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Geersing TH, Pourahmad DM, Lodewijk F, Franssen EJF, Knibbe CAJ, Crul M. Analysis of production time and capacity for manual and robotic compounding scenarios for parenteral hazardous drugs. Eur J Hosp Pharm 2024; 31:352-357. [PMID: 36792350 PMCID: PMC11265554 DOI: 10.1136/ejhpharm-2022-003576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The increasing amount of hazardous preparations in combination with shortages leads to a call for more efficient compounding methods. This research aims to evaluate the required amount of time, production capacity and direct labour costs of the manual, manual software-supported and robotic compounding of parenteral hazardous drugs. METHODS This multicentre study was conducted at the clinical pharmacy departments of three Dutch hospitals with different compounding methods: St Antonius hospital (manual software-supported compounding), Amsterdam University Medical Centre (Amsterdam UMC) (both robotic compounding and manual compounding without software support) and OLVG (robotic compounding). Time measurements of individual hazardous drugs were performed in all three hospitals. At Amsterdam UMC and St Antonius hospital, the times per compounding phase, the production capacity and the direct labour costs per preparation were also determined. To reflect real-world situations, the combination of robotic and manual compounding was also studied. RESULTS The total compounding process, including the actions before compounding and the release-time and cleaning time, lasted 6:44 min with robotic compounding and was faster than manual compounding with and without software support (6:48 and 9:48 min, respectively). The production capacity of one full-time equivalent (FTE) on 1 day (P1FTE1day) was 15 preparations per FTE per day with manual compounding with and without software support, and 57 preparations per FTE per day with only robotic compounding. If manual and robotic compounding were combined, the production capacity was 30 preparations per FTE per day. In this setting, the direct labour costs per preparation were €5.21, while these costs were €13.18 with only manual compounding. CONCLUSION Compared with manual compounding, robotic compounding was faster over the total compounding process. A combination of manual compounding and robotic compounding could lead to 100% more preparations per FTE and 2.5 times lower direct labour costs compared with manual compounding.
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Affiliation(s)
- Tjerk H Geersing
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
- Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Demelza M Pourahmad
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, The Netherlands
| | - Femke Lodewijk
- Pharmaceutical Business Administration, Hogeschool Utrecht, Utrecht, The Netherlands
| | | | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
- Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, location Vrije Universiteit, Amsterdam, The Netherlands
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Geersing TH, Dogan D, Nejadnik MR, Romeijn S, Knibbe CAJ, Crul M. Aggregate Formation and Antibody Stability in Infusion Bags: The Impact of Manual and Robotic Compounding of Monoclonal Antibodies. J Pharm Sci 2024; 113:1029-1037. [PMID: 37839612 DOI: 10.1016/j.xphs.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/07/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
Monoclonal antibodies (mAbs) can be damaged during the aseptic compounding process, with aggregation being the most prevalent form of degradation. Protein aggregates represent one of several risk factors for undesired immunogenicity of mAbs, which can potentially lead to severe adverse drug reactions and less effective treatments. Since data on aggregate and particle formation by robotic compounding is missing, we aimed to compare the antibody stability between robotic- and manual compounding of mAbs with regard to formation of (sub)visible aggregates. Infliximab and trastuzumab were compounded into infusion bags with the APOTECAchemo robot or manually by nurses or pharmacy technicians. The products were analyzed by quantifying (sub)visible particles with nanoparticle tracking analysis, dynamic light scattering (DLS), light obscuration, micro-flow imaging, high pressure size exclusion chromatography (HP-SEC), and visual inspection. HP-SEC showed high percentages monomers in trastuzumab (99.4 % and 99.4 %) and infliximab (99.5 % and 99.6 %) infusion bags for both manual and robotic compounding, respectively. DLS indicated more consistent and reproducible results with robotic compounding, and confirmed monodisperse samples with a higher polydispersity index for manual compounding (0.16, interquartile range; IQR 0.14-0.18) compared to robotic compounding (0.12, IQR 0.11-0.15). This study shows that the studied compounding methods had a minor impact on the number of aggregates and particles, and that robotic compounding of mAbs provided at least similar quality as manual compounding.
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Affiliation(s)
- Tjerk H Geersing
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands; Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands.
| | - Dunja Dogan
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - M Reza Nejadnik
- Department of Pharmaceutical Sciences & Experimental Therapeutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242, United States
| | - Stefan Romeijn
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands; Division of Systems Pharmacology and Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centre location Vrije Universiteit, Amsterdam, the Netherlands
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Chennaq M, El Baraka S, Cherif Chefchaouni A, Benahmed H, Chaibi A, Belahcen MJ, Rahali Y. Manual versus automated chemotherapy preparation: A retrospective pharmaco-economic analysis. J Oncol Pharm Pract 2024:10781552241230889. [PMID: 38332625 DOI: 10.1177/10781552241230889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
INTRODUCTION The National Oncology Institute of Morocco's (NIO) shift to an automated cytotoxic drug preparation system (PHARMODUCT®) has prompted an evaluation of its economic and clinical impacts compared to traditional manual methods. METHODS A retrospective cost-benefit analysis over six months, extrapolated to annual projections, assessed initial investments, labour, equipment, drugs and consumables. Four commonly used chemotherapy drugs were analyzed, with a focus on the cost implications of drug waste in manual preparation versus the efficiency of vial-sharing in automated methods. RESULTS The automated system incurred a higher initial cost $2,934,098.74, but reduced annual drug consumption costs by 19.74% and drug-related expenses by $41,228.27. It also decreased personnel costs by $48,073.35. Despite the upfront investment, the system is projected to break even within two years, with no medication waste due to its vial-sharing capability. CONCLUSION The initial higher investment in pharmaceutical automation promises considerable long-term savings and efficiency gains. Despite the study's limited scope and duration, the findings endorse the adoption of automated systems in oncology pharmacy settings for sustainable financial management and improved clinical outcomes.
