Impact of Robotic Antineoplastic Preparation on Safety, Workflow, and Costs

Abstract

Purpose: Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices. Methods:We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/ manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period). The primary outcomes were serious medication errors and staff safety events with the potential for harm of patients and staff, respectively. Secondary outcomes included medication accuracy determined by gravimetric techniques, medication preparation time, and the costs of both ancillary materials used during drug preparation and personnel time.Results: Among 1,421 and 972 observed medication preparations, we found nine (0.7%) and seven (0.7%) serious medication errors (P ϭ .8) and 73 (5.1%) and 28 (2.9%) staff safety events (P ϭ .007) in the baseline and intervention periods, respectively. Drugs failed accuracy measurements in 12.5% (23 of 184) and 0.9% (one of 110) of preparations in the baseline and intervention periods, respectively (P Ͻ .001). Mean drug preparation time increased by 47% when using the robot (P ϭ .009). Labor costs were similar in both study periods, although the ancillary material costs decreased by 56% in the intervention period (P Ͻ .001). Conclusion:Although robotically prepared antineoplastic and adjuvant medications did not reduce serious medication errors, both staff safety and accuracy of medication preparation were improved significantly. Future studies are necessary to address the overall cost effectiveness of these robotic implementations.

Development of Dual-Arm Anticancer Drug Compounding Robot and Preparation System with Adaptability and High-Speed

“…The robotic device is expected to provide safety for both the patients and pharmacists (9). It will increase accuracy of the pharmaceutical calculation and A B Precision Electronic Scales reduce error, and improve quality of anticancer drugs.…”

A three-year study of a first-generation chemotherapy-compounding robot

“…preparations for anesthesiology and chemotherapy has been reported to involve higher rates of discrepancy from designated ranges of acceptability. 3,7 A study that assessed the accuracy of volumetric technique in the preparation of chemotherapy doses found that 71.7% of the doses prepared were within ±5% and 87.4% were within ±10% of the ordered dose. 8 The study authors suggested that "the process of volumetric technique alone is not sufficient to accurately prepare chemotherapy doses, and a focus of improving the process of preparing i.v.…”

“…These include the prohibitive cost of initial system implementation, doubts about operational efficiency (i.e., how many doses can be prepared in a given period of time by a robotic versus a manual process), a lack of knowledge regarding the long-term benefits of robotic compounding, and the unknown risks of adopting new robotic technology. 2,3 This report describes the experience of implementing and utilizing a first-generation chemotherapycompounding robot for the preparation of i.v. antineoplastic agents over a period of three years at King Faisal Specialist Hospital & Research Centre (KFSH&RC) in Riyadh, Saudi Arabia.…”

“…antineoplastic medications. [2][3][4][5] One feature of robotic systems that offers an advantage over manual (i.e., volumetric measurement-based) preparation is the use of gravimetric measurements to precisely weigh the quantities of antineoplastic medications and other products needed to prepare a dose. The robot's accuracy is predetermined (a typical margin of error is ±5%); any preparation that exceeds the margin is rejected, or "failed."…”

Safe handling of cytotoxics: guideline recommendations

“…Further studies are required to establish the cost-effectiveness of these robotic implementations. Each health care facility will need to assess the need for such devices in their environment 19 .…”