No abstract

BackgroundDue to the toxicity of molecules involved and the seriousness of adverse drugs events, chemotherapy compounding is a high risk medical practice. To ensure high standards of safety and quality of the process, in September 2014 our hospital pharmacy developed a new oncology workflow, based on implementation of a robotic system for intravenous (IV) chemotherapy compounding. In order to avoid any mistakes that can lead to potential medication errors, the technology adopted was equipped with a set of different sensors able to guarantee the appropriate identification of the all components used for the compounding.PurposeTo present the improvement introduced by automation in terms of quality and safety of the cure offered to patients, highlighting the importance of a total controlled oncology workflow.Material and methodsWe analysed 8 weeks of automated IV production, focusing on potential medication errors intercepted by the automated system. All of these events were recorded and processed by APOTECAmanager, the pharmacy IV production management software.ResultsThe 2 month production evaluation results in 2312 IV chemotherapies prepared were analysed. The automated system detected 59 potential medication errors, preventing any erroneous therapy compounding. In detail:50 events associated with incorrect components barcode scanning (eg, sodium chloride instead of dextrose bag scanning);5 occurrences during the vial weighing procedure;4 episodes during the vial label identification.All these events were related to incorrect material loading carried out by the technician. We assessed the weekly trend in potential error occurrences: Monday and Tuesday results were the highest frequency (7.1% and 6.2%, respectively, of total daily production). We also noticed that 51% of detected errors occurred between 8am and 11am in the morning.ConclusionEvery step in the oncology workflow is now totally controlled, allowing the traceability of each operation, from prescription to administration. The results showed the added benefit of this technology in terms of reduction of potential medication errors and self-assessment of your own compounding procedure; at the same time, evidences point out to the need for implementing specific interventions in clinical practice to reduce the probability of occurrence of these events.No conflict of interest

an extraction of the software was done to study the forced steps (the steps refused by the software but accepted by the pharmacist because of the correct volume read) over a period of 6 months. Results The metrological tests enable to qualify the balances. The bias of the weighing scales fluctuates between 0.94% and 4.40%. Over 6 months, 15 227 preparations were realised with a total of 1 89 334 steps including 49 180 weighing steps. Among those, there were 2023 forced steps (4.1%). The most forced cytotoxic molecules were identified. The two most forced stages were the weighing of the syringe with cytotoxic (41%) and of the final pouch (23%). The 50 ml syringe is responsible for 41% of this forced stage and, in 85% of the cases, it is because the volume to collect has a decimal value. Conclusion Concerning the sensitivity, a method is elaborated to determine the rate of the false negatives with a fake cytotoxic preparations plan and calculated weighing errors. Our method validation plan is complete with the validation of the two components: precision scale and software. REFERENCES AND/OR ACKNOWLEDGEMENTSNo conflict of interest.

This abstract was published in error and withdrawn at the author’s request.

BackgroundIn April 2016 the Central IntraVenous Additive Service (CIVAS) began to compound non-toxic injectable therapies with a robotic system.1 The production started with antiemetic therapies, followed by antibiotic therapies ready to infuse, as cefazoline 1 g in syringes and piperacillin-tazobactam 4.5 g in bags.PurposeThe purpose of this study is to present the new drugs involved that led to production increasing and to describe how CIVAS guarantees the non-hazardous preparations’ supply to hospital departments.Material and methodsAn analysis concerning the actual hospital antibiotic treatment needs has been carried out through the electronic medical record (EMR). Drugs in ready-to-use injectable form were immediately excluded as well as those with a daily consumption under 20 units. Among the remaining amount of medications, only those with a sufficient physical and chemical stability,2 that allow batch production and at least 7 days of storage, were considered. For every new molecule, a testing production with five batchs of 10 preparations each were compounded through a robotic system, in order to evaluate the dosage accuracy.ResultsThe new validated drugs included in the automated production result were: oxacillin 1 g, cefotaxime 2 g, azithromycin 500 mg, vancomycin 500 mg and ceftriaxone 1 g, all in 100 ml NaCl bags. The average dosage accuracy ranges from 93.43% of azithromycin to 99.64% of cefotaxime, always compliant with the 10% error limit set by the Official Pharmacopoeia. The annual workload, including piperacillin-tazobactam 4.5 g and cefazoline 1 g already compounded inside the automated system, is estimated as 80 000 bags.ConclusionWithin 2017, the robotic system will cover the dispensing of antibiotic treatments of 50% of hospital departments, reaching 100% by the end of 2018.References and/or Acknowledgements1. Bufarini C, et al. Centralised non-hazardous intravenous compounding: from theory to clinical practice. Eur J Hosp Pharm2017;24(1):A1–A288 PP-041.2. ‘Stabilis 4.0’. www.stabilis.orgNo conflict of interest