Ready to Use Packaging

Cleveland Clinic Abu Dhabi 1

Rabih Dabliz, Pharm.D., FISMP

Senior Manager, Quality & Medication Safety

Challenges in the United Arab Emirates

Minimal availability of ready to use injectables:

- Pre-filled syringes

- vials vs. ampoules

- Pre-mixes

Lack of barcoding on all products

Inability to outsource sterile compounding

Cleveland Clinic Abu Dhabi 2

Minimal Availability of Ready to Use Injectables

Cleveland Clinic Abu Dhabi 3

Clexane vs. Lovenox

Cleveland Clinic Abu Dhabi 4

Safety Needles

Lovenox®Clexane®

Regular Needles

Batching Pre-filled Syringes

Cleveland Clinic Abu Dhabi 5

❖ Pharmacy batches several pre-filled syringes for Anesthesia:

- NORepinephrine

- nitroglycerin

- epinephrine

- EPHEDrine

❖ Products look-alike which results in potential for mix-up

Batching Pre-filled Syringes

Cleveland Clinic Abu Dhabi 6

AUXILIARY

LABELS

Batching Premixes

Cleveland Clinic Abu Dhabi 7

HydroMORPHONE 10 mg/mL

Cleveland Clinic Abu Dhabi 8

❖ Only strength available in the country up until 2015

❖ Imported directly from the United Stated a unit-dose strength, however:

1. Higher Cost2. Higher wastage due to short

expiration/transport time3. Unsustainable stock due to UAE

laws around ordering narcotics

❖ Unable to receive next batch until 2019

❖ Requires updating all our order sets each time a different strength is available

Cleveland Clinic Abu Dhabi 9

❖ Difficulty sustaining supply of vials and pre-filled syringes

❖ Majority of the stock is ampoules which are bulky and easy to break

❖ Current brand is a south Korean one

❖ Mitigation was placement of Styrofoam pads in our Automated Pyxis Cabinets(Will insert picture)

Propofol Ampoules

Cleveland Clinic Abu Dhabi 10

Look-Alike Products

Lack of Barcoding on Products

Cleveland Clinic Abu Dhabi 11

Cleveland Clinic Abu Dhabi 12

❖ Majority of products we receive do not have a barcode from manufacturer

❖ Pharmacy barcode labels every single medication on formulary

~1.6 K Medications

~175 K Labels/Month

No Barcoding on Products

140

145

150

155

160

165

170

175

180

185

December January February March April MayTh

ou

san

ds

Barcode Labeling

46% of Injectables in IV RoomDon’t have a barcode from

manufacturer

Cleveland Clinic Abu Dhabi 13

❖ ADVANTAGES:- Uniform packaging:

1. Green Rain Code (NDC)

2. Expiration Date

3. Lot Number

- Tracking Recalls

Barcode Labeling in Pharmacy

Cleveland Clinic Abu Dhabi 14

Barcode Labeling in Pharmacy

NURSING

PHARMACY

Inability to Outsource SterileCompounding

Cleveland Clinic Abu Dhabi 15

Video of an Actual Event

Cleveland Clinic Abu Dhabi 16

https://vimeo.com/242725788/dbc4d051c3