- Patient-specific blister packaging IQWiG Reports – Commission No. A18-35 [BOOK]Institute for Quality and Efficiency in Health Care (IQWiG): Cologne (Germany)BOOK
- CONCLUSIONS: PSBP as an option for simplifying drug dispensation to nursing home residents has long been the subject of intensive and controversial discussion. On the one hand, potential advantages of PSBP are cited (e.g. improved drug therapy safety, relief of nursing staff and an associated increase of the individual quality of care, and hence satisfaction of residents with their care). On the other hand, the process is associated with potential problems (e.g. nursing staff losing familiarity with drugs, numerous drugs that cannot be blistered, loss of patient autonomy). Despite the intensive debate, this Rapid Report found few (7) prospective comparative studies when mapping the evidence on PSBP. Six of these studies were randomized controlled trials (RCTs). All of the studies were conducted in the outpatient setting, and each answered specific research questions (e.g. blister packaging of certain drugs or for patients with specific diseases). None of the studies were conducted in Germany. No prospective interventional study was found which investigated the research question of interest, the benefit of PSBP in the inpatient (nursing home) setting. Since drug dispensing to patients in these studies differed considerably in the outpatient versus inpatient settings (e.g. regarding medication management and age structure), the results of outpatient studies are not transferable to the inpatient (nursing home) setting. Overall, there is no hint of (greater) benefit or (greater) harm of PSBP in comparison with drug dispensing without PSBP in the inpatient (nursing home) setting. In addition, insufficient evidence is available on drug dispensation using PSBP in the inpatient (nursing home) setting as regards costs, the time spent by nursing staff, and scenarios (different blistering processes and sites, level of digitization in nursing homes, blister packaging for patients on stable versus unstable regimens, complete or partial blister packaging of the medication with continued need for manual dispensing [certain dosage forms, acute medications] and resources needed when switching medication). The data provided in the literature should be considered highly unreliable. The analysis performed as part of the Rapid Report is based on many assumptions and pragmatic approaches. No sound conclusions can be drawn. The identified studies described potential cost savings associated with PSBP due to reduced wastage in case of tablet-based (rather than pack-based) billing as well as time savings for nursing staff. Additional expenditures are incurred to the statutory health insurance (SHI) when blister packaging is remunerated. Currently, the billing of blister-packed drugs is not uniformly regulated by law. On the basis of the currently available data, it is difficult to prepare a comprehensive assessment. Overall, due to a lack of valid data, the cost-effectiveness of drug dispensation using PSBP in the inpatient setting cannot be conclusively assessed. The considerations presented in this report provide examples of the interactions between the remuneration of blistering services and savings due to reduced wastage. Beyond the lack of reliable data, it should be mentioned that it was not possible to consider other care-related expenditures, for example costs incurred to the SHI for outpatient physician contacts or hospitalizations, which may be affected by blister packaging. Further, exclusively the costs of the blistered drugs were considered. In summary, further research is clearly needed to answer questions about the patient-relevant benefit of PSBP, its effects on nurses’ professional competence and work-related quality of life, indicators of drug therapy safety, and economic aspects of blister packaging. Reliable studies must be designed and carried out to determine whether and how the care of patients in nursing homes would be affected by the use of PSBP. To answer the research question of the benefit assessment, an RCT would be preferable. In addition to investigating the benefit and harm of PSBP, such a study could simultaneously determine the costs of care and nurses’ time spent. This report includes a suggested study design for such a trial.
