Jerry Fahrni

Tag: IV ROOM

  • “Improving Safety and Efficiency in the IV Room” : thoughts on the ASHP webinar

    I previously wrote about a live webinar put on by ASHP – Improving Safety and Efficiency in the IV Room: Key Features of Automated Workflow Systems – on Wednesday, May 20 2015. The webinar was made up of three separate, 20 minute presentations:

    • Medication Error Reduction Strategy Using Dispense Preparation and Dispense Check by Tom Lausten, RPh, Director of Pharmacy at Children’s Hospital of Wisconsin.
    • IV Workflow Systems: Barcode Plus Volumetric Verification by Steve Speth, RPh, Pharmacy Operations Manager at IU Bloomington.
    • Automated i.v. Workflow Systems and Technologies by Caryn Bellisle, RPh, Director of Pharmacy Regulatory Compliance at Brigham and Women’s Hospital.

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  • Upcoming ASHP Webinar: Improving Safety and Efficiency in the IV Room

    This caught my attention. ASHP is holding a live webinar – Improving Safety and Efficiency in the IV Room: Key Features of Automated Workflow Systems – on Wednesday, May 20 2015 at 2:00 PM ET.

    According to the webinar site “Technology for IV rooms can be used to streamline work processes and support staff.  However, despite the advancements in technology there are still significant challenges in the compounding of sterile products. This webinar will take a look at IV room technologies and how it has improved IV room operations and overall safety for patients.  The speakers will also review the cost benefits, the key safety components including barcode scanning, imaging and gravimetric technology, and the best practices related to implementation and maintenance of these automated processes.”

    Objectives listed include:

    • Describe the most common IV Compounding Safety technologies available in workflow programs today
    • Describe and contrast the types of errors that the workflow technologies may affect
    • List key benefits of workflow systems beyond the reduction of errors
    • List and describe key considerations when choosing an IV workflow system

    I look forward to attending as this is an area of great interest for me. I will be looking for depth of information presented in an unbiased manner. Not sure how deep they can go in an hour, but should be worthwhile nonetheless.

    You can register for the webinar here, or by following the link above.

  • ASHP updates chemotherapy guidelines [UPDATED]

    ASHP Guidelines for Chemotherapy

    It seems as though everyone has chemotherapy on the brain. The National Institute for Occupational Safety and Health (NIOSH) is in the process of updating their Alert on Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. NIOSH already released a new list of hazardous drugs late last year. The U.S. Pharmacopeial Convention (USP) is busy finalizing General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings. And now, ASHP has published updated chemotherapy guidelines.(1)
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  • More thoughts on USP <797> and pharmacy IV rooms [comment from reader]

    A friend and colleague, Ray Vrabel, left a comment on my post from April 20th. I thought what Ray had to say was too good not to post. He raises some good points, which are worth more discussion.

    Ray is a sharp guy, and he and I have had some good conversations over the past couple of years. He’s passionate about patient safety and pharmacy practice. While I don’t always agree with everything that Ray has to say, I definitely appreciate his thoughts and opinions.

    Make sure to read more of Ray’s thoughts here.

    Jerry,

    Your post has got me wondering about a number of things: Area 51, The Kennedy Assassination, Obama’s birth certificate, and now USP797.

    You raise the question which I have always wondered about: What was the problem that USP797 was attempting to solve? Was there documentation of significant problems associated with pharmacy-prepared IV admixtures by pharmacies who were following the ASHP Guidelines in place before USP797? Did anyone conduct a multi-hospital study to determine if hospitals following pre-USP797 ASHP Guidelines had any clinical problems associated with pharmacy IV admixtures? In other words, what is the science that drove the USP797 standards?

    We have effectively turned our pharmacy IV Rooms into GMP-like sterile manufacturing facilities. So now, if properly followed, we have hospital pharmacies preparing a very high quality product from a sterility standpoint. That’s a good thing, but we also have a number of unintended consequences:

    (1) Most IV admixtures are now prepared by pharmacy technicians, but they are no longer being directly supervised by pharmacists because of the onerous garbing requirements, making it inconvenient for the pharmacist to move into and out of the IV room.

    (2) While there is now a requirement that every pharmacy must follow UPS797 standards, we do not have a technician licensure/certification requirement for all technicians in all states.

    (3) While USP797 has required the use of all types of environmental, operational, and testing products, there is no requirement for pharmacies to use barcode checking of the IV admixture ingredients (i.e., Label, bag, and additives). Why do we have excellent sterility requirements with no requirement for accuracy of IV additive preparation?

    What’s wrong with this picture? We now have sterile IV admixtures, but we don’t have any standards to make sure that the IV admixture is made correctly (i.e., correct ingredients). I feel that barcode scanning during medication preparation (BCMP) should be the minimum standard for ALL IV admixtures in ALL pharmacies. For more on this, please see my LinkedIn post: https://www.linkedin.com/pulse/why-hospital-gift-shops-more-important-than-pharmacy-iv-vrabel.

  • What practice area benefits most from increased sterile compounding regulation?

