As the word â€œrobotâ€ passes its 90th birthday1 – introduced by Karel Capek in his play R.U.R. (Tossumsâ€™s Universal Robots) in January 1921 â€“ it’s become obvious that robotics has not only captured the imagination of geeks everywhere, but has become a point of interest in many industries including healthcare.
Late last year ASHP began pushing the idea of a new pharmacy practice model, PPMI. TheÂ movement was a hot topic for a while, but seems to have lost a lot of steam recently â€“ â€œHence the name: movement. It moves a certain distance, then it stops, you see? A revolution gets its name by always coming back around in your faceâ€ (Tommy Lee Jones in Under Siege 1992) – Anyway, when the PPMI movement was still going strong many important people in the pharmacy world struggled with the best way to approach a new pharmacy practice model. Many believe, and rightly so,Â that the best way for pharmacists to reinvent themselves is to becomeÂ the cornerstone of a more robust patient care model. After careful consideration I believe the best hope for developing such as model will be to rely heavily on pharmacy robotics to handle much of the repetitive dispensing duties now handled by pharmacist on a day to day bases. You know, free up the pharmacists. It’s not a new concept, but one that seems to escape us.
Obviously it will take some time to develop robotics to the point where it will be effective inÂ such a system, and it certainly wonâ€™t be cheap, and pharmacists will have to fight with state boards of Â pharmacy to accept it, and pharmacy administrators will have to work closely with their hospitals to develop such a systems, and someoneâ€™s going to have to be brave enough to step up to the plate and get stated, and so on and so forth. In other words it’s going to be hard and it wonâ€™t happen overnight.
Whoâ€™s up for a little project? For now let’s just take a quick look at some of the things that lead me to believe robotics is worthÂ another look as a potential solution.
Hospitals make a lot of intravenous (IV) preparations. That makes sense when you consider that most people admitted to the hospital are there because their acute illness requires more care than can be administered at home; not always, but in most cases. This is especially true for patients in the intensive care unit, i.e. the ICU.
A fair number of the medications used in the ICU are prepared on demand for a host of reasons including stability, differences in concentration, difficulty in scheduling secondary to rate variability, etc. Any pharmacist or nurse reading this will understand what I’m talking about. Example medications that fall into this category include drips like norepinephrine, epinephrine, phenylephrine, amiodarone and nitroprusside.
Last year I mused about using devices on the nursing stations designed to package oral solids on demand at the point of care. I still like the idea for several reasons, all of which can be found in the original post. Â Based on currently available technology the same concept could be applied to preparation of IV products at the bedside. Robotic IV preparation has come a long way and these devices could be used at the point of care to make a nurses, and patient’s, life a whole lot easier. The use of robotic IV preparation at the bedside could reduce wait times for nurses and lesson the workload on pharmacy.
Continue reading It may be time to consider robotic IV preparation at the bedside
“Robotic IV Automation (RIVA) is a medical device developed by Intelligent Hospital Systems Inc. (IH Systems). Hospital pharmacies use RIVA to automatically and accurately prepare IV syringes and bags. By automating the preparation of IV syringes and bags, RIVA addresses the issues of safety for the patient and the pharmacy technician, efficiency and effectiveness in the pharmacy and the challenges of a changing regulatory environment. RIVA allows hospital pharmacies to compound sterile preparations in a United States Pharmacopeia (USP) 797 environment while producing admixtures in either syringes or bags. The automation of repetitive and complex tasks reduces the incidence of errors and contamination.” – The RIVA system is built on .Net 2.0 written in C# running on Windows XP Embedded OS. The system costs somewhere in the neighborhood of $1.2 million and uses a robotic arm to prepare IV syringes and bags behind a glass case. There are two videos on YouTube worth watching here and here. They are very similar, but offer different views of the robotic arm in action.
RIVA appears to be popular in Children’s hospitals as three of the four hospitals listed on the company’s website include Primary Children’s Medical Center of Salt Lake City, Children’s Hospital of Orange County, and The Children’s Hospital of Philadelphia. I’ll be in Philadelphia in about a week and only live a few hours from Orange County. I wonder if I could arrange a demo. Hmmm.