Category: Professional Posters
Purpose: Compounding of sterile products is one of the few pharmacy processes not performed routinely by automation, leaving preparation of high risk medications, such as chemotherapy, open to human error. Automation can be used to reduce repetitive use injuries and limit employee exposure to hazardous medications during compounding. The purpose of our project was to evaluate the impact of implementing a chemotherapy compounding robot on chemotherapy turnaround time.
Methods: Available compounding robots were researched, and APOTECAchemo compounding robot was selected. A ten year return on investment calculation was performed, and cost savings from decreased closed system transfer devices, no additional cost for staffing, and minimal additional costs for supplies justified the cost of a robot.
Prior to robot installation, extensive planning occurred to create an appropriate space for the robot within our new facility. Oncology pharmacists decided which medications to compound with the robot through investigation of current chemotherapy medication databases available through APOTECAchemo and local practices. Our information technology team created a suitable communication interface within our electronic medical record (EMR) to allow for robot chemotherapy dispensing upon order verification. In addition, baseline chemotherapy turnaround time, defined as total time from the release of a chemotherapy order in the EMR to pharmacist verification of the product, was measured.
During robot installation, engineers were onsite for set-up and programming. Pharmacy technicians procured robot-specific supplies, such as syringes, needles, and intravenous bags. Hands-on training with the engineers occurred for both pharmacy technicians and pharmacists. After implementation, engineers remained onsite for two weeks to teach pharmacy technicians troubleshooting techniques, manage any programming concerns, and ensure pharmacist comfort using the robot software for product verification. Following implementation, customer service was available via telephone to promptly assist with additional issues. Chemotherapy turnaround times were again measured.
Results: The robot was used to compound 57.9% of our chemotherapy products (2217 of 3830 total chemotherapy products) during the first eight months. Prior to robot implementation, average chemotherapy turnaround time was 33 minutes, with 17 minutes from release of orders to technician compounding preparation and 16 minutes from technician compounding preparation to pharmacist verification of the product. After robot implementation, average turnaround time was 41 minutes, with 17 minutes from release of orders to technician compounding preparation and 24 minutes from technician compounding preparation to pharmacist verification of the product.
Conclusion: After extensive planning and troubleshooting, numerous chemotherapy drugs were compounded using a robot in our infusion center. Implementation of the robot did not considerably change chemotherapy turnaround times. During the same time period of robot implementation, several process changes were put into place for compliance with United States Pharmacopeia 797 and 800 at our facility, so further analysis of the change in chemotherapy turnaround time may be warranted. Overall, a chemotherapy compounding robot was successfully integrated into our community ambulatory infusion center with minimal impact on chemotherapy turnaround time.