Should you purchase a robot to help compound sterile preparations in the i.v. room?

The promise of a future where robots handle pharmacy distribution has been around for quite some time. It seems to always be “just a few years away”. I’ve seen my share of robotic distribution systems implemented in pharmacy operations, and the expectation has always been better than the reality.

But what about using robotic systems in the i.v. room to help make sterile preparations? It seems like the perfect place for this type of tool. Activities in i.v. rooms are dangerous and expensive. If one could utilize a robot to increase safety and decrease cost, then it would seem like a no brainer. Unfortunately it’s not as simple as that.

Over the past 16 months I’ve observed several different robots – INTELLIFILL I.V. by Baxter, APOTECAchemo by APOTECA, i.v.STATION by Aesynt, and RIVA by IHS – in several different pharmacy environments – inpatient batch processing for multiple hospitals, inpatient patient specific production for single hospital, inpatient chemotherapy, and outpatient chemotherapy. During that time I’ve formed several opinions about the current crop of i.v. room robots; some good, some not so good.

Let’s take a quick look at the pros and cons for using robotics in the i.v. room:*

Pros

Safety – Based on numbers provided by the companies that manufacture i.v. room robots, they don’t make mistakes. You should always take information coming from the manufacturer with a grain of salt, but in this case I believe the data. When used properly, robots don’t make mistakes while compounding i.v. medications. Are they 100%? No, of course not, but when something doesn’t add up the robots don’t hesitate to discard the product and start over. The companies selling i.v. room robots understand that there really is no room for error, and build accordingly.

Long production runs – In some cases you can load a robot with enough medication to run for several hours. This is especially true for batch runs, but not necessarily for patient specific items. This is highly dependent on your situation, i.e. how you plan to get the most out of your robot. Remember, robots don’t load and unload themselves.

Don’t need to “rest” – An extension from above, robots don’t require rest. That’s not to say that robots don’t have problems, but those issues are typically frontloaded during the initial few months of operation. This based on interviews with several hospitals currently using robots in the i.v. room.

They’re sexy – Sounds weird, but I’ve heard this on more than one occasion. Not everyone has a particularly scientific reason for purchasing a robot for i.v. room production. Some simply “want a robot”.

Reduce waste – Can a robot reduce waste? I think you could make an argument either way. In theory an i.v. room robot has the potential to reduce waste. Is this truly seen in practice? Depends on who you ask. For example: “Dr. Jones’ [Kevin Jones, PharmD, MBA, the director of pharmacy at Primary Children’s Medical Center, in Salt Lake City] foremost financial justification for the robot to administrators was the potential to reduce losses related to drug waste. “There’s lots of wasted medications at a pediatric hospital because we prepare so many customized, weight-based doses that cannot be redirected to other patients,” he explained. Dr. Jones estimated that monthly waste-related losses have dropped from $120,000 to $45,000. “Theoretically, you could do that without a robot, but this way we also eliminate worries about contamination and errors.” The hospital, he added, recouped the purchase price in about three years.”¹ Note the part where he says you could reduce waste without a robot. Like I said, you could argue either way.

Cons

Expensive – There’s no getting around this one. Robots can cost you anywhere from $200,000 to north of $1 Million. It all depends on what you want. With that said, I’m certain there are completely reasonable ROIs that can be built to support the purchase of an i.v. room robot should that be your goal.

Limited formulary – The thought that an i.v. room robot will handle all your compounding needs is wrong. It’s a myth. The current crop of robots handle small formularies, typically less than 20 different medications. With that said, if you have a desire to do long production runs of one or two items, then this may not be a deterrent.

Cannot use same robot for hazardous and non-hazardous compounding – Not really earth shattering news, but I thought it needed to be said. Pharmacies don’t typically utilize the same compounding surface for hazardous and non-hazardous drugs anyway, so why would you expect to be able to do it with a robot.

Size – I.V. room robots take up room. Not all robots are built the same, and some are definitely smaller than others, but you will require a certain amount of available space in your i.v. room if you hope to install a compounding robot.

Slow – What do you mean by slow? After all, saying that something is slow is completely subjective. That is true, but I can say without hesitation that the robots I’ve observed in pharmacies took longer to prepare doses than any of the well-trained technicians that I’ve ever worked with. The “slowness” may be offset by certain intangibles like the ability to run for several hours without stopping, not making a mistake, handling drugs where time is not a high priority, i.e. hazardous compounds, and so on. Just something that you should be aware of when looking to purchase a robot. A robot will not replace the productivity of a highly functional i.v. room technician.

So, should you purchase a robotic system to help with compounding sterile preparations in the pharmacy? It depends on your needs. I know that sounds like a lame conclusion, but it’s not black and white. As I said last week “There are several variables to consider when selecting technology for the i.v. room, as well as a number of questions that must be answered during the evaluation process. First and foremost you must be able to articulate your endgame, i.e. what do you hope to accomplish?” The same holds true when looking at whether or not to add a robot to your compounded sterile preparation production. There may be perfectly reasonable uses for a robot in your situation. It’s up to you to decide whether or not it makes sense for your operation.

I still believe that robotics are the future of i.v. room compounding. Making sterile preparations in the i.v. room manually is a losing proposition no matter how you look at it.

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*based on the current crop of robots as of January 2015

1. Frandzel, S. (2015). Pharmacy Practice News – A Tale of Two IV Robots. [online] Pharmacypracticenews.com. Available at: http://goo.gl/NpwwKj [Accessed 28 Feb. 2014].