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Affiliation(s)
- Meryem Chennaq
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Ibn Sina University Hospital Center, Rabat, Morocco
| | - Soumaya El Baraka
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Ibn Sina University Hospital Center, Rabat, Morocco
| | - Ali Cherif Chefchaouni
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Ibn Sina University Hospital Center, Rabat, Morocco
| | - Houda Benahmed
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
| | - Aicha Chaibi
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | | | - Younes Rahali
- Faculty of Medicine and Pharmacy, Mohammed V University in Rabat, Rabat, Morocco
- Ibn Sina University Hospital Center, Rabat, Morocco
- Team of Formulation and Quality Control of Health Products, Faculty of Medicine and Pharmacy, Mohammed V University-Rabat, Rabat, Morocco
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Lagrange FJ, Lagrange JV. Process performance of a new liquid medication dispensing robot. Eur J Hosp Pharm 2023; 30:340-346. [PMID: 34857643 PMCID: PMC10647870 DOI: 10.1136/ejhpharm-2021-002811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Liquid medications provide an alternative to splitting pills and dosages by measuring an amount of liquid rather than crushing tablets or opening capsules. Special attention should also be paid to specific patient groups with swallowing difficulties or requiring enteral feeding administration. Liquid medicines are also often used to ease withdrawal symptoms for people suffering from addiction. Nevertheless, filling liquid medication cups with the right medication and precise doses may be difficult for healthcare professionals. The Nooddis ('Nominative Oral Dose Dispenser'-Pierre Lôo Hospital, France and Packinov, France) is a new robotic system for the automated filling of single dose liquid medications. Since the performance of such a complex piece of equipment depends on compliance of the service provider to our building guidelines, the process performance verification is a necessary prerequisite before starting routine production. METHODS The performance of the Nooddis robot (accuracy, precision, and tapering calculation) and its ability to fill medicine cups was evaluated with 18 different liquid medications using an automatic in-line checkweigher. Microbiological testing was also performed. RESULTS 648 sealed cups were prepared for qualification. The filling accuracy was within the limit of ±10% from 75 µL to 21.25 mL. The repeatability (% relative SD (%RSD) 0.05 to 4.93) and intermediate precision (%RSD 0.01 to 6.59) were validated for all preparations. All medicine cups met the requirements of USP and European Pharmacopoeia acceptance criteria for microbiological quality. Automated tapering calculations allowed for easy production of daily doses for the tapering periods chosen. CONCLUSION Since the system met the required quality standards, the Nooddis robot, with automatic in-line tapering system, is regarded as an accurate technology that can fill the exact amount of liquid oral medication in single dose cups. This may promote closer monitoring, which supports medication tapering as well as medication misuse prevention. With a packaging cost similar to current unit dose cup systems, it is a relevant alternative to fractioned or crushed tablets, as well as opened capsules. Further developments for some sterile liquid medications are yet to be studied.
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Affiliation(s)
- Fabrice Jean Lagrange
- Department of Pharmacy, Lab testing Unit (BSPharm, PhD,Technology Implementation Engineer), Pierre-Lôo Hospital, GHT58, La Charite-sur-Loire, France
| | - Jean Valdomar Lagrange
- Epitech and CSULB (IT Engineer), Le Kremlin-Bicetre Paris and Long Beach, CA, France and USA
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Cherif Chefchaouni A, Boudina Y, Chennaq M, Belahcen MJ, Rahali Y. Contribution of an anticancer drug compounding robot in reducing the risks of manual preparation in a hospital pharmacy unit specialized in oncology. J Oncol Pharm Pract 2023; 29:1334-1342. [PMID: 35938183 DOI: 10.1177/10781552221118846] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In the last few years, pharmaceutical technology has evolved. In the field of oncology pharmacy, robots for the preparation of anti-cancer drugs have appeared to progressively replace manual preparation. The objective of this study is to evaluate the contribution of the robot in reducing the risk of manual preparation. METHODS The study was conducted at the pharmacy of the National Institute of Oncology in Rabat (May-August 2021). The method used to compare the two types of preparation is the method of analysis of failure modes, their effects and their criticality (FMECA). It will calculate the criticality index (CI = severity × frequency × detectability). The risks have been categorized into human, technical, and environmental risks. RESULTS The anticancer drugs reconstitution step was the most critical in manual preparation (CI = 126.7) and robotic preparation (CI = 40.7). The robot has made it possible to reduce several CIs of manual preparation including: musculoskeletal disorders of pharmacy operators -93 (89%), error in cancer drug and diluent selection -72 (60%), as well as lack of traceability -145 (97%). CONCLUSION The preparation robot has made it possible to reduce many of the risks of manual preparation, and constitutes an important advance in the field of oncology pharmacy.
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Affiliation(s)
- Ali Cherif Chefchaouni
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Yassine Boudina
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | - Meryem Chennaq
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- Ibn Sina University Hospital, Rabat, Morocco
| | | | - Younes Rahali
- National Institute of Oncology, Ibn Sina University Hospital, Rabat, Morocco
- Team of Formulation and Quality Control of Health Products, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Climent-Ballester S, García-Salom P, Sanz-Valero J. Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature. Front Public Health 2023; 11:1233264. [PMID: 37711235 PMCID: PMC10498460 DOI: 10.3389/fpubh.2023.1233264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.
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Affiliation(s)
- Seira Climent-Ballester
- Pharmacy Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro García-Salom
- Pharmacy Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Javier Sanz-Valero
- National School of Occupational Medicine, Carlos III Health Institute, Madrid, Spain
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Yang C, Ni X, Zhang L, Peng L. Intravenous compounding robots in pharmacy intravenous admixture services: A systematic review. Medicine (Baltimore) 2023; 102:e33476. [PMID: 37171327 PMCID: PMC10174346 DOI: 10.1097/md.0000000000033476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND There is a lack of best evidence of intravenous compounding robots for hospital decision-makers. This study aimed to conduct a systematic review of intravenous compounding robots. METHODS A comprehensive search of relevant professional health technology assessment websites and electronic databases was conducted from inception to February 3, 2022. Current studies related to intravenous compounding robots were included in this systematic review. Two reviewers independently screened the literature, extracted data, and assessed quality. The results were reported by qualitative description because of heterogeneity in the characteristics of the data in the included studies. RESULTS Thirty-three studies were included. Effectiveness: The robots improved production efficiency compared with usual/manual preparation; however, the intravenous preparation process requires further optimization. Additionally, robots reduced the incidence of medicine residues, preparation errors, and preparation failures. The solution properties of intravenous admixture medicines were satisfactory, and the robots also contributed to error recognition. Safety: The robots reduced product pollution and environmental pollution, but vigilance is still required to ensure that pollution stays low. The robots also reduced the incidence of health damage to technicians. Economy: The robots reduced material costs in these studies; however, whether they can reduce labor costs remains unclear. Social suitability: Technicians had a high degree of satisfaction with the robots, but few relevant studies focused on this aspect. CONCLUSIONS Intravenous compounding robots have certain advantages in terms of effectiveness, safety, economy, and social adaptability.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaofeng Ni
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lijuan Peng
- Department of Purchasing, West China Second Hospital, Sichuan University, Chengdu, China
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Vo N, Desmaris R, Brandely-Piat ML, Vasseur M, Rieutord A, Aboudagga H. [Robotic production of injectable anticancer drugs in hospital pharmacies]. Bull Cancer 2023:S0007-4551(23)00152-2. [PMID: 37105854 DOI: 10.1016/j.bulcan.2023.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Following the 2005 decree on securing the medicine supply chain, the production of "chemotherapies", anticancer drugs (cytotoxic, cytostatic, immunotherapy), was centralised within hospital pharmacies. To cope with increasingly growing activities, pharmacies are moving towards robotisation. This work offers feedback from four French sites pioneers in robotic production. MATERIAL AND METHOD A review of the literature was carried out on the PubMed and Google Scholar scientific databases and GERPAC publications relating to the robotic production of chemotherapy preparations. This review allowed to select 25 articles. RESULTS The robotisation of the production of "chemotherapies" requires infrastructural prerequisites, a reengineering of the manufacturing process and the patient journey. This impacts all the parties involved in this complex process. The "cobotisation" concept or collaborative robotics must be anticipated by the teams. Robotisation is an institutional decision, which must be owned by the pharmaceutical team and endorsed by the medical team and management. DISCUSSION/CONCLUSION For reasons of optimisation, safeguarding and management of human resources, a large number of centres get equipped with robotic systems. Robotic preparation should extend to other non-hazardous preparation, as it is already the case in other countries. This strategic view should be carried out today to anticipate problems, ensure safety and improve the healthcare quality.
