Despite all the findings on errors and problems with sterile preparation in the pharmacy cleanroom, there's an under-appreciation for just how risky manual IV compounding processes are.
The results speak for itself, with worldwide error rates with IV medications estimated at between 9.4% and 97.7% in a March 2018 observational study. The same study found that the most common problems are associated with not maintaining an aseptic technique during drug preparation, using the wrong diluent and labeling errors.
To overcome these challenges, hospitals and compounding pharmacies can embrace a technology solution that includes workflow automation. Implementing this technology in the cleanroom can build both sterility and accuracy in each and every dose, ensuring that the right drug and right dose are dispensed.
The question many pharmacists confront is, how do you build the business case to encourage the leadership and budget decision-makers to spend money on automation?
Doing what's best for all reasons
The arguments in favor of automation are extensive from best practice adoption to achieve regulatory compliance, enhance workflow, and even to achieve cost savings and deliver a return on investment.
The Institute for Safe Medication Practices (ISMP) is an international medication safety organization that has done a great deal to improve patient safety related to the medication delivery process. ISMP recently issued guidelines for the safe preparation of compounded sterile preparations and has identified minimum criteria for IV workflow, such as barcode scanning. ISMP has stated it is a staunch advocate of technology solutions such as barcoding, gravimetric verification of drug and diluent volumes and robotic image recognition and urges their adoption to support manual processes and provide further protections during sterile compounding.
Hospital administrators also understand the critical importance of regulatory compliance with the bar around regulatory and best practices guidelines being raised each day. How does an organization demonstrate that they are complying with medication safety principles? It is difficult at best to continue to use manual methods of documentation for quality and compliance, and quite frankly, inefficient use of valuable organizational resources.
There are also good bottom line arguments to support workflow automation, since it can improve key processes, such as checking and verification. Too often, pharmacists are not operating efficiently because they need to spend inordinate amounts of time entering the IV room to carry out process checks. Using technology to handle these activities will improve operational efficiencies, allow pharmacists to redirect their efforts, and deliver a financial benefit. There's also the added benefit of improved staff retention since freeing up the pharmacist to focus on value-add activities will improve work satisfaction and the delivery of patient care.
Justifying the costs
Manual processes also inevitably result in waste, and automating workflow can prevent high-cost drug waste from preparation errors in areas of practice such as oncology. This alone could be enough to justify the cost of implementing IV workflow systems.
Furthermore, some studies into barcode verification systems have shown savings from preventing selection errors, a key consideration given each dose could cost thousands of dollars. Indeed, some studies have shown errors in a range of 2 to 3 per 1000, which quickly add up.
The argument for automation of the sterile compounding workflow is extensive, but above all, it has been shown to reduce errors, which means improving patient safety a key objective for all hospitals.