Implementation and evaluation of a sterile compounding robot in a

AJHP RESIDENTS EDITION

STERILE COMPOUNDING ROBOT

Implementation and evaluation of a sterile compounding robot in a satellite oncology pharmacy Sunny B. Bhakta, Pharm.D., BCPS (M.S. student), Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX, and University of Houston College of Pharmacy, Houston, TX. A. Carmine Colavecchia, Pharm.D., M.S., Ph.D., BCPS, Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX, and University of Houston College of Pharmacy, Houston, TX. William Coffey, B.S.Pharm., D.D.S., Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX. David R. Curlee, B.S.Pharm., Department of Pharmacy Services, Houston Methodist Hospital, Houston, TX. Kevin W. Garey, Pharm.D., M.S., FASHP, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston TX.

Purpose. The purpose of this study was to quantify the impact of robotic technology on efficiency, accuracy, and cost in a satellite oncology pharmacy. Methods. A 33-week quasi-experimental study was conducted at an academic, quaternary care institution with 1,119 licensed beds from June 2016 to February 2017 to evaluate the turnaround time (TAT) for preparations compounded by automated robotic compounding technology (ARCT) versus historical procedures. Secondary endpoints included mean preparation time and percentage of doses with a TAT of 5% compared with the prescribed dose. Four of these 7 deviations were due to operator error in the placement of the bag in the ARCT, which resulted in pre-

mature termination of the preparation and an evaluation error outside of the target acceptable variation. One failure was attributed to the loading of a partial vial, which resulted in inadequate drug delivery to the final container. The remaining 2 deviations involved cyclophosphamide and carboplatin and were attributed to device dosage deviations. They occurred early during ARCT implementation, requiring recalibration of the robot. The remaining 4 failed preparations were attributed to device and engineering control issues that occurred early during the adoption of the technology. These events involved the needle alignment device and drug-doser apparatus and required calibration to ensure adequate drug withdrawal and transfer to the syringe and final container. Cost-effectiveness. The mean savings per dose ranged from $14.83 to $85.43 based on AWP costs of the components required to make the doses. An average savings of $27.56 per unit produced during ARCT was utilized to perform cost-savings pro-

Figure 1. Drug preparation time (dotted line) and turnaround time (solid line) for 4 selected oncology agents during the study. Implementation of automated robotic compounding technology (ARCT) occurred at week 14.

75.0

ARCT Implementation

Time (min)

65.0

55.0

45.0

35.0

25.0

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21

Study Week

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  AM J HEALTH-SYST PHARM | VOLUME 75 | SUPPLEMENT 2 | JUNE 1, 2018

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AJHP RESIDENTS EDITION

STERILE COMPOUNDING ROBOT

% Preparations With Turnaround Time