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Affiliation(s)
- Ngoc Vo
- Gustave-Roussy, Département de pharmacie clinique, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Romain Desmaris
- Institut Curie, département de pharmacie clinique, 8, rue Thuillier, 75005 Paris, France
| | - Marie-Laure Brandely-Piat
- Service pharmacie, groupe hospitalier Paris centre, Site Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Michèle Vasseur
- Pharmacie centrale, centre hospitalier universitaire de Lille, rue Philippe-Marache, 59037 Lille cedex, France
| | - André Rieutord
- Gustave-Roussy, Département de pharmacie clinique, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Hail Aboudagga
- Gustave-Roussy, Département de pharmacie clinique, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
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Desmaris RP, Roche M, Mitha A, Azam S, Blazy V, Rieutord A, Aboudagga H. Automated preparation of cytotoxic drugs: the evidence for an interface between the robot and computerized provider order entry? Eur J Hosp Pharm 2023; 30:e12. [PMID: 35273004 PMCID: PMC9986918 DOI: 10.1136/ejhpharm-2022-003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Mathilde Roche
- Department of Clinical Pharmacy, Gustave Roussy, Villejuif, Île-de-France, France
| | - Assia Mitha
- Department of Clinical Pharmacy, Gustave Roussy, Villejuif, Île-de-France, France
| | - Sabine Azam
- Department of Information Technology and Digital Transformation, Gustave Roussy, Villejuif, Île-de-France, France
| | - Vincent Blazy
- Department of Information Technology and Digital Transformation, Gustave Roussy, Villejuif, Île-de-France, France
| | - Andre Rieutord
- Department of Clinical Pharmacy, Gustave Roussy, Villejuif, Île-de-France, France
| | - Hail Aboudagga
- Department of Clinical Pharmacy, Gustave Roussy, Villejuif, Île-de-France, France
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Shin S, Koo J, Kim SW, Kim S, Hong SY, Lee E. Evaluation of Robotic Systems on Cytotoxic Drug Preparation: A Systematic Review and Meta-Analysis. Medicina (B Aires) 2023; 59:medicina59030431. [PMID: 36984432 PMCID: PMC10056266 DOI: 10.3390/medicina59030431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023] Open
Abstract
Background and Objectives: With the increased prevalence of patients with cancer, the demand for preparing cytotoxic drugs was increased by health-system pharmacists. To reduce the workload and contamination of work areas in pharmacies, compounding robots preparing cytotoxic drugs have been introduced, and the use of the robots has been expanded in recent years. As reports on the comprehensive and quantitative evaluation of compounding robots remain lacking, a systematic review and meta-analysis were conducted to provide descriptive and quantitative evaluations of the accuracy of preparing injectable cytotoxic drugs. Materials and Methods: A systematic review and meta-analysis were conducted using published studies up to 2020. To identify eligible studies, PubMed, EMBASE, and Cochrane Library were used. All studies reporting the outcomes relevant to drug-compounding robots such as accuracy, safety, and drug contamination were included. Outcomes from included studies were descriptively summarized. Drug contamination by the robot was quantitatively analyzed using the odds ratio (OR) with a 95% confidence interval (CI). The risk of bias was assessed using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). Results: A total of 14 compounding robot studies were eligible for review and 4 studies were included in the meta-analysis. Robotic compounding showed failure rates of 0.9–16.75%, while the accuracy range was set at 5%. Two studies reported that robotic compounding needed more time than manual compounding, two reported that robotic compounding needed less time, and one just reported preparation time without a control group. In a meta-analysis regarding the contamination of the compounding area, manual compounding was associated with lower contamination, although the result was not statistically significant (OR 4.251, 95% CI 0.439–51.772). For the contamination of infusion bags, the robot was associated with lower contamination (OR 0.176, 95% CI 0.084–0.365). Conclusions: Robotic compounding showed better accuracy than manual compounding and, without control groups, showed a high accuracy rate and also reduced the risk of drug contamination and compounding workload. The preparation time of the robot was not consistent because the type of robot and introduced system were different. In conclusion, robotic compounding showed mixed results compared to the manual compounding of drugs, so the system should be introduced considering the risks and benefits of robots.
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Affiliation(s)
- Sangyoon Shin
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Jamin Koo
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Suk Won Kim
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Seungyeon Kim
- College of Pharmacy, Dankook University, Cheonan 31116, Republic of Korea
| | - So Yeon Hong
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
- Department of Pharmacy, Seoul National University Bundang Hospital 82, Gumi-ro 173, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, Republic of Korea
| | - Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea
- Correspondence: ; Tel.: +82-2-740-8588
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12
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Chen H, Guo Y, Wei H, Chen X. The impact of pharmacist oriented mode on risk control in a Chinese centralized intravenous admixture service centre. Sci Rep 2021; 11:5445. [PMID: 33686207 PMCID: PMC7940617 DOI: 10.1038/s41598-021-85077-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 11/09/2022] Open
Abstract
Centralized intravenous admixture service (CIVAS) centres, which are pharmaceutical departments found in Chinese hospitals, provide high-quality intravenous fluids and pharmaceutical services for patients, and errors in their working procedures can lead to adverse consequences. Pharmacists, the primary CIVAS centre personnel, play a role in risk control; however, to date, the effect of pharmacists' participation in risk management has not been reported. The main aim of this study was to evaluate the pharmacist's role in risk control and evaluate its impact. A retrospective observational study was designed to assess the principal working process in the CIVAS centre of a provincial healthcare setting. Errors in the main working process were identified, and intervention measures were formulated. The pharmacist intervention effect was evaluated by assessing the identification rate of improper prescriptions; the incidence rate of drug preparation, compounding, packaging and delivery process errors; and expenditures on wasteful drugs. There was a higher identification rate for improper prescriptions after the intervention (P < 0.05), while the incidence of drug preparation (P < 0.05), admixture (P < 0.05), and packaging and delivery errors (P < 0.01) was significantly lower; the total wasteful medication expenditure was also dramatically reduced. The potential creativity of pharmacists in error control can provide dependable intravenous drugs for patients and reduce the running expenditures for CIVAS.
