Medication supply in closed loop medication - conceptual understanding and prerequisites

Closed loop medication (CLM) is an electronic supported medication management process. In addition to reducing errors, the approach provides better documentation, better traceability and better support for evaluating efficacy. Commonly today, medication information is registered in many standalone systems and manual transfer between these represents a risk of human error. To be able to discuss the CLM concept, a shared understanding is needed. In this paper, a definition of CLM is suggested and the concept is elaborated regarding prerequisites and dependencies. The definition of CLM was discussed in meetings with stakeholders regionally. Sales data from the hospital pharmacy in Trondheim (July–December 2016) were reviewed with respect to possible inclusion in a CLM. Dependencies, e.g. pharmaceutical formulation and suitability regarding repackaging into identifiable unit doses, was considered. The following definition of CLM is suggested: ‘CLM is an electronically supported process for medication management where information from ordering to the point of administration is transferred seamlessly between different systems. Documentation during the process is done electronically and traceable. The CLM follows the single medication unit’. At St. Olav’s hospital in the city of Trondheim, Norway, the local unit dose system repackages tablets, capsules, suppositories, ampoules, vials and more. The weekly output is about 45 000 units. Approximately 60% of total sales may be identifiable at the point of administration. For tablets and capsules, the number is about 80%. Only 14% of the medications are available as identifiable unit doses from the industry. These numbers strongly indicate that in order to reach the CLM ambitions, systems for repackaging of medications are needed.