Robotic i.v. medication compounding: Recommendations from the international community of APOTECAchemo users

Yaniv, Angela W.; Orsborn, Adam; Bonkowski, Joseph; Chew, Lita; Krämer, Irene; Calabrese, Samuel; Ramos, Mar; Palombi, Alessandro; Lim, Siew Woon; Tabbara, Osama; Masini, Carla; Schierl, Rudolf; Bufarini, C; Peaty, Nate; Paolucci, D

doi:10.2146/ajhp151027

Cited by 23 publications

(32 citation statements)

References 7 publications

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“…A total of 5797 unique citations were identified in the electronic searches and after removal of 622 duplicates, 5175 articles were screened by title and abstract. In total, 5103 articles were excluded, and 72 articles were potentially relevant and following full publications review, 18 publications were included 14–31. Hand searching yielded an additional seven publications for inclusion 32–38.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, a total of 25 publications met the inclusion criteria (figure 1). 14–38 All studies were published from 2009 onwards. A summary of study design and results is provided in the online supplementary file, table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Rather, a qualitative summary of the results was reported. In general, studies were well reported and all studies were rated as having a moderate global rating with the exception of Yaniv 2017 which was rated as weak due to the study design 14…”

Section: Methodsmentioning

confidence: 99%

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Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review

Batson¹,

Mitchell

Lau

et al. 2019

Eur J Hosp Pharm

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ObjectivesThe current systematic review (SR) was undertaken to summarise the published literature reporting the clinical and economic value of automation for chemotherapy preparation management to include compounding workflow software and robotic compounding systems.MethodsLiterature searches were conducted in MEDLINE, Embase and the Cochrane Library on 16 November 2017 to identify publications investigating chemotherapy compounding workflow software solutions used in a hospital pharmacy for the preparation of chemotherapy.Results5175 publications were screened by title and abstract and 18 of 72 full publications screened were included. Grey literature searching identified an additional seven publications. The SR identified 25 publications relating to commercial technologies for compounding (Robotic compounding systems: APOTECAchemo (n=12), CytoCare (n=5) and RIVA (n=1); Workflow software: Cato (n=6) and Diana (n=1)). The studies demonstrate that compounding technologies improved accuracy in dose preparations and reduced dose errors compared with manual compounding. Comparable levels of contamination were reported for technologies compared with manual compounding. The compounding technologies were associated with reductions in annual costs compared with manual compounding, but the impact on compounding times was not consistent and was dependent on the type of compounding technology.ConclusionsThe published evidence suggests that the implementation of chemotherapy compounding automation solutions may reduce compounding errors and reduce costs; however, this is highly variable depending on the form of automation. In addition, the available evidence is heterogeneous, sparse and inconsistently reported. A key finding from the current SR is a ‘call to action’ to encourage pharmacists to publish data following implementation of chemotherapy compounding technologies in their hospital, which would allow for evidence-based recommendations on the benefits of chemotherapy compounding technologies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review

Batson¹,

Mitchell

Lau

et al. 2019

Eur J Hosp Pharm

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“…12 Shifting from manual to robotic compounding is also a means of reducing the risks associated with drug preparation activities. 13 CaLev is not an anticancer drug as it does not have a cytotoxic mechanism of action. 14 Despite this, we decided to shift its preparation from manual to robotic compounding, normally reserved for anticancer drugs, because of its impact on the laboratory work-flow.…”

Section: Introductionmentioning

confidence: 99%

Stability of calcium levofolinate reconstituted in syringes and diluted in NaCl 0.9% and glucose 5% polyolefin/polyamide infusion bags

Sanogo

Silimbani

Gaggeri

et al. 2020

J Oncol Pharm Pract

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Purpose Calcium levofolinate (CaLev) for intravenous administration is commercially available as a powder that must be reconstituted for injection or reconstituted and then diluted before administration. The lack of stability data on CaLev solutions renders necessary extemporaneous manual preparation, preventing the use of automated/semi-automated systems, with a consequent loss in terms of quality and safety. Methods The present work assessed the chemical–physical and microbiological stability of CaLev prepared in sodium chloride 0.9%, glucose 5% and water for injections and stored in polyolefin/polyamide bags and polypropylene syringes at 2–8°C protected from light. For this purpose, we developed and validated a new rapid High Performance Liquid Chromatography with Ultra Violet Diode-Array Detection (HPLC-UV-DAD) method. Results The samples tested were stable for 14 days, retaining >95% of their initial concentration and showing no change in colour, turbidity or pH. Microbiological tests performed on the samples were negative. Conclusions Our results confirmed the analytical stability of CaLev in NaCl 0.9%, glucose 5% and water for injection at concentrations used in clinical practice at our institute. This enables our centralized laboratory to organize the preparation of this drug in advance and the use of robots rather than manual preparation reduces the workload and the risk of preparation errors.

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“…2 Nevertheless, although the presence of IV compounding robots in hospitals has led to a significant revolution in clinical practice, their use has mainly occurred in the preparation of IV anticancer drugs as a result of high toxicity and low therapeutic index of certain chemotherapeutic drugs. [3][4][5][6][7] Indeed, manual compounding is still the most common practice for the preparation of nonhazardous (n-Hz) IV medications such as antibiotics, anti-emetics, diuretics, cortisones and so on. 8 This latter process, performed by either technicians in the hospital pharmacy or by nurses in the hospital wards, can lead to undetectable medication errors and microbiological contamination.…”

Section: Introductionmentioning

confidence: 99%

Microbiological validation of a robot for the sterile compounding of injectable non-hazardous medications in a hospital environment

et al. 2019

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Robotic i.v. medication compounding: Recommendations from the international community of APOTECAchemo users

Abstract: An international panel of pharmacy professionals, researchers, and technology leaders with experience in i.v. robotics developed a set of 35 recommendations toward a better understanding of the role of automated i.v. compounding in hospital and health-system pharmacies worldwide.

Cited by 23 publications

References 7 publications

Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review

Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review

Stability of calcium levofolinate reconstituted in syringes and diluted in NaCl 0.9% and glucose 5% polyolefin/polyamide infusion bags

Microbiological validation of a robot for the sterile compounding of injectable non-hazardous medications in a hospital environment

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