The risks inherent in IV drug compounding—most recently underscored by the ongoing fallout of the meningitis compounding crisis—has brought renewed attention to robotic IV compounding systems.
The contamination debacle prodded hospitals that had already been considering robotics to accelerate their decision-making processes, according to Bill Shields, vice president of marketing and sales at IHS global, which offers RIVA, a fully automated IV compounding robot.
“We’ve been talking to these hospitals for a long time,” Mr. Shields said. “Many have been saying ‘yes, we want to get this, but not immediately.’ Now they’re taking another hard look at compounding automation.”
One of the driving design considerations for RIVA was minimizing human factors in the compounding equation. Designers viewed in-hospital compounding as a manufacturing process where safety breaches, production bottlenecks and errors arise from inescapable human foibles. With the robot, operators load stock drug vials, diluent bags and empty syringes and IV bags; set the production parameters; start the machine; and then collect the finished and labeled admixture bags or syringes from output chutes.“Other than taking the dust caps off the vials when you load them, there’s almost no touching of the medication containers before the robot goes to work,” said Kevin Jones, PharmD, MBA, the director of pharmacy at Primary Children’s Medical Center, in Salt Lake City, which began using the RIVA robot in early 2009. “Once the racks are filled up, we can turn it loose for three to five hours.”
The unit operates 18 to 22 hours daily, during which it can fill 400 to 500 syringes. About half of the 900,000 IV doses prepared by the hospital pharmacy annually come out of the robot, which can be programmed to produce batches of the same drug and dose or individualized, patient-specific doses.
According to IHS, preparing 350 syringes with RIVA requires three hours of a technician’s time. All of the manipulations occur inside the robot’s aseptic environment. Accuracy checks include weighing drug vials before and after use, weighing syringes before and after filling, comparing a photo of drug labels with file photos, and bar-code scanning. The machine rejects preparations that fail any of those tests. Pulsed ultraviolet light bombards vial access points for sanitization. According to Dr. Jones, periodic testing for contaminants, which began shortly after RIVA’s installation, has yet to return a single positive culture.
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