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.
The device would function much like automated dispensing cabinets do now. Pharmacy would evaluate the order and enter it in to the pharmacy system. With all appropriate clinical checking complete, the nurse could go to the automated IV preparation robot (AIVPR), pull up the patient and select the appropriate infusion to be made. Based on the needs of the nurse and patient the AIVPR would compound the preparation on the spot. If you really wanted a pharmacist to lay eyes on the product you could utilize remote monitoring to observe preparation of the product. Something similar to DoseEdge comes to mind. As long as appropriate quality assurance programs were in place, and you had a good audit trail, I don’t see a problem.
Some currently available AIVPRs include:
IntelliFill I.V. by ForHealth Technologies, Inc
Patient Safety Benefits
- Multiple safety steps assure the correct drug is prepared for the correct patient with precision and speed often not attainable by manual processes
- Vision system captures images of the source vial for each syringe for manual review and verification
- Weight confirmation performed for each dose
- Automated dosage-preparation trail for each dose dramatically reduces time and labor required to check doses for accuracy
- Barcode-verified drug selection at multiple locations
- Automated syringe labeling with verification
- WYSIWYG label formatting is drug specific to minimize errors
- Patient-specific labeling of first and routine orders
- Barcode-scanning capability for final bedside check
- Drug-specific labeling of flush and pre-made doses
- Unobstructed syringe barrel facilitates QC checks
- Eliminates risks of decentralized syringe manufacturing (unlabeled syringes and sterility)
- Syringe delivery benefits for fluid-restricted patients
RIVA enhances the care of patients and health of your pharmacy team by improving the safety and accuracy of IV admixture compounding. By using state of the art safety features and practices, detailed electronic auditing, and integration to current hospital systems, RIVA ensures that hazardous and non- hazardous doses are accurate for paediatric, neonatal, and adult patients.
Constructed around a scalable, distributed, and fail-safe architecture, i.v.STATION offers unprecedented final container flexibility, life-critical patient safety, and robotic precision and performance.
i.v.STATION may be deployed in a variety of locations, including central and satellite pharmacies and direct patient care areas, due to its self-contained form, ISO Class 5 environment, and small â€œfoot printâ€.
i.v. STATION actually looks like an ideal start to the system I’ve imagined. It even offers a decentralized architecture that allows modules to be installed in remote locations while remaining under the control of the central pharmacy via a network interface. It really is a neat setup.
I would have liked to provide video content for i.v. STATION in action, but the company website required registration to access the videos. And I just don’t feel like getting sales calls for the next twelve months. I’m just sayin’.