Pondering the need for an IV workflow management system (IVWMS)? You’re not alone if you are. According the most recent PP&P State of Pharmacy Automation Survey, 15% of facilities have already implemented something and another 29% plan to do so in the next few years. The only surprise is the relatively low percentage of facilities planning on implementation in the near future.
There are plenty of IVWM systems to choose from, even though the PP&P SOPA Survey doesn’t reflect that. (1) Every system is designed with the same goal in mind, but don’t let that fool you. Each vendor puts their own spin on the process with varying degrees of functionality, cost, ease of implementation, customer support, and so on.
With such a range of products you really can’t go wrong, right? Not true. Depending on the needs of a facility, one could definitely make a regrettable decision.
Here are the global pros and cons of IVWMS as I see them, in no particular order:
Pros:
- Improved safety: bar code scanning during CSP preparation, imaging for volume verification, +/- gravimetrics
- Decreased compounding errors
- Remote verification, i.e. removal of a pharmacist from the IV room. Some don’t see this as an advantage, but I certainly do.
- Improved data capture. Whether or not the information gets used is anyone’s guess, but it’s there for the taking.
- Improved documentation for regulatory compliance. Lot numbers, expiration dates, images of product components, etc. Part of the benefits of data capture.
- Workload tracking. Also part of data capture.
- Decreased cost from fewer wasted doses, i.e. items that won’t get made because the doses fall out of the work queue when discontinued. This doesn’t always happen in a manual system.
- Consistent workflow, possibly streamlined.
Cons:
- Financial and labor resources needed to purchase and implement. Depending on what projects one has in the hopper, this can have a significant impact on a facility.
- Financial and labor resources needed for continued system maintenance.
- Another disperate system added to the mix, including another database to manage and maintain.
- No true interoperability. Some systems offer rudimentary interfaces, i.e. one way data transfer, but not true interoperability between systems. This is the Holy Grail for third party vendors.
- Change, especially in workflow.
- Addition of hardware to the cleanroom. This varies from system to system, but remember that anything added to the cleanroom environment has the potential to impact airflow and must be cleaned.
Not all pros and cons apply to each system. For example, some systems are much less expensive than other, some require fewer resources to maintain, some offer much more robust functionality, some have a smaller physical footprint in the cleanroom, and so on. The goal for anyone looking at these systems is to maximize the Pros and minimize the Cons.
Feel free to leave additional Pros and/or Cons in the comment section.
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- The 2015 SOPA Survey shows the following vendors “under consideration”: DoseEdge by Baxter, BD Cato by BD, i.v.SOFT by Aesynt, Pharm-Q by Envision, IVTrac by PlusDelta, and Script Pro’s Telepharmacy. Pharm-Q by Envision no longer exists as the IP for the product was gobbled up by BD, and ScriptPro is a small player in this space. The vendors listed in the survey do no represent a good cross section of available systems. There are others.
The biggest value of IVWM Systems – Elimination of Patient Harm and Death!
The first two “Pros†that you list for having an IVWM system are “Improved safety†and “Decreased compounding errorsâ€. I agree with your assessment as it applies to our systems, but I don’t feel the use of these terms conveys the real benefit to our patients.
The real benefit of IVWM systems is the “elimination of PATIENT HARM and DEATH caused by human error (slips)â€.
The magnitude of this type of simple human error was recently demonstrated by the case in Bend, Oregon where the pharmacy staff accidentally prepared a patient-specific fosphenytoin IV admixture using the neuromuscular-blocking drug, rocuronium. The nurse involved in the administration process scanned the barcode on the patient-specific IV bag labeled “fosphenytoin†and the point-of-care system verified that it was the correct bag for the patient. Soon after the nurse left the room after starting the IV, the patient went into cardiac arrest, suffered cerebral anoxia, was later taken off life support, and died.
Every one of us has made a human “slip” type of error. If anyone hasn’t, it is only a matter a time before you will (again). The problem with our current manual systems in the IV room is that it is very easy for this type of error to go undetected, since the pharmacy technician is often functioning independently and only having their work checked by a pharmacist after the fact. Is this safe enough?
The only way to minimize the occurrence of human “slip” errors is to use simple barcode scanning technology to independently confirm that the correct IV admixture ingredients have been assembled for the preparation of a patient-specific IV admixture. Most importantly, this should be done for EVERY IV admixture prepared in the pharmacy. Otherwise, the pharmacy will never detect when a dangerous drug is accidentally used to prepare what would otherwise be a low-risk IV admixture.
Granted, there are other errors that can occur after you have assembled the correct ingredients for a given patient IV admixture (i.e., drawing up the incorrect dosage amount), but these errors fall into the error category called “mistakes”, an error in choosing an objective or specifying a method of achieving it, as opposed to “slips” which are errors in carrying out an intended method for reaching an objective (Reference: James Reason, 1990, http://bit.ly/1YdwS6u).
Mistakes, like drawing up the incorrect volume of a correct ingredient, can be minimized by proper education, training, and skills assessment. Slips, on the other hand, are a type of error that can be made by the best, most knowledgeable, well trained employee. Why, because we are all human.
The other capabilities of IVWM systems (e.g., imaging, gravimetrics, remote verification) all have additional value that they bring, but at the core of all of these products is the barcode checking of the IV admixture ingredients.
Human slip errors can occur during any aspect of the medication management process in the hospital setting, but nowhere else can they have as devastating an effect as they can in the IV room. Hospitals have implemented very sophisticated Automated Dispensing Cabinet technology to manage unit dose medications (i.e., right drug, in right pocket/bin location, in right ADC) but only a few hospitals have fully implemented IVWM systems to ensure that patient IV admixtures are prepared correctly. What’s wrong with this picture?