Usefulness of separator seals in double-bag amino acid containers

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  • AIDA HIDEKO
    Department of Hospital Administration, Juntendo University Graduate School of Medicine
  • SUMOMOZAWA YASUO
    Department of Hospital Administration, Juntendo University Graduate School of Medicine
  • YUKISHITA TAKEHIKO
    Department of Hospital Administration, Juntendo University Graduate School of Medicine
  • LEE KEIKO
    Department of Hospital Administration, Juntendo University Graduate School of Medicine
  • USUI MAKI
    Department of Nursing, Juntendo University Hospital
  • TEZUKA SATSUKI
    Department of Nursing, Juntendo University Hospital
  • MUROOKA KUNIHIKO
    Department of Pharmacy, Juntendo University Hospital
  • BABA KIYUMI
    Department of Pharmacy, Juntendo University Hospital
  • KOBAYASHI HIROYUKI
    Department of Hospital Administration, Juntendo University Graduate School of Medicine
  • SASE KAZUHIRO
    Department of Pharmacy, Juntendo University Hospital

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Other Title
  • アミノ酸ダブルバッグ製剤の未開通防止装置の有用性に関する研究
  • アミノサン ダブルバッグ セイザイ ノ ミカイツウ ボウシ ソウチ ノ ユウヨウセイ ニ カンスル ケンキュウ

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Abstract

Objective : Double-bag amino acid container is a convenient and innovative product designed to prevent the Maillard reaction by partitioning amino acids and glucose into two compartments until administration. However, it does not eliminate the human error of forgetting to break the partitions before administration. In this study, we compared the external separator seal with an internal one to determine the usefulness of these built-in devises, and to also determine their effectiveness in preventing erroneous administration due to a lack of attention. Materials and Methods : Ten registered nurses with no prior experience in administering a single drug using a double-bag system operated the separator seals of three different products : Bfluid (Otsuka Pharmaceutical Co., Ltd.), Amigrand (Terumo Corporation and Mitsubishi Tanabe Pharma Corporation), and Paresafe (Ajinomoto Co., Inc.). Each participant was assigned an observer that measured the time and evaluated the participant's handling of the separator seals.The labels on the double-bag that the participants used to visually assess the status of the partitions were also assessed.In addition, 132 registered nurses with proficiency in handling double-bag preparations were surveyed for 6 months. Results : We found that the internal separator seal (Amigrand) prevented human error more frequently than external seals (Bfluid, Paresafe). Seven participants on Bfluid and one on Paresafe were able to remove the separator seal by hand, irrespective of breaking the partitions.The labels on the double-bag consisted of 41 items on Bfluid (68.3%), 36 items on Amigrand (51.4%), and 26 items on Paresafe (37.2%). A significant difference was found between “ease of breaking the partitions” (p=0.0047) and “mixed response regarding the handling of separator seals” (p=0.0165) -with respect to the visibility of labels.Our survey showed that the separator seal reduced the incidence of administering unopened preparations in 68.2% of participants receiving Amigrand, 58.1% receiving Paresafe, and 51.0% receiving Bfluid.Although a significant difference was not detected among the three products, Amigrand received the highest rating. Conclusions : We conclude that Amigrand is the most secure double-bag preparation among the three products because its separator seal cannot be deliberately removed and the labels on the bag permit smooth breaking of the partitions.

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