- Aspiration of a drug in a blister pack. [Case Reports]Respirol Case Rep 2019; 7(9):e00492RC
- We report a rare case of aspiration of a drug in a press-through package (PTP) treated by not just pulling it but using a unique technique. A 73-year-old woman was referred to our department because of a persistent cough resulting from aspiration of a PTP. Flexible bronchoscopy identified the PTP in the trachea immediately above the carina. Just pulling the centre of the PTP edge with biopsy forc…
We report a rare case of aspiration of a drug in a press-through package (PTP) treated by not just pulling it but using a unique technique. A 73-year-old woman was referred to our department because of a persistent cough resulting from aspiration of a PTP. Flexible bronchoscopy identified the PTP in the trachea immediately above the carina. Just pulling the centre of the PTP edge with biopsy forceps could not move it, and we then rotated it by pulling the corner of the PTP edge to directly below the vocal cord. Passing over the vocal cord was difficult, which made us remove the bronchoscope and urge the patient to cough. These rotation techniques and voluntary coughing successfully removed the foreign body. This unique procedure may aid in the removal of a similar foreign body using a flexible bronchoscope forceps with insufficient grasping force.
- Adherence to anti-estrogen therapy in women with hormone receptor-positive breast cancer utilizing bubble packaging: a pilot study. [Journal Article]Breast Cancer Res Treat 2019; 177(2):395-399BC
- CONCLUSIONS: Adherence rate to bubble packaging was higher than that in historical studies. Although this is a single-arm pilot study, these data suggest bubble packaging of anti-estrogen may be a reasonable option to improve adherence in hormone receptor-positive breast cancer patients.
- Evaluation of the extent of damage to the esophageal wall caused by press-through package ingestion. [Journal Article]PeerJ 2019; 7:e6763P
- Press-through package (PTP) is the most common accidentally ingested foreign body in Japan. Accidental ingestion of PTP can result in esophageal damage. An approach for evaluating the risk of esophageal injury has not been established. Therefore, we used porcine esophageal tissue and silicone sheets to establish a method for assessing the risk of esophageal damage on accidental PTP ingestion. We …
Press-through package (PTP) is the most common accidentally ingested foreign body in Japan. Accidental ingestion of PTP can result in esophageal damage. An approach for evaluating the risk of esophageal injury has not been established. Therefore, we used porcine esophageal tissue and silicone sheets to establish a method for assessing the risk of esophageal damage on accidental PTP ingestion. We pathologically evaluated porcine lower esophageal tissue using a scratch tester. Using porcine esophageal tissue, scratch tests were performed with 4 test objects and pathological damage was compared. It was assumed that each object was accidentally ingested. The objects were polyvinylidene chloride (PVDC)-coated polyvinyl chloride (PVC) PTP, soft PThPa, round PTP, and a disposable scalpel. The porcine esophagus was replaced with a silicon sheet, and an automatic friction machine was used for quantitative evaluation. The silicon sheet was scratched using HHS 2000 with 750-g load at 50 mm/min. We investigated the frictional force exerted on the surface for each of the objects. The degree of damage (depth) was the highest for the disposable scalpel, followed by PVDC-coated PVC PTP, while the degree of damage (depth) was the lowest for soft PThPa and round PTP. The mean frictional forces on the silicon sheet were 524.0 gf with PVDC-coated PTP, 323.5 gf with soft PThPa, 288.7 gf with round PTP, and 922.7 gf with the disposable scalpel. We developed approaches to qualitatively and quantitatively evaluate the risk of esophageal damage after accidental PTP ingestion. Our findings indicate that the risk of gastrointestinal damage after accidental PTP ingestion is low with soft PTP and round PTP.
- [Questionnaire Survey for Pharmacists to Identify Factors Associated with Confusion Errors Involving Similar-appearing Press-through Package (Blister Pack)]. [Journal Article]Yakugaku Zasshi 2018; 138(10):1305-1312YZ
- Similar-appearing press-through package (PTP) sheets (also known as blister packs) that contain different medicines may result in incorrect medication due to confusion errors. To evaluate the significance of this problem and to identify the factors that may lead to such errors, we conducted a questionnaire survey for pharmacists. Three hundred and eighty-two pairs of PTP sheets with similar appea…
Similar-appearing press-through package (PTP) sheets (also known as blister packs) that contain different medicines may result in incorrect medication due to confusion errors. To evaluate the significance of this problem and to identify the factors that may lead to such errors, we conducted a questionnaire survey for pharmacists. Three hundred and eighty-two pairs of PTP sheets with similar appearance were included in the questionnaire. Factors related to color (sheet color at the front of the sheet 90.9%, color of tablet/capsule 57.1%, print color at the front of the sheet 45.9%) were most frequently selected as influencing the perceived similarity of the reported pairs, followed by tablet/capsule shape (46.2%), sheet size (32.4%), and mark and character positioning on sheets (6.8%). In the pairs of similar PTP sheets, pairs manufactured by the same pharmaceutical company accounted for 15%. The frequency of confusion errors or near-errors due to similar appearance of PTP sheets was highest at the time of collecting PTP sheets from the medicine shelf and returning the sheets to the medicine shelf, followed by the time of inspection of prepared medicines and medication instructions. The questionnaire results also indicate that patients themselves can confuse similar PTP sheets and take the wrong medicine. Further quantitative studies are needed to clarify the key factors that cause confusion errors due to similar appearance and to identify potential remedial measures.
- Multiple intestinal perforations due to blister pill pack ingestion. [Case Reports]BMJ Case Rep 2018; 2018BC
- A 72-year-old woman with morbid obesity and history of psychosis attended the emergency room due to abdominal pain. CT scan revealed a mesenteric infiltration surrounding a thickened wall bowel agglomeration; inside, a dense 2 cm foreign body with no pneumoperitoneum or peritoneal effusion. Surgery revealed four contained bowel perforations due to a blister pill pack inside the ileum; consequentl…
A 72-year-old woman with morbid obesity and history of psychosis attended the emergency room due to abdominal pain. CT scan revealed a mesenteric infiltration surrounding a thickened wall bowel agglomeration; inside, a dense 2 cm foreign body with no pneumoperitoneum or peritoneal effusion. Surgery revealed four contained bowel perforations due to a blister pill pack inside the ileum; consequently, a 30 cm bowel resection was performed. Ingestion was restarted on day 2, a superficial wound infection was evacuated on day 4 and the patient was discharged 6 days after surgery. Foreign body ingestion is relatively common in paediatric patients. Adult cases are usually related to vision problems, intellectual disability and psychiatric or cognitive disorders. Mostly, no consequences are reported, but some cases (<1%) can lead to complications such as perforations or gastrointestinal (GI) bleeding. Endoscopic extraction may be considered when placed in the upper GI tract, but surgery remains imperative if perforation is established.
- Blister-packed levothyroxine sodium or bottle-packed levothyroxine sodium. [Journal Article]J Basic Clin Physiol Pharmacol 2018; 29(4):309-311JB
- Blister Packaging Medication Increases Treatment Adherence in Psychiatric Patients. [Randomized Controlled Trial]J Psychiatr Pract 2017; 23(5):320-327JP
- CONCLUSIONS: Psychiatric patients adhere better to prescription medication regimens when receiving their medications in BP.
- Validity of the days supply field in pharmacy administrative claims data for the identification of blister packaging of medications. [Journal Article]Pharmacoepidemiol Drug Saf 2017; 26(12):1540-1545PD
- CONCLUSIONS: While the NPV was high, the PPV for identifying blister packaging using the days supply field in pharmacy claims data was modest given the low prevalence in blister pack use. The best predictor occurred when 28 days was compared with 30 days. KEY POINTS Blister packs are arranged in 4 × 7 compartments and are often used to improve adherence, but no studies have examined whether it was possible to identify the use of blister packs using the days supply field in pharmacy claims data. Findings show that a 28-day supply yielded a high sensitivity and specificity for identifying the use of blister packaging compared with a 30-day supply, but there is potential for misclassification. Future studies directed at examining subgroups that are more likely to use blister packs and replication of findings using other data sources in other jurisdictions are encouraged.
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- [Ileus caused by pill in blister pack]. [Case Reports]Ugeskr Laeger 2017; 179(2)UL