drug syringe and a 22-gauge, 11/2 in needle for deep I.M. injection. Each assembled syringe and needle is packaged in an individual carton, but the two components may have different manufacturer expiration dates. When assigning an expiration date to the combined product, the manufacturer uses the earlier of the two expiration dates and prints that date on the carton. According to the manufacturer, the date printed on the outer carton of the combination pack is the correct expiration date for the assembled syringe and needle.
IVABRADINE
Oral solution now more widely available for infants
Ivabradine (Corlanor) is approved to treat stable symptomatic heart failure due to dilated cardiomyopathy in pediatric patients age 6 months and older who are in sinus rhythm with an elevated heart rate. The drug may be started in the hospital to ensure it is effective and well-tolerated before an outpatient prescription is written.
Ivabradine is available in 5 mg and 7.5 mg tablets and as an oral solution of 5 mg/5 mL. However, until recently, hospitals could purchase the product in tablet form only; the oral solution was available only through a single specialty pharmacy that would not dispense the drug to hospitals.
The recommended starting dose for children age 6 months and older and weighing under 40 kg is just 0.05 mg/kg twice daily. Without an oral solution available, the hospital pharmacy was required to compound liquid doses needed for children using tablets. For a 10 kg patient, the dose is just 1/10 of a tablet. To create an appropriate dose, the full tablet had to be crushed and mixed in water, and only a portion of the final mixture given to the patient. This introduced a clear risk for dosing errors.
The manufacturer, Amgen, has recently made the oral solution available to hospitals through Cardinal Health. To order, hospitals and 340B pharmacies can call 855-855-0708.