What the NECC fiasco means for automation in pharmacy IV rooms

According to the CDC website, the fungal meningitis outbreak linked to a tainted batch of steroid injections made by the New England Compounding Center in Framingham, Massachusetts has resulted in more than 500 case reports and 36 deaths (as of November 28, 2012).

A lot of things happen when something like this occurs. People become fearful, regulatory agencies begin to scrutinize processes and practices, organizations like ASHP begin to formulate statements and create plans to deal with questions and backlash, healthcare systems begin to reconsider how they do things, and people begin to change the way they think. It’s a natural progression. I’ve seen it happen more than once during my career; never to this extent, but I’ve seen it before. It typically leads to practice changes and an entirely new market for consultants.

The NECC case has caused quite a stir in the pharmacy community. I’ve seen a wild swing in topics of discussion among pharmacists in the acute care setting, i.e. hospitals. Two things in particular have caught my attention: 1) all of a sudden everyone is worried about compounding safety in the IV room, and 2) everyone is talking about robotics. I’ve talked to a couple of friends that are still practicing pharmacy and they are “in the process of looking at IV robots”. Both cited NECC as the reason for their new interest in robotics.

I’m on the record via this website as saying that the IV room is a dangerous, and often overlooked area in the acute care pharmacy. It’s a shame that it took the death of 36 people to make people sit up and take notice. It has always been a mystery to me why the IV room was ignored when evaluating pharmacy workflow. That will change. People are already starting to talk about what’s going to happen in the IV room as a result of the meningitis deaths. Pharmacies are scrambling for information. Look for lots of discussions around IV room processes and technologies in the coming months. I expect it will be a hot topic over coffee at ASHP Midyear next week.

I’m also on the record via this website with my thoughts on robotics in the IV room. I personally believe robotics in a great concept and ultimately the solution we need. “My favorite area of pharmacy robotics has to be the use of robots for preparation of intravenous medications in the clean room. This area is a hot topic of discussion and appears to be advancing faster than most other areas in pharmacy automation and technology at the moment.” [1] With that said, I don’t believe that robotics for compounding IV mediations have matured to a point where they’re ready for primetime. I see them in certain niches, i.e. high risk compounding, hazardous medications (chemotherapy), etc, but not for mainstream replacement of a technician. I think we’re still more than five years away from that.

The biggest obstacle to proper IV room robotics, in my opinion, is the overall concept of the robots themselves. Most are designed to mimic the human process for compounding an IV medication. Why would anyone want to mimic us? Can you imagine if the auto industry built robots that tightened bolts by manipulating a crescent wrench? How long would it take to build a car?

Unfortunately the components for compounding in the IV room, i.e. vials, bags, syringes, etc, are designed for use with the human hand. Until that changes robotics in the IV room will be hamstrung; chicken, egg problem for sure. Do we build the proper robot and hope that the manufacturers of IV components will fall in line with out vision, or do we convince manufactures to change their product lines with the promise of developing a robot to accommodation them?  It’s a difficult problem for one to solve, but one that must be addressed.

This is a problem that I would like to see tackled by an academic medical center/university through advanced research. If we can build a Mars rover I’m sure someone can figure out how to build a great compounding robot for the IV room.
1. Time to accept pharmacy robotics as our friend and ally. Posted January 31, 2011.

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