Implementation and evaluation of a gravimetric i.v. workflow software system in an oncology ambulatory care pharmacy

Reece, Kelley M.; Lozano, Miguel A.; Roux, Ryan; Spivey, Susan M.

doi:10.2146/ajhp150169

Cited by 35 publications

(68 citation statements)

References 6 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%

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%

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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“… 3 37 39 46 The highest-reported error rate (49.0%) was identified by Niemann and colleagues, 46 while the lowest-reported incidence (0.6%) was from a study by Reece et al . 54 …”

Section: Resultsmentioning

confidence: 99%

Systematic evidence review of rates and burden of harm of intravenous admixture drug preparation errors in healthcare settings

et al. 2017

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ObjectiveTo examine published evidence on intravenous admixture preparation errors (IAPEs) in healthcare settings.MethodsSearches were conducted in three electronic databases (January 2005 to April 2017). Publications reporting rates of IAPEs and error types were reviewed and categorised into the following groups: component errors, dose/calculation errors, aseptic technique errors and composite errors. The methodological rigour of each study was assessed using the Hawker method.ResultsOf the 34 articles that met inclusion criteria, 28 reported the site of IAPEs: central pharmacies (n=8), nursing wards (n=14), both settings (n=4) and other sites (n=3). Using the Hawker criteria, 14% of the articles were of good quality, 74% were of fair quality and 12% were of poor quality. Error types and reported rates varied substantially, including wrong drug (~0% to 4.7%), wrong diluent solution (0% to 49.0%), wrong label (0% to 99.0%), wrong dose (0% to 32.6%), wrong concentration (0.3% to 88.6%), wrong diluent volume (0.06% to 49.0%) and inadequate aseptic technique (0% to 92.7%)%). Four studies directly compared incidence by preparation site and/or method, finding error incidence to be lower for doses prepared within a central pharmacy versus the nursing ward and lower for automated preparation versus manual preparation. Although eight studies (24%) reported ≥1 errors with the potential to cause patient harm, no study directly linked IAPE occurrences to specific adverse patient outcomes.ConclusionsThe available data suggest a need to continue to optimise the intravenous preparation process, focus on improving preparation workflow, design and implement preventive strategies, train staff on optimal admixture protocols and implement standardisation. Future research should focus on the development of consistent error subtype definitions, standardised reporting methodology and reliable, reproducible methods to track and link risk factors with the burden of harm associated with these errors.

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“…Although standards and guidelines are critical elements of a safe system, they are not sufficient. Automated compounding processes from robotics to bar coding and gravimetric weighing, with built-in error prevention functions, have shown promise in error reduction 18 , 19 , 34 - 36 and may address or eliminate many of the latent errors observed in the current study. Meanwhile, unlike other industries with high-risk production processes, chemotherapy compounding has not adopted live quality control mechanisms that confirm the actual contents of the prepared compounds (with the exception of a few French sites).…”

Section: Discussionmentioning

confidence: 97%

“…12 - 16 Meanwhile, new research with more-sensitive error detection techniques than in past studies has continued to reinforce that error rates with manual IV compounding are unacceptably high. 17 - 19 …”

Section: Introductionmentioning

confidence: 99%

Intravenous Chemotherapy Compounding Errors in a Follow-Up Pan-Canadian Observational Study

Gilbert

Kozak²,

Dobish

et al. 2018

JOP

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Purpose:Intravenous (IV) compounding safety has garnered recent attention as a result of high-profile incidents, awareness efforts from the safety community, and increasingly stringent practice standards. New research with more-sensitive error detection techniques continues to reinforce that error rates with manual IV compounding are unacceptably high. In 2014, our team published an observational study that described three types of previously unrecognized and potentially catastrophic latent chemotherapy preparation errors in Canadian oncology pharmacies that would otherwise be undetectable. We expand on this research and explore whether additional potential human failures are yet to be addressed by practice standards.Methods:Field observations were conducted in four cancer center pharmacies in four Canadian provinces from January 2013 to February 2015. Human factors specialists observed and interviewed pharmacy managers, oncology pharmacists, pharmacy technicians, and pharmacy assistants as they carried out their work. Emphasis was on latent errors (potential human failures) that could lead to outcomes such as wrong drug, dose, or diluent.Results:Given the relatively short observational period, no active failures or actual errors were observed. However, 11 latent errors in chemotherapy compounding were identified. In terms of severity, all 11 errors create the potential for a patient to receive the wrong drug or dose, which in the context of cancer care, could lead to death or permanent loss of function. Three of the 11 practices were observed in our previous study, but eight were new. Applicable Canadian and international standards and guidelines do not explicitly address many of the potentially error-prone practices observed.Conclusion:We observed a significant degree of risk for error in manual mixing practice. These latent errors may exist in other regions where manual compounding of IV chemotherapy takes place. Continued efforts to advance standards, guidelines, technological innovation, and chemical quality testing are needed.

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Implementation and evaluation of a gravimetric i.v. workflow software system in an oncology ambulatory care pharmacy

Cited by 35 publications

References 6 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

Systematic evidence review of rates and burden of harm of intravenous admixture drug preparation errors in healthcare settings

Intravenous Chemotherapy Compounding Errors in a Follow-Up Pan-Canadian Observational Study

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