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Affiliation(s)
- Hongxia Chen
- Department of Clinical Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China. .,Intravenous Admixture Services Centre, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China.
| | - Yanrong Guo
- Intravenous Admixture Services Centre, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Hualing Wei
- Department of Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
| | - Xiaoyu Chen
- Department of Clinical Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China.,Department of Pharmacy, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, Guangxi, China
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Riestra AC, López-Cabezas C, Jobard M, Campo M, Tamés MJ, Marín AM, Brandely-Piat ML, Carcelero-San Martín E, Batista R, Cajaraville G. Robotic chemotherapy compounding: A multicenter productivity approach. J Oncol Pharm Pract 2021; 28:362-372. [PMID: 33573462 DOI: 10.1177/1078155221992841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this study is to compare productivity of the KIRO Oncology compounding robot in three hospital pharmacy departments and identify the key factors to predict and optimize automatic compounding time. METHODS The study was conducted in three hospitals. Each hospital compounding workload and workflow were analyzed. Data from the robotic compounding cycles from August 2017 to July 2018 were retrospectively obtained. Nine cycle specific parameters and five productivity indicators were analysed in each site. One-to-one differences between hospitals were evaluated. Next, a correlation analysis between cycle specific factors and productivity indicators was conducted; the factors presenting a highest correlation to automatic compounding time were used to develop a multiple regression model (afterwards validated) to predict the automatic compounding time. RESULTS A total of 2795 cycles (16367 preparations) were analysed. Automatic compounding time showed a relevant positive correlation (ǀrs|>0.40) with the number of preparations, number of vials and total volume per cycle. Therefore, these cycle specific parameters were chosen as independent variables for the mathematical model. Considering cycles lasting 40 minutes or less, predictability of the model was high for all three hospitals (R2:0.81; 0.79; 0.72). CONCLUSION Workflow differences have a remarkable incidence in the global productivity of the automated process. Total volume dosed for all preparations in a cycle is one of the variables with greater influence in automatic compounding time. Algorithms to predict automatic compounding time can be useful to help users in order to plan the cycles launched in KIRO Oncology.
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Affiliation(s)
- Ana C Riestra
- Pharmacy Department, Fundación Onkologikoa Fundazioa, Donostia-San Sebastián, Gipuzkoa, Spain
| | | | - Marion Jobard
- Service de Pharmacie Clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - María J Tamés
- Pharmacy Department, Fundación Onkologikoa Fundazioa, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Ana M Marín
- Pharmacy Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Marie L Brandely-Piat
- Service de Pharmacie Clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Rui Batista
- Service de Pharmacie Clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gerardo Cajaraville
- Pharmacy Department, Fundación Onkologikoa Fundazioa, Donostia-San Sebastián, Gipuzkoa, Spain
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14
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Capilli M, Enrico F, Federici M, Comandone T. Increasing pharmacy productivity and reducing medication turnaround times in an Italian comprehensive cancer center by implementing robotic chemotherapy drugs compounding. J Oncol Pharm Pract 2021; 28:353-361. [PMID: 33567974 DOI: 10.1177/1078155221992851] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The management of antineoplastic drugs used for chemotherapy is widely recognized as a high-risk activity. In 2018, our oncology pharmacy implemented workflow improvements to manage the growing workload due to the centralisation of activities from a hospital's satellite pharmacy, moving towards automated compounding of antineoplastic drugs.The aim of this study was to determine the impact of the centralization on the productivity of the pharmacy department and evaluate the performances of the robotic chemotherapy drugs compounding. MATERIAL AND METHODS Data were collected from the hospital information system and the workflow management software, and examined over a 3-year period (2017-2019). The total annual throughput in terms of doses prepared and patients treated and the Medication Turnaround Time (MTAT) were determined. Productivity and dosage accuracy were calculated for the robotic system. RESULTS In 2018, the number of patients treated increased by 16.6%, consequently, the overall number of intravenous preparations compounded in the pharmacy increased by 17.2%. Regarding manual compounding, the total number of antineoplastic preparations decreased by about 2%. Investigational treatments manually compounded increased by about 27%, in contrast to the non-investigational treatments, which decreased by 9.4%. Regarding robotic compounding, the annual production increased by 50.4%. In 2018, the MTAT decreased about 24%. The dosage accuracy and precision of the total amount of doses were -1.1% and 1.2%, respectively. CONCLUSION This study indicates that in the effort to satisfy an ever-increasing workload, computerization and automation are essential instruments to maintain and ensuring high standards of quality.
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Affiliation(s)
| | | | - Matteo Federici
- Hospital Pharmacy, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Turin, Italy
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15
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Pang B, Earl M, Knoer S, Yaniv A, Willner M, Boyd A. Comparison of IV oncology infusions compounded via robotics and gravimetrics-assisted workflow processes. Am J Health Syst Pharm 2021; 78:122-134. [PMID: 33064792 PMCID: PMC7665334 DOI: 10.1093/ajhp/zxaa366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose A study was conducted to compare an intravenous (IV) gravimetric technology–assisted workflow (TAWF) platform to an IV robotic system. In the study we reviewed both IV technology platforms using the same gravimetric quality assurance system, which allowed for direct comparison. Methods All oncology preparations compounded from January 2016 through December 2018 using either system were included in our retrospective analysis. Final preparation accuracy, IV system precision, and workflow throughput (analyzed using lean process methodologies) were evaluated. Results Data analysis indicated that use of the IV gravimetric TAWF system was associated with a significantly lower percentage of accuracy errors compared to the IV robotics system (1.58% vs 2.47%, P < 0.001), with no significant difference in absolute precision (1.12 vs 1.12 P = 0.952). Lean analysis demonstrated that overall completion time (17:49 minutes vs 24:45 minutes) and compound preparation time (2:39 minutes vs 6:07 minutes) were less with the IV gravimetric TAWF vs the IV robotics system. Conclusion Implementation of either an IV gravimetric TAWF system or IV robotics system will result in similar compounding accuracy and precision. Preparation time was less with use of the IV gravimetric TAWF vs the IV robotic system, but the IV robotic system required less human intervention. Both systems ensure medication safety for patients, although the IV robotic system has increased safeguards in place. Therefore, the primary driver for implementing these systems is alternative factors such as cost of systems implementation and maintenance, employee safety, and drug waste.
