Medication compounding is a complicated and high-stakes operation that many hospitals have outsourced to compounding centers in an effort to save money and cut down on liability. However, recent high-profile events where sterility and safety issues have resulted in patient deaths, have hospitals rethinking their sterile compounding strategy—many looking to bring the process in-house to ensure better sterility and control.
But how does a health system tackle the problem of bringing the process back inside the facility? Manual sterile compounding practice raises a different set of concerns. For example, a common practice in many IV rooms, the syringe “pull back” method, has been routinely criticized by the Institute for Safe Medication Practices as a “weak” system of measurement that should not be used.
Advances in technology have provided the means to automate the sterile compounding process, allowing health systems to produce their own compounds with relative ease, and conduct operations with comprehensive oversight and visibility that provide leadership with peace of mind.
Insourced robotic sterile compounding creates a feasible solution for facilities that want to protect their patients and employees while working toward greater cost savings. This year, the University of Rochester Medical Center (URMC) shared results of their experience with implementing robotic compounding, utilizing Omnicell’s i.v.STATION.
For any new equipment installation, it is common for stakeholders to feel trepidation around the implementation and onboarding process. In the case of non-hazardous compounding, URