RxADMIX – a semiautomated manual system for compounding sterile preparations

RxADMIX has been around for a while. I first mentioned it back in September of 2012 (Cool Pharmacy Technology – RxAdmix).

Mark and I initially had RxADMIX pegged for inclusion in our report, In the Clean Room, but after several failed attempts to reach the company for information we removed them from our list. That’s a real shame. I thought the company had gone under, but it it appears that RxADMIX is alive and well. I found the YouTube video below, posted on October 31 2014, a couple weeks ago. It looks like the company is doing a bit of new marketing.

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Pharmacies and RFID

RFID technology is intriguing in many ways. It offers some advantages over bar code scanning technology, but then again it tends to be more costly and labor intensive. I’ve always thought RFID technology would find significant use in pharmacy practice, but that hasn’t happened. It has found some niche areas in healthcare, but not to the extent that I thought it would.

I read two RFID articles over the weekend, and on the surface they appear to be in stark contrast. But after giving it some thought I’m not so sure that’s entirely true.
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Interesting developments in robotic IV preparation overseas

One of the unexpected benefits of writing In the Clean Room has been the interest that it has generated outside the U.S. Mark and I have had some interesting conversations with people from all over the world as a result.

One of our colleagues from Germany shared these interesting new developments from overseas. All three of the “robots” listed below are designed for compounding hazardous drugs, i.e. chemotherapy. The number of different approaches and concepts used for robotic sterile preparation is amazing.

PharmaHelp from Fresenius Kabi
Basically a hood with built-in automated compounded technology. The concept appears to be focused on batch preparation driven by workflow management software. The process is aided by RFID and gravimetric technology.* PharmHelp reminds me of a combination of the EXACTAMIX Compounder and INTELLIFILL I.V. There is a video at the site, but I couldn’t find a way to embed it here.

KIRO Oncology from KIRO (Mondragon)
Two things of interest with KIRO Oncology: 1) Dual-armed approach. The use of two robotic arms makes sense as one of the current limitations to the compounding robots I’ve seen in the U.S. is the use of a single arm. The use of a single arm creates a rate-limiting step, 2) It is “self-cleaning”. Check the video below, “self-cleaning” starts at about 1:35.

MOTOMAN from YASKAWA (Japan)
A MOTOMAN dual arm robot from YASKAWA. Again, dual-arm approach. I’d like to see more video on this guy as the video below isn’t very good. When I do a web search for MOTOMAN I find mostly industrial use robots. Not sure how far they are with using their technology in the IV room.

 

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*It’s important to note that not all countries utilize bar code scanning technology like we do in the U.S. The FDA did us a big favor when they required drug manufacturers to place bar codes on medications. Not so in other countries. Many drug products in other countries do not contain bar codes.

Bar-Coded Medication Preparation for Chemotherapy [article]

The September 2014 issue of Pharmacy Purchasing & Products contains an article on the use of bar code scanning during the preparation of compounded sterile products (CSPs).  The article touches on some of the topics that Mark and I cover in our report, In the Clean Room; errors in the IV room, bar code scanning during medication preparation, image capture, remote verification, and so on.

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Lexicomp’s new Drug ID mobile module [video]

Lexicomp has a new Drug ID module for their suite of mobile applications.

Based on the Tweet I thought the new application would identify “loose drugs” with the camera on a mobile device like Medsnap, but that’s not the case.
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In the Clean Room: A Review of Technology-Assisted Sterile Compounding Systems in the US [report]

For the better part of the past year I’ve been working on a project with Mark Neuenschwander of The Neuenschwander Company looking at technologies used in pharmacy clean rooms to prepare sterile compounds.

The research into this area took much longer than originally anticipated. We discovered along the way that this subject is much more complex than it appears on the surface. Information is difficult to find, some of the technologies are little more than marketing material on a company website, and the subject matter is in its infancy.
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Saturday morning coffee [October 4, 2014]

“Keep true, never be ashamed of doing right, decide on what you think is right and stick to it.” ~George Eliot

So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

The mug below comes straight from a little shop in the French Quarter in New Orleans. My wife and I were recently there for a few days while I attended a conference. We had a great time. The food, the people, the atmosphere, all good. We ate a lot of good food, include beignets and my first ever muffaletta.

MUG_NOLA2
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The yin and yang of mobile healthcare

My “swag bag” from the unSUMMIT contained an issue of Specialty Pharmacy Continuum, a throw-away pharmacy journal focused on specialty pharmacy practice. Like most throw-away pharmacy journals I read these days, I found the content timely and interesting.

One of the articles – Get Appy! New Tech a Bridge to Patient Care – discusses how Avella Specialty Pharmacy is using mobile technology to connect with their patients. Apparently Avella is pretty forward thinking.
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The illusion of multitasking

Yesterday I went through the drive-thru of a local fast food chain. The young lady manning the register asked for my order, so I started giving it to her. She asked me to pause for a second, and when she resumed she repeated the first part of my order back to me. She had it completely wrong. This happens to me all the time in the drive-thru, which is why I typically avoid them at all cost. Yesterday I made an exception and instantly regretted it.

People working drive-thru windows at fast food joints typically try to multitask, i.e. take an order from one person while trying to put an order together for another, and so on. In my experience this usually results in what happened to me yesterday. Frequently I have to repeat part, if not all, of my order. I find it quite irritating.

Multitasking is a myth, plain and simple. People do not have the mental capacity to concentrate on more than one thing at a time. Don’t take my word for it. There’s plenty of evidence to back up my claim.

Christopher Chabris, PhD is a professor, research psychologist, and coauthor of the best-selling book The Invisible Gorilla. His research focuses on two main areas: how people differ from one another in mental abilities and patterns of behavior, and how cognitive illusions affect our decisions. He has published papers on a diverse array of topics, including human intelligence, beauty and the brain, face recognition, the Mozart effect, group performance, and visual cognition. He was also the keynote speaker at the unSUMMIT that I attended last week. The presentation was fantastic.

According to Dr. Chabris everyone thinks they can multitask, but very few can. His research estimates that a mere 2.5% of people can “do ok as a multitasker”. Unfortunately his research has demonstrated that everyone thinks they can multitask, and those that consider themselves true multitaskers tend to do the worst in experiments that require one’s attention.

Everything that Dr. Chabris spoke about applies to pharmacy, but I found two things particularly interesting:

  • Post completion errors – this is when someone forgets to complete the last step of a process. Examples include leaving an original paper on a copy machine, or in healthcare, when someone leaves the guide wire from a PICC insertion in place. Even when people are told they forgot the final step they often can’t figure out what went wrong. Dr. Chabris refers to this as “satisfaction of search”, i.e. you see what you expect to see. This type of thing happens all the time in pharmacy practice, especially during the distribution process and the IV room.
  • “Illusion of attention” – this is when people think they can pay attention to multiple things at once. He refers to this as an “everyday illusion”, of which multitasking is a prime example. These misconceptions are hard to overcome and systematically wrong. How many times have you witnessed a pharmacist or pharmacy technician trying to do more than one thing at a time – talk on the phone while filling a script, retrieve tablets from a “Baker cell” while on the phone, etc? Happens all the time.

Overall the presentation was solid and the information valuable. I recommend taking a look at Dr. Chabris’ work. The concepts can be applied both directly and indirectly to errors that occur in the pharmacy.