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Affiliation(s)
| | | | - Scott Knoer
- Cleveland Clinic, Cleveland, OH.,American Pharmacists Association, Washington, DC
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16
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Geersing TH, Klous MG, Franssen EJF, van den Heuvel JJG, Crul M. Robotic compounding versus manual compounding of chemotherapy: Comparing dosing accuracy and precision. Eur J Pharm Sci 2020; 155:105536. [PMID: 32877721 DOI: 10.1016/j.ejps.2020.105536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cytostatic drugs are increasingly being prepared with a cytostatic robot, though it is not known whether the dose of the final product is more accurate after automated or manual preparation. This study is the first to compare accuracy and precision of automated preparations with manual preparations by measuring volumes and drug concentrations. METHODS The accuracy and precision of automated and manual preparations were compared by gravimetric and concentration measurements. During ten days 80 solutions were prepared; 40 robot preparations and 40 manual preparations. With both preparation methods, 20 methotrexate (MTX) and 20 cyclophosphamide (CP) bags were compounded. We simulated normal working conditions by performing the preparations on Monday till Friday. The MTX and CP concentrations were measured with validated ultra high performance liquid chromatography (UHPLC) methods on the last preparation day. RESULTS With UHPLC analysis, dose accuracy (mean dose error) of robotic or manual preparation of MTX were 1.70% and 0,96% respectively. With gravimetric analysis, these values were 0.50% and 1.96%. Precision (standard error) of the robotic preparation for MTX was significantly smaller than that of manual preparation (p < 0.001). Dose accuracy (mean dose error) of robotic or manual preparation of CP, with UHPLC analysis, were 6.10% and 5.20% respectively. With gravimetric analysis, these values were 0,67% and 0,18%. CONCLUSION We conclude that both robotic and manual compounding produce accurate cytostatic products in which the mean percentage of active substance differs by less than 10% from the prescribed amount. Both preparation methods are compliant with the Dutch Medicines Act and the European Pharmacopoeia.
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Affiliation(s)
- T H Geersing
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands.
| | - M G Klous
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands
| | - E J F Franssen
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands
| | | | - M Crul
- Amsterdam University Medical Center, Department of Clinical Pharmacology and Pharmacy, Amsterdam, the Netherlands
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17
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Cirino M, Provasi R, Cebulec I, Palmieri C, Schincariol P, Zanon D. Pediatric blinatumomab preparation: Risk assessment on SmPC for software compliance. J Oncol Pharm Pract 2020; 27:1674-1683. [PMID: 33106105 DOI: 10.1177/1078155220966394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Blinatumomab is an anticancer drug used in the treatment of Acute Lymphoblastic Leukaemia (ALL) in both adults and children. ALL is the most common form of cancer in children and patients who are refractory to standard treatments have poor prognosis. The preparation of blinatumomab is unique and extremely complex. It's important to carry out any information to identify all the critical issues related to the preparation of blinatumomab: sharing procedure between prescribers, staff of the Centralized Chemotherapy Preparation Unit [Unità Farmaci Antiblastici (UFA)] and administering nurses aimed at reducing the clinical risk related to the management of the drug blinatumomab and to obtain correct prescriptions on the real dose to be prepared, safe worksheets with computer processing of all variables (volumes to be added and corresponding dose of drug) and complete labels containing all the information necessary for the control of the preparation and its correct infusion. METHODS A computerized process involves the use of specific software to which precise instructions must be given. This study is divided into two phases, the first one focused on the analysis of Summary of Product Characteristics (SmPC) and the extrapolation of any unclear part of SmPC. The second phase involved the manufacturer to answer a questionnaire. RESULTS This comparison with the company allowed to perfect the blinatumomab preparation process leading to: 1. allow the patient to be discharged and return a few times for infusions and consequently reduce the number of medical prescriptions; 2. set up the drug for each patient every 4 days; 3. reduce costs related to devices, staff employed. CONCLUSION Computerizing the preparation of anti-blastic drugs is a necessary path for the safety of the patient and all the operators involved, however it may be necessary to make changes in the preparation process to allow the software to work correctly. The comparison between pharmacist, clinician and, where necessary, the manufacturer of the drug, was effective in the preparation of this drug.
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Affiliation(s)
- Mario Cirino
- Presidio Ospedaliero Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Riccardo Provasi
- Presidio Ospedaliero Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Irina Cebulec
- Presidio Ospedaliero Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Clara Palmieri
- Presidio Ospedaliero Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Paolo Schincariol
- Presidio Ospedaliero Ospedale Maggiore, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Davide Zanon
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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18
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Batson S, Mitchell SA, Lau D, Canobbio M, de Goede A, Singh I, Loesch U. Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review. Eur J Hosp Pharm 2020; 27:330-336. [PMID: 33097615 DOI: 10.1136/ejhpharm-2019-001948] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The 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. METHODS Literature 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. RESULTS 5175 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. CONCLUSIONS The 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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Affiliation(s)
| | | | - Davina Lau
- Becton Dickinson Corporation, London, UK
| | | | - Anna de Goede
- Department of pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inderjit Singh
- 5 Pharmacy Department, University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ulrich Loesch
- Manufacturing, University Hospital Basel, Basel, Switzerland
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19
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Amodeo I, Pesenti N, Raffaeli G, Sorrentino G, Zorz A, Traina S, Magnani S, Russo MT, Muscolo S, Plevani L, Mosca F, Cavallaro G. Robotic Therapy: Cost, Accuracy, and Times. New Challenges in the Neonatal Intensive Care Unit. Front Pharmacol 2019; 10:1431. [PMID: 31849676 PMCID: PMC6901951 DOI: 10.3389/fphar.2019.01431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/08/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The medication process in the Neonatal Intensive Care Unit (NICU), can be challenging in terms of costs, time, and the risk of errors. Newborns, especially if born preterm, are more vulnerable to medication errors than adults. Recently, robotic medication compounding has reportedly improved the safety and efficiency of the therapeutic process. In this study, we analyze the advantages of using the I.V. Station® system in our NICU, compared to the manual preparation of injectable drugs in terms of accuracy, cost, and time. Method: An in vitro experimental controlled study was conducted to analyze 10 injectable powdered or liquid drugs. Accuracy was calculated within a 5% difference of the bottle weight during different stages of preparation (reconstitution, dilution, and final product). The overall cost of manual and automated preparations were calculated and compared. Descriptive statistics for each step of the process are presented as mean ± standard deviation or median (range). Results: The median error observed during reconstitution, dilution, and final therapy of the drugs prepared by the I.V. Station® ranged within ±5% accuracy, with narrower ranges of error compared to those prepared manually. With increasing preparations, the I.V. Station® consumed less materials, reduced costs, decreased preparation time, and optimized the medication process, unlike the manual method. In the 10 drugs analyzed, the time saved from using the I.V. Station® ranged from 16 s for acyclovir to 2 h 57 min for teicoplanin, and cost savings varied from 8% for ampicillin to 66% for teicoplanin. These advantages are also capable of continually improving as the total amount of final product increases. Conclusions: The I.V. Station® improved the therapeutic process in our NICU. The benefits included increased precision in drug preparation, improved safety, lowered cost, and saved time. These advantages are particularly important in areas such as the NICU, where the I.V. Station® could improve the delivery of the high complexity of care and a large amount of intravenous therapy typically required. In addition, these benefits may lead to the reduction in medication errors and improve patient and family care; however, additional studies will be required to confirm this hypothesis.
