Cleanrooms – the forgotten realm of acute care pharmacy

Cleanroom environments, a.k.a. IV rooms, inside acute care pharmacies compound some of the most complex and dangerous medications used inside a hospital. Unfortunately this area is often overlooked when implementing safety features such as bar-code verification, identification of high-alert medications, advanced training and competency and so on. I was reminded of the dangers of intravenous products by a recent story coming out of Alabama where the death of 9 patients was linked to TPN (total parenteral nutrition) contaminated with Serratia marcenscens.

While IV rooms remain a high risk area they tend to fall off the radar of many hospital administrators when it comes to implementing technology capable of reducing risk. USP <797> tends to get all the glory even though much of the guidelines proposed in this USP chapter have yet to be shown any more effective than diligent hand washing and impeccable technique.

Improving patient safety inside the cleanroom environment

Bar-code verification – BCMA continues to provide a simple solution to enhance patient safety at the beside. What’s often overlooked is the benefits of utilizing bar-code scanning inside the acute care pharmacy, especially in the IV room. Not only does bar-code scanning provide a secondary layer of safety, it can help pharmacies manage and track inventory as well as create audit trails for later use.

Systems that utilize bar-code technology in the IV room include DoseEdge from Baxa and i.v.SOFT from Health Robotics. I’ve talked about DoseEdge before, but only recently discovered i.v.SOFT. Both solutions offer several excellent features to assist in making the IV room a safer place.

Robotics – The pharmacy world has been quietly making robotic advances in the IV room. While robotics appears to be more popular in the non-IV areas of a pharmacy, my favorite area of pharmacy robotics has to be in the preparation of intravenous medications. It’s a hot topic of discussion and appears to be advancing faster than most other areas in pharmacy automation and technology at the moment.

Health Robotics has been quite prominent in the area of IV room automation with i.v.STATION for non-hazardous compounding and CytoCare for hazardous compounding. The company recently released the results of their i.v.STATION beta-test. The results appear promising.

RIVA by Intelligent Hospital Systems is another fully contained automated IV preparation system. Secondary to i.v.STATION, RIVA is probably the most often cited IV room robot.

IntelliFill I.V by ForHealth Technologies, Inc is another automated IV solution that’s slightly different than i.v.STATION and RIVA as it specializes in preparation of small-volume IV medications. It’s hard to tell where IntelliFill I.V. fits because I rarely hear the system mentioned when talking about IV room automation. According to Baxa “the IntelliFill i.v. from Baxa is the market leader for pharmacy automation — with more than 29 million safe doses processed to date. Recently named as one of the 12 Advances in Medical Robotics by Information Week IntelliFill i.v. has more active user sites than all of its competitors combined.”

Carousel dispensing technology (CDT) – I’ve talked briefly about CDT before, but was unaware that the technology can be used inside a cleanroom environment as well as in the general pharmacy.

CleanRoom Connect from SencorpWhite “is an advanced AS/RS system for moving and securely storing inventory as it goes into and out of a clean room environment. CleanRoom Connect provides an ideal clean room gateway in a wide range of applications from pharmaceutical compounding in hospitals to clean rooms in medical device manufacturing.” I have to admit that I think it’s a pretty slick piece of hardware.

More information on CleanRoom Connect can be found here (PDF) and here (PDF)