The cleanroom environment, a.k.a. the IV room, is one of my favorite areas inside an acute care pharmacy. It is often alive with activity, and can often be the busiest area of the pharmacy. It is also a unique place since the use of intravenous (IV) medications is vital to the successful outcomes of patients, but at the same time can result in some of the most egregious errors in healthcare. While the IV compounding process is under tight control as demanded by USP guidelines, the method of preparation and distribution is decidedly more conventional, i.e. IV rooms often rely heavily on humans. It’s an interesting dichotomy found nowhere else in the pharmacy. It is for these reasons that I find it interesting that pharmacy IV rooms have lagged behind other areas of pharmacy operations in automation and technology. However, that’s beginning to change.
Pharmacy IV rooms are no longer overlooked when implementing innovative technologies. As pharmacy operations continue to evolve it is becoming clear that IV rooms are starting to receive their due respect. A certain percentage of healthcare systems already utilize some form of technology in the IV room, however the numbers are small. A 2007 ASHP national survey on informatics found that, depending on number of beds, between 9% and 27% of facilities were utilizing some form of device in sterile product preparation1 (small-volume and large-volume parenterals). It is unknown what technologies these facilities were utilizing at the time of the survey.
Based on information from the 2011 Pharmacy Purchasing & Products survey on the State of Pharmacy Automation, adoption of automation and technology in the IV room remains low. Only 4% of those pharmacies surveyed were using a robotic IV device.2 Of those 4% most implementations were in large hospitals. Furthermore, the survey shows that the overall use of robotics in acute care pharmacies is declining. However, that same survey showed increased interest in IV room automation, specifically “workflow management” systems. Approximately 20% of all survey respondents indicated interest in implementing one of these systems, 10% within the next two years.
This was the focus of another recent Pharmacy Purchasing & Products article.3 The article discusses the implementation of IV workflow management tools at two sites within Indiana University Health: Riley Hospital for Children and Bloomington Hospital. According to the article “Prior to adopting IV management tools, [they] employed [a] rather unsophisticated method for processing IV orders common in many hospitals. Labels were printed for individual IV doses or batches three or four times a day and a pharmacist would hand off the labels at the cleanroom pass-through window for a technician to sort by time.” This is common practice in many acute care pharmacy operations.
Indiana University Health determined that their system was outdated and basically unsafe, which led them to search for a viable alternative. Their review resulted in the selection of an IV workflow management system because “such technology could provide the solution [they] needed to bridge the gap between [their] overall bar code scanning protocol and [their]IV dose preparation process.”
Implementation provided Indiana University Health with several advantages over their previously utilized system for IV preparation. Items specifically mentioned in the article include:
- Improved safety through the use of bar code scanning
- Reduced waste
- Expiration tracking for compounded medications
- Standardized method of training and preparation
- ncreased accountability
- Improved data and reporting for medications compounded in the IV room
Overall the technology has been well received and successful at Indiana University Health. The article concludes with “this type of scanning should become the standard of care for all facilities with compounding processes in place.” I agree.
1. Am J Health-Syst Pharm. 2008; 65:2244-64
2. State of Pharmacy Automation, Pharm Purch Prod. 2011
3. Pharm Purch Prod. Nov. 2011, Vol. 8, No. 11
Afterthought: DoseEdge is dominating the workflow management category inside the IV room at the moment. I’ve talked with a lot of pharmacy directors over the past 6 months and they’re either using DoseEdge or evaluating it as an option. I wrote about DoseEdge nearly two years ago here.
Baxa Corporation webinar on “DoseEdge®: Changing Pharmacy Practice Through Workflow Management.” Presented by Dennis Tribble, PharmD, FASHP. Original air date: March 25, 2010