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Affiliation(s)
- Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gabriele Sorrentino
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Zorz
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Traina
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Magnani
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Teresa Russo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Muscolo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Plevani
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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20
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Werumeus Buning A, Geersing TH, Crul M. The assessment of environmental and external cross-contamination in preparing ready-to-administer cytotoxic drugs: a comparison between a robotic system and conventional manual production. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:66-74. [PMID: 31489970 PMCID: PMC7004186 DOI: 10.1111/ijpp.12575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 11/28/2022]
Abstract
Objectives The primary aim of the study was to compare environmental and external (cross‐) contamination of traces of cytostatics, during preparation of 5‐fluorouracil and cyclophosphamide using a robotic system (APOTECAchemo) or the conventional manual compounding procedure. The secondary aim was to validate the cleaning procedure of the robot. Methods Eighty ready‐to‐administer (RTA) infusion bags with 5‐fluorouracil, cyclophosphamide or sodium chloride were compounded using both techniques on 3–5 days. Wipe samples were taken from several locations in the compounding room before and after cleaning, and also from the technician’s gloves. These samples were analysed for 5‐fluorouracil and cyclophosphamide concentrations using GC/MS/MS. Key findings A total of 284 wipe samples were collected during the study (113 from the manual and 171 from the robotic process). External contamination on the outside of infusion bags was 3.75% for both manual and robotic compounding. For manual compounding, external cross‐contamination occurred on 2.5% of the prepared infusion bags. External cross‐contamination occurred on 1.25% of the infusion bags for the robotic procedure. Inside the compounding room, 9% of the environmental wipe samples were contaminated in case of manual production and 24% for robotic compounding. Since 50% of the contaminated environmental samples for the robotic system were taken after cleaning, the cleaning procedure was extended and parameter setting for cyclophosphamide handling was performed. After this, residual environmental or external contamination was no longer detectable. Conclusion Comparison of both preparation methods showed that external (cross‐)contamination of infusion bags was lower using the robotic system. An optimized cleaning procedure showed the best results in environmental contamination for the robot.
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21
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Carrez L, Bouchoud L, Fleury S, Combescure C, Falaschi L, Sadeghipour F, Bonnabry P. Work overload is related to increased risk of error during chemotherapy preparation. J Oncol Pharm Pract 2019; 25:1456-1466. [PMID: 31084249 DOI: 10.1177/1078155219845432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Chemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations. METHOD Simulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of < 5%, 5%-10%, 10%-30%, and >30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively. RESULTS Twenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p < 0.0001). Thirty-nine preparation errors were recorded: 30 wrong concentrations (deviation > 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p < 0.05). CONCLUSION Although pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.
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Affiliation(s)
- Laurent Carrez
- 1 Pharmacy, Geneva University Hospitals, Geneva, Switzerland
| | - Lucie Bouchoud
- 1 Pharmacy, Geneva University Hospitals, Geneva, Switzerland
| | - Sandrine Fleury
- 1 Pharmacy, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Farshid Sadeghipour
- 2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Pascal Bonnabry
- 2 School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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22
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Jobard M, Brandely-Piat ML, Chast F, Batista R. Qualification of a chemotherapy-compounding robot. J Oncol Pharm Pract 2019; 26:312-324. [PMID: 30997871 DOI: 10.1177/1078155219843322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
KIRO® Oncology (Kiro Grifols, Spain) is a robotic system for automated compounding of sterile injectable drugs including intravenous cytotoxic treatments. The present article describes the qualification procedure applied prior to production phases. Peristaltic pumps which ensure the reconstitution of drugs were tested with water and NaCl 0.9%. The performance of the robot (accuracy and precision) to prepare bags, syringes and elastomeric pumps was evaluated with three placebo solutions (aqueous, foaming and viscous) using gravimetric controls. Microbiological controls were also performed. The pumps met the requirements set for volumes ranging from 5 to 100 mL. A total of 274 preparations was compounded. For the bags, the filling accuracy was within the limit of ±10% from 1 to 48 mL with aqueous solution, from 0.6 to 48 mL with foaming solution and from 5 to 48 mL with viscous solution. For all syringes and elastomeric pumps, it was within the limit of ±10%. The precision was validated for all preparations, except for bags and syringes prepared with 0.6 and 0.25 mL, respectively. The samples of surfaces and air complied with ISO 5 class environment. Among the 24 gloves tests performed, two presented microbiological growth. All Media fill tests were validated. The qualification procedure led us to exclude injections of any active principle volume strictly lower than 1 mL. The microbiological contamination of operators' gloves remains a critical point. Our operators will be made aware of the issue during the training period.
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Affiliation(s)
- Marion Jobard
- Service de Pharmacie clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Marie-Laure Brandely-Piat
- Service de Pharmacie clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François Chast
- Service de Pharmacie clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Rui Batista
- Service de Pharmacie clinique, Hôpitaux Universitaires Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France
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23
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Heloury J, Bouguéon G, Deljehier T, Jourand A, Berroneau A, Crauste-Manciet S. Automation of Aseptic Sterile Preparation: Risk Analysis and Productivity Comparison with Manual Process. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2019. [DOI: 10.1515/pthp-2019-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Two automation methods for aseptic preparation in hospital pharmacy, robot and peristaltic pump, were compared to manual process both for risk analysis using Failure Modes Effects and Criticality Analysis (FMECA) method and for productivity using time analysis grids built for each process.
The results obtained with the different workflow organizations showed that the worst-case conditions for productivity was production “on demand” of tailor-made preparations. in that case, the manual process was not significantly different from the robotic process (p-value=0.72). For the standardized preparations, the semi-automatic process preparing a batch from bulk solution from “to be reconstituted” drugs was significantly superior to the robotic process preparing repetitive series of doses (p-value<0.01). Productivity of the robot was dramatically increased when the robot performed standardized preparations either from ready to use solutions or mixed cycles due to the robot design. When different processes were FMECA analyzed for risk analysis the robotic process was found as the safer process in comparison to others with a total of Criticality Indexes of 1060, 719, 656 for manual, semi-automatic and robot, respectively. Except for the robotic, semi-automatic and manual processes needed additional IT control systems to limit the risk of failures.
