Real-World Experience of a Standalone Robotic Device for Batch Compounding of Small-Volume Parenteral Preparations

Abstract

Purpose: Intravenous (IV) drugs prepared by a robotic device offer additional safeguards and advantages, which result in decreased errors and wastage, operational efficiency, and a retrievable electronic audit trail when compared with the traditional method of IV drug compounding. Objectives: To describe the real-world experience of using Robotic IV Automation (RIVA; ARxIUM) from its implementation phase (August-December 2014) through to its operational phase (March 2015-March 2018) for batch compounding of small-volume preparations. Method: The Data Warehouse and Analytics were used extensively to generate reports for batch-prepared small-volume preparations from the implementation phase (August 2014-December 2014) through to the operational phase (March 2015-March 2018). These reports analyzed cleaning history, doses produced by drug and size, waiting times, daily usage and the rejection rate data of RIVA. A self-administered structured questionnaire with open-ended and closed questions was administered to the experienced stakeholders on the performance of RIVA after the evaluation period. The response scales used anchors such as 1 = strongly disagree to 5 = strongly agree. The questionnaire contained a 5-point Likert scale of 16 domains, including demographic data. Results: The number of sterile products prepared by the robot averaged about 5000 per month when it was fully operational (March 2015-April 2018). The highest number of daily preparations was 335 with an average of 262 during our evaluation period; this involved 21 production queues and a run time of 17:42 h/d and an average of 16:33 h/d/wk. We were able to operate the robot at about 45% of its true capacity; this enabled us to prepare a minimum of 30% of the small-volume parenteral preparations required at the time. Responses from the closed questions resulted in the agreeance that the overall impression of RIVA was “very good.” The safety features of RIVA had a median score of being “very safe.” The real impact of the automation was felt during the downtime of the IV robot; at this point, staff could evaluate the impact the robot had on the work flow within the IV room. Conclusions: This study demonstrated that it is feasible to replace some of the manual compounding of small-volume parenteral preparations through batch compounding using an IV robotic device. Despite operating the robot at about 45% of its true capacity, we prepared a minimum of 30% of our high-load small-volume parenteral preparations, which was our goal. Having proactive inventory planning would maximize the use of the IV robot and reduce the idle time, thus enabling the robot to function to its maximum potential and increase its efficiency.

Intravenous compounding robots in pharmacy intravenous admixture services: A systematic review

“…Five studies [ 9 , 10 , 25 , 30 , 32 ] evaluated the incidence of preparation failures. The model used in 2 of the studies was the CytoCare, and the incidence of failures was 12% (n = 1028) [ 10 ] and 18.7% (n = 4509), [ 9 ] respectively.…”

“…The model used in another study was the APOTECAChemo, and the incidence of failures was 2.44% (n = 11,642). [ 30 ] A 3-year real-world study [ 25 ] showed that the percentage of actual failed preparations was <1% by RIVA. The reasons for preparation failures included robot shutdowns, mechanical failures, recalibration, and other practical problems.…”

“…Only one study [ 25 ] investigated technicians’ satisfaction with robots, and the results showed that responders agreed that the overall impression of robots was “very good.” The outcomes and conclusions of the included studies were detailed in Table 6 .…”

“…All studies were screened strictly in accordance with the inclusion and exclusion criteria. Finally, 33 studies [7–39] included 2 HTAs, 16 controlled studies, 13 noncontrolled studies, 1 qualitative study, and 1 economic study. The literature inclusion process and results are shown in Figure 1.…”

“…Thirty-one original studies [7–10,13–39] were included and published from 2013 to 2021 by researchers from 11 countries. As classified by study type, these studies comprised 16 controlled studies (4 RCTs, 12 NRCTs), 13 noncontrolled studies (12 single-arm studies, 1 investigation report), 1 qualitative study (in-depth interview), and 1 economic study.…”