For hospital administrators committed to improving patient safety, the pharmacy should be an area of particular attention. Not only does the pharmacy touch virtually every patient, it is too frequently the source of medication errors, especially with medications that are manually compounded. Despite tremendous advances in pharmacy workflow and aseptic techniques, medication errors continue to present a serious challenge to patient safety
Earlier this year, several Ontario hospitals were appalled to learn that some cancer patients received diluted chemotherapy preparations made by an outsourced compounding pharmacy. An investigation found the pharmacy’s technicians failed to account for overfill in standard IV bags – so the drugs the hospitals and their patients received may have contained less-than-therapeutic concentrations.
While that case may be an egregious example, medication errors are all too common. A survey of three Canadian hospitals published in the Journal of Pediatric Nursing reported 372 medication errors over the three-month study period, four of which resulted in patient deaths. In January, the National Post reported on a 2012 Canadian study which found nearly 10 per cent of pediatric patients at 22 hospitals suffered an adverse event, with medication-related incidents being the second most common cause.
Manual medication compounding must be done with meticulous care and attention to detail. But despite the best efforts of pharmacy workers to mix medications perfectly, humans are not perfect and even the most experienced technicians make mistakes. Some studies have documented observed manual error rates of up to 10 per cent in hospital pharmacies.
As a result, ensuring the safety of compounded medications has been a priority for hospitals. Many have instituted procedures involving dozens of steps with multiple checks and re-checks. Such protocols are important but also time-consuming and inefficient for hospital pharmacies that produce hundreds of IV doses a day. That’s why automated compounding systems are increasingly seen as an essential component of safe and efficient pharmacy operation.
Pharmacy automation technology has existed for more than a decade and is being adopted by a growing number of hospitals for its ability to ensure accuracy, repeatability and patient safety. One of the biggest advantages automated compounding technology provides is removing the primary source of contamination and error – humans – from the compounding process. Automated compounders have an aseptic chamber where medications are mixed and some even can be operated outside a clean room environment.
The automated compounding system our company developed, RIVA, provides other safeguards as well. Vials are photographed and their barcodes are scanned; both are then matched to a product database to ensure the right product is being used in each step.
As compounding progresses, pulsed UV light provides extra disinfection to critical puncture sites, syringes are automatically capped (reducing the risk of needle sticks), and the finished product is dispensed in a syringe or IV bag with an electronic barcode label for documentation. The result is a sterile and accurate medication compound that is verifiably safe for the patient.
Importantly, because of the multiple safety technologies and aseptic environment in which medications are compounded, the technology provides USP<797>-compliant beyond use dating, helping pharmacies maximize production efficiency. RIVA also can be configured with negative air pressure to protect pharmacy workers during chemotherapy compounding.
Safety and accuracy are the leading reasons CancerCare Manitoba is installing RIVA to prepare chemo compounds for patients. Its CEO Dr. Dhali Dhaliwal put it simply: “This state-of-the-art technology prepares chemotherapy drugs safely and improves accuracy in a clean and contained environment.” Two other Canadian hospitals have installed RIVA for general use and many others are interested in acquiring the technology.
By increasing safety, the technology also saves money. Automation lowers the cost-per-dose of medication and reduces the need for outsourcing. Equally important, automated compounding minimizes the risk of medication errors that can result in patient injury, emergency intervention, extended hospitalizations and liability.
For those who might look to output quality as evidence of production efficacy, pharmacy automation has proven a resounding success. Since RIVA technology was commercialized in 2008, systems have been installed at more than 30 sites worldwide and have cumulatively produced some 2 million IV doses safely and accurately. Further, installed units have performed more than 200,000 routine contamination tests with zero failures.
Throughout the healthcare system, technology has been implemented to enhance the safety and efficiency of countless procedures and systems. For hospitals working to ensure the highest standards of patient care, automated pharmacy compounding technology is an essential means of enhancing medication and patient safety.