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Affiliation(s)
- Jeanne Heloury
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
| | - Guillaume Bouguéon
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
- ARNA laboratory ChemBioPharm U1212 INSERM – UMR 5320 CNRS , Bordeaux University , Bordeaux , France
| | - Thomas Deljehier
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
| | - Audrey Jourand
- Quality department , Bordeaux University Hospital , Bordeaux , France
| | - Aude Berroneau
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
| | - Sylvie Crauste-Manciet
- Pharmaceutical Technology Department , Bordeaux University Hospital , Bordeaux , France
- ARNA laboratory ChemBioPharm U1212 INSERM – UMR 5320 CNRS , Bordeaux University , Bordeaux , France
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Geersing TH, Franssen EJF, Pilesi F, Crul M. Microbiological performance of a robotic system for aseptic compounding of cytostatic drugs. Eur J Pharm Sci 2019; 130:181-185. [PMID: 30710619 DOI: 10.1016/j.ejps.2019.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/22/2019] [Accepted: 01/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Compounding of cytostatic drugs requires strict aseptic procedures, while exposure to toxic drugs and repetitive manual movements should be minimized. Furthermore, reuse of vials is desirable to lower the costs. To assess if all this might be safely achieved with a robot, this study aimed at qualifying the aseptic preparation process with the robotic system APOTECAchemo. METHODS The aseptic compounding of patient-individual cytostatic solutions was simulated with media fill simulation tests to qualify the performance according to European GMP Annex 1. The contamination in the environment was measured in critical places using settle plates, contact plates, active air sampling and particle counting. Media-fill simulation tests were prepared in 3 production batches. The second part of the study evaluated the microbiological shelf-life of commercial drug vials after repeated puncturing. On six days, fifty syringes of 15 ml media were prepared from the same 50 vials with the robot. After each preparation, vials were covered with an IVA seal upon unloading from the robot to protect them from microbiological contamination. RESULTS No microbiological contamination was found in any of the 96 media fill preparations, nor in any of the 300 syringes that were prepared with repeated puncturing. The compounding area met class A limits, while class A criteria were not fulfilled by the contact plates and settle plates placed on the right side of the loading area. There, the average colony forming units (cfu) were 3 and 1.17, respectively, meeting class B criteria. CONCLUSIONS Robotical compounding of cytostatic drugs with APOTECAchemo meets the microbiological requirements of the European GMP. In addition, the robot can reuse vials repeatedly and safely, thereby enabling extended usage.
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Affiliation(s)
- T H Geersing
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands
| | - E J F Franssen
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands
| | - F Pilesi
- Loccioni, Moie di Maiolati (Ancona), Italy
| | - M Crul
- Amsterdam University Medical Center, Department of Clinical Pharmacology and Pharmacy, Amsterdam, the Netherlands.
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Deljehier T, Bouguéon G, Heloury J, Moreno V, Berroneau A, Crauste-Manciet S. Simulation program of a cytotoxic compounding robot for monoclonal antibodies and anti-infectious sterile drug preparation. J Oncol Pharm Pract 2019; 25:1873-1890. [DOI: 10.1177/1078155218823911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to develop a specific simulation program for the validation of a cytotoxic compounding robot, KIRO® Oncology, for the preparation of sterile monoclonal antibodies and anti-infectious drugs. The impact of excipient formulations was clearly measured using simulation accuracy tests with worst case excipient (i.e. viscous, foaming) and allowed to correct the robotic settings prior to real production. Corrections brought accuracies within the acceptable range of ±5%. KIRO® Oncology robot has also the capacity of self-cleaning and a simulation combining media fill test, and environmental monitoring was able to validate the aseptic process including simulation of worst case conditions and highlighting the areas not accessible to self-cleaning to be corrected by additional manual cleaning measures. The risk of chemical contamination was simulated by using fluorescent dye of the process with high-risk excipient formulation and overpressure vials. Quality control reliability was simulated by using a model drug, and final concentration was determined by high-performance liquid chromatography-ultraviolet detection. Finally, productivity was simulated using different models of production showing the impact of the type of drug, the number of vials and the poor standardization of the process.
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Affiliation(s)
- Thomas Deljehier
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
| | - Guillaume Bouguéon
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
- ARNA Laboratory ChemBioPharm U1212 INSERM, UMR 5320 CNRS Bordeaux University, Bordeaux, France
| | - Jeanne Heloury
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
| | - Valérie Moreno
- Biomedical Department, Bordeaux University Hospital, Bordeaux, France
| | - Aude Berroneau
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
| | - Sylvie Crauste-Manciet
- Pharmaceutical Technology Department, Bordeaux University Hospital, Bordeaux, France
- ARNA Laboratory ChemBioPharm U1212 INSERM, UMR 5320 CNRS Bordeaux University, Bordeaux, France
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Krämer I, Federici M. Implementation and microbiological stability of dose-banded ganciclovir infusion bags prepared in series by a robotic system. Eur J Hosp Pharm 2018; 27:209-215. [PMID: 32587079 DOI: 10.1136/ejhpharm-2018-001745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The implementation of dose-banding (DB) in centralised, pharmacy-based cytotoxic drug preparation units allows the preparation of standardised doses in series. The aim of this study was to evaluate the feasibility of DB for the prescribing of ganciclovir (GV) infusion solutions and to investigate the microbiological stability of dose-banded, automatically prepared ready-to-administer GV infusion bags by media-fill simulation tests and sterility tests. METHODS The frequency of prescription of GV doses was retrospectively analysed before and after implementing the DB scheme. Four dose-ranges or 'bands' and the corresponding standard doses (250, 300, 350, 400 mg) were identified. The maximum variance was set at ±10% of the individually prescribed dose. The aseptic preparation of a series of GV infusion bags was simulated with double strength tryptic soy broth as growth medium and prefilled 0.9% NaCl polyolefin infusion bags as primary packaging materials. The simulation process was performed with the APOTECAchemo robot on five consecutive days. In total, 50 infusion bags were filled, incubated and stored for 12 weeks at room temperature. The media-filled bags were visually inspected for turbidity after 2, 4, 8, 10 and 12 weeks. Following incubation, growth promotion tests were performed. During the simulation tests, airborne contamination was monitored with settle plates and microbial surface contamination with contact plates. Pooled sterility tests were performed for a series of 10 standard GV infusion bags after a 12-week storage period under refrigeration (2 °C-8 °C). RESULTS After implementation of the DB scheme, about 60% of the prescribed GV doses were prepared as standard preparations by the robotic system. The number of different GV doses was reduced by 61.8% (76 vs 29). None of the 50 media-filled bags showed turbidity after a storage period of 12 weeks, indicating the absence of microorganisms. The environmental monitoring with settle/contact plates matched the recommended limits set for cleanroom Grade A zones, except in the loading area of the robot. Media fills used for the sterility tests remained clear during the incubation period, thereby revealing sterility. Positive growth promotion tests proved the process's reliability. CONCLUSIONS A DB scheme for prescribing and preparation of standard GV infusion bags was successfully implemented. Microbiological tests of aseptic preparation of infusion bags in series by the APOTECAchemo robot revealed an adequate level of sterility and a well-controlled aseptic procedure. The sterility was maintained over extended storage periods, thereby encouraging extended beyond-use dating.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matteo Federici
- Department of Pharmacy, University Medical Centre, Johannes Gutenberg-University Mainz, Mainz, Germany
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Albert-Marí A, Valero-García S, Fornés-Ferrer V, Poveda-Andrés JL. Exploratory analysis for the implementation of antineoplastic logarithmic dose banding. Int J Clin Pharm 2018; 40:1281-1291. [DOI: 10.1007/s11096-018-0714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022]
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Unluturk MS, Tamer O, Utku S. A robotic system to prepare IV solutions. Int J Med Inform 2018; 119:61-69. [PMID: 30342687 DOI: 10.1016/j.ijmedinf.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/01/2018] [Accepted: 09/09/2018] [Indexed: 11/17/2022]
Abstract
Drugs need to be used regularly and correctly in order to be effective. When medicines are used correctly, negativities that threaten human health and life can be avoided, but they can cause unwanted situations that can occur until the end of life when they are used incorrectly. The most common drug administration errors in hospitals are: The wrong dosage of the drug given to the patient, the timing and / or the method of administration, the wrong drug given to the patient, the drug given to the wrong patient, or even not given. Furthermore, the information about the drug that is administered to the patient may not be registered at all. In this research, a robotic drug preparation system and a communication server accepting prescription orders have been developed. Component engineering methodology is further utilized in the design of the Drug Preparation System to maximize reuse, increase product reliability, reduce design, code and test efforts. The IV Robotic Drug Preparation Robot is composed of a robotic work station and a Cartesian carrier to carry the work station to the desired location. The robotic work station has several grippers to handle syringes, to pull the piston of the syringe and to lock the closed system connector to the vial. The IV Robotic Drug Preparation System and communication server are developed and being used in the hospitals. Due to this system, medicines left unused in vials can be used and a great amount of savings is obtained from the drug purchases.
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Affiliation(s)
- Mehmet S Unluturk
- Yasar University, Department of Software Engineering, 35100, Izmir, Turkey.
| | - Ozgur Tamer
- Dokuz Eylul University, Department of Electrical and Electronics Engineering, Izmir, Turkey
| | - Semih Utku
- Dokuz Eylul University, Department of Computer Engineering, Izmir, Turkey
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Carrez L, Martin V, Verrey AS, Furrer P, Bouchoud L, Falaschi L, Bonnabry P. Qualification and Performance Evaluation of an Automated System for Compounding Injectable Cytotoxic Drugs. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2018. [DOI: 10.1515/pthp-2018-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Use of automated systems for the production of chemotherapy will increase in answer to hospitals’ needs to rationalise production. The aim of the study was to evaluate the performance of a PharmaHelp® automated system for compounding chemotherapy.
Methods
Viable and non viable particles in air and liquid were measured by particle counter. Surface chemical contamination was simulated with a quinine solution. Microbiological contamination and aseptic processes were studied using media-fill tests. Dose accuracy was evaluated using a gravimetric method, in simulation studies and with real products in daily practice. Productivity was calculated by batch of ten IV-bags.
Results
No particles or microbiological contamination were detected. Filling was accurate for all the volumes of non-viscous solution studied (97–103 %). Minimum volumes which could be prepared accurately were 2 mL and 5 mL for the non-viscous and viscous solutions, respectively. For 2–5 mL volumes, the robot was less accurate than average, and 0–2 % of bags were rejected (deviation>10 %). Average fill deviations were from 0–3 % for 2–5 mL volumes and<1 % for volumes above 5 mL. Average production time for ten bags was 61±11 min.
Conclusions
The automated system was able to produce chemotherapy effectively, delivering appropriate quality with productivity comparable to manual preparations. These results confirmed that such automated systems have the potential to guarantee optimal safety for patients and technicians.
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Affiliation(s)
- Laurent Carrez
- Pharmacy , Geneva University Hospitals , Geneva , Switzerland
- School of Pharmaceutical Science , University of Geneva, University of Lausanne , Geneva , Switzerland
| | - Vincent Martin
- Pharmacy , Geneva University Hospitals , Geneva , Switzerland
| | | | - Pascal Furrer
- School of Pharmaceutical Science , University of Geneva, University of Lausanne , Geneva , Switzerland
| | - Lucie Bouchoud
- Pharmacy , Geneva University Hospitals , Geneva , Switzerland
| | | | - Pascal Bonnabry
- Pharmacy , Geneva University Hospitals , Geneva , Switzerland
- School of Pharmaceutical Science , University of Geneva, University of Lausanne , Geneva , Switzerland
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Krämer I, Federici M, Schierl R. Environmental and Product Contamination during the Preparation of Antineoplastic Drugs with Robotic Systems. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2018. [DOI: 10.1515/pthp-2018-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Robotic systems are designed to minimize the exposure to antineoplastic drugs during automated preparation. However, contamination cannot be completely excluded. The aim of the study was to evaluate the contamination with antineoplastic drugs on the working surfaces and on the outer surface of the ready-to-use products (infusion bags and syringes) during automated preparation with different versions of a robot and manual preparation.
Methods
Surface contamination with platinum (Pt) and 5-fluorouracil (5-FU) was measured by wipe sampling and quantified by voltammetry for Pt and GC-MS for 5-FU. Sampling was performed on pre-defined locations in the working areas before and after preparation of standardized test products. The outer surfaces of Pt- or 5-FU-containing infusion bags and 5-FU-containing syringes were sampled without and after manual capping.
Results
Overall, the surface contamination in the working areas of the robotic system ranged from 0.4 to 114 pg/cm2 for Pt and from 1.3 to 1,250,000 pg/cm2 for 5-FU. The highest contamination levels were detected after preparation on the gripper of the robotic arm and on the surface beneath the dosing device. In most cases, measured concentrations were higher after preparation. Outer surfaces of infusion bags prepared with the robotic system were less contaminated than manually prepared bags. Contamination on the outer surface of syringes varied depending on the procedure adopted.
Conclusions
The risk of contamination is localised inside the working area of the robot. The outer surfaces of products were only marginally contaminated. Cleaning procedures of the working area are to be further investigated. An effective decontamination procedure for the working area of the robot and automated capping of filled syringes should be developed to further minimize the occupational risk.
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Affiliation(s)
- Irene Krämer
- Department of Pharmacy , University Medical Center, Johannes Gutenberg-University Mainz , Langenbeckstraße 1, 55131 , Mainz , Germany
| | - Matteo Federici
- Department of Pharmacy , University Medical Center, Johannes Gutenberg-University Mainz , Langenbeckstraße 1, 55131 , Mainz , Germany
| | - Rudolf Schierl
- Institute and Clinic for Occupational, Social and Environmental Medicine , University Hospital , LMU Munich , Munich , Germany
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