    I recently sat through a webinar that was recorded during a live symposium at ASHP Midyear in Anaheim on December 8, 2014. The symposium was entitled “Understanding the New Federal Framework for Oversight of Sterile Compounding” (1) and consisted of three separate presentations, one of which was given by Eric Kastango. (2)
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  • Cool Pharmacy Technology – Kiro Oncology System

    I’ve recently had conversations with several companies outside the U.S. developing robotic technology for the i.v. room. One of those systems is the Kiro Oncology System. Check the video below.

    A couple of things worth noting:

    • The system uses dual robotic arms during the compounding process. This is something that is important for the next generation of i.v. room robots. The current crop of i.v. room robots here in the U.S. use a single arm. Think about the inefficiency of one-armed sterile compounding.
    • The Kiro Oncology System is self-cleaning. This is a concept that appears to be more popular “in Europe” than it is here in the U.S. Kiro Oncology isn’t the first overseas group I’ve dealt with that is pushing the idea of self-cleaning. None of the U.S. vendors have ever mentioned it.

  • Cleanroom technology for pharmacy – DRUGCAM

    DRUGCAM is an interesting piece of pharmacy cleanroom technology. On one hand it falls into the semi-automated systems category because the person using it has to manually manipulate all the components of the sterile compound they’re making. In other words, it’s not a robot. On the other hand DRUGCAM uses some interesting technology and software to automate some of the steps in the process.

    DRUGCAM uses multiple cameras(1) to automatically detect the items being used during the compounding process. As the user passes components in front of the cameras, the system automatically identifies them. No bar code scanning required. That’s probably a good thing outside the U.S. as I’ve learned that not all countries require manufacturers to place a bar code on their drug containers. If the system doesn’t recognize the item, the user is notified via visual cues on the screen.

    DRUGCAM uses the same technology to automatically detect the volume of fluid pulled into syringes, and also detect when the same syringe is empty following addition of the contents to the final container. I’m not sure how the system determines the correct syringe position, but it’s pretty interesting.

    One other thing that makes DRUGCAM unique is that it takes video of the entire compounding process. I’ve mentioned this idea to several vendors over the past few years, but no one really seemed interested in the idea of using video.(2) I think it offers potential advantages over still photos. For one, if something looks weird you can always move forward or back in the compounding process to see what went wrong.

    Check the video below. It shows DRUGCAM being used in a glovebox.

    DRUGCAM is not currently available in the U.S. If you’d like more information just follow the link to the DRUGCAM website.

    —————-

    (1) When I saw DRUGCAM at the ASHP Summer Meeting back in June 2013 the engineer told me that the system utilized two cameras, but I can’t find that information on the product website.
    (2) Everyone I’ve talk with was concerned about the storage requirements for the video. My brother works for a company that designs security cameras, software, etc. Those companies have been dealing with high-definition video storage for years.

  • Saturday morning coffee [March 14 2015]

    “There is nothing in which people more betray their character than in what they laugh at.” – Goethe

    So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The mug below comes straight from Voodoo Doughnuts in Portland, OR. My wife and youngest daughter were up North last week visiting colleges. They surprised me upon their return with a box of Voodoo Doughnuts and this mug. The doughnuts were delicious.

    MUG_VoodooDoughnuts
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  • A missed opportunity for safety – why scanning a limited formulary in the i.v. room is a mistake

    “Although some hospitals have chosen to limit use of these systems [IV workflow technology] for focused areas like admixture of chemotherapy or high-alert drugs, there’s no telling when someone might accidentally introduce a high-alert drug when preparing other drug classes that wouldn’t ordinarily be scanned. Therefore, to be maximally effective, the system must be utilized for all compounded admixtures”. (ISMP)

    A couple of weeks ago I wrote about the need to use bar-code scanning technology during compounded sterile product (CSPs) preparation. In my mind it’s a no-brainer. The i.v. room is a dangerous place, and no amount of “double checking” is going to change that.
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  • Making the case for bar code medication preparation (BCMP) in sterile compounding

    The tragic death of a hospitalized patient in Oregon [1] has once again put a spotlight on pharmacy i.v. rooms. Unfortunately this isn’t the first i.v. error to harm, or kill a patient and I’m sad to say that it probably won’t be the last. We know that IVs present higher risks than most other medications and the literature presents abundant evidence of the prevalence of pharmacy compounding errors which result in patient harm or death.2-11

    According to a 1997 article by Flynn, Pearson, and Baker: A five-hospital observational study on the accuracy of preparing small and large volume injectables, chemotherapy solutions, and parenteral nutrition showed a mean error rate of 9%, meaning almost 1 in 10 products was prepared incorrectly prior to dispensing.6

    The inherent problem with compounded sterile products (CSPs) is that the efficacy of IV medication administration hinges on the integrity of dose preparation and labeling in the pharmacy. If an item is compounded incorrectly in the pharmacy, no amount of verification at the bedside will alter that. Other than looking at an IV bag or syringe to ensure that no gross particulate matter is present, without chemical analysis it is impossible to verify the contents. Occasionally a color change will acknowledge the addition of the correct additive – yellow multivitamins, red doxorubicin, and so on – but even then, the correct amount (volume/dosage) cannot be verified.
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