Robotic compounding versus manual compounding of chemotherapy: Comparing dosing accuracy and precision

Geersing, T H; Klous, M.G.; Franssen, Eric J. F.; Heuvel, J.J.G. van den; Crul, Mirjam

doi:10.1016/j.ejps.2020.105536

Cited by 10 publications

(9 citation statements)

References 11 publications

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“…The performance requirements are yet to be made precise by regulations. To our knowledge, apart from the recommendations made for chemotherapy robots, only a few articles deal with the qualification protocols of such appliances 7–10…”

Section: Discussionmentioning

confidence: 99%

“…One study compared the accuracy of manual and robotic compounding 10. However, our dispensing robot was primarily designed to minimise preparation errors by minimising the human factor during preparation, improve working conditions for our technicians and nurses, minimise the number of full time operators needed, improve quality of preparations, and reduce production time for preparing a large number of medicine cups.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with chemo robotic compounding,7–10 the checkweigher automatically drives and synchronises each peristaltic pump head until the right weight of the prescribed dose is filled. In doing so, over-filling and under-filling are avoided.…”

Section: Discussionmentioning

confidence: 99%

“…Since a continuous gravimetric flow control is provided, the test for weight variation of unit doses was not conducted. In contrast to existing chemo robotic compounding,7 9 10 dose preparation factors like diluent selection or accuracy of reconstitution of drugs in powdered form before preparation does not exist and the system does not mimic a complex human movement. For example, in intravenous compounding, the gravimetric check does not rely on operator visual examination, so the dexterity of pharmacy technicians or nurses performing the oral dose is not taken into account.…”

Section: Discussionmentioning

confidence: 99%

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Process performance of a new liquid medication dispensing robot

Lagrange

2021

Eur J Hosp Pharm

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ObjectivesLiquid 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.MethodsThe 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.Results648 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.ConclusionSince 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Process performance of a new liquid medication dispensing robot

Lagrange

2021

Eur J Hosp Pharm

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“…However, these areas of research have focused on improvements to the final product compounding time. [13][14][15][16] They do not evaluate the impact on errors from moving from paper to computerised processes, akin to the implementation of electronic prescribing. In addition, there are few studies which have looked at the views of staff relating to the adoption of new technologies, and none which use qualitative interviewing methodology to explore views in depth.…”

Section: What This Study Addsmentioning

confidence: 99%

Impact of implementing the aseptic compounding management system, Medcura, on internal error rates within an oncology pharmacy aseptic unit: a mixed methods evaluation

et al. 2022

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Background As cancer survivorship improves, pressure on oncology services to provide safe, timely treatments increases. Traditional manual compounding processes are error prone, putting patients at risk. Additionally, errors have a detrimental impact on service delivery and staff morale. Information technology is increasingly utilised to improve safety and service delivery of systemic anticancer therapy (SACT). The compounding process control system, Medcura, was developed to manage the endto-end process and reduce transcription and calculation errors. Objectives To evaluate the impact of implementing Medcura on internal errors and staff perceptions of errors. Method An aseptic process control system, Medcura, was implemented in a busy pharmacy chemotherapy production unit. Internal error and severity data were collected and analysed for 14 months before and during implementation, and 24 months after implementation. In addition, one-to-one semi-structured interviews were carried out with pharmacy staff, pre-and postimplementation. Interviews were transcribed and thematically analysed. Results Error rates decreased after implementation from 2.9% to 2.1%. The types of error detected also changed with a decrease in worksheet and labelling errors, and an increase in assembly errors. The severity of the errors, as a percentage of total errors made, also decreased after implementation. Staff were predominantly positive about Medcura; it reduced the number of errors, eased the preparation of worksheets and labels, reduced pressure and work-related stress, and improved job satisfaction. Conclusions Implementing Medcura has resulted in a reduction in both error rate and severity. Specifically, errors related to label and worksheet generation have seen the largest reduction. Staff have viewed these changes positively and report reduced levels of workrelated stress. Further development and roll-out will improve patient safety and staff morale. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY⇒ Implementing an aseptic compounding management system such as Medcura can improve patient safety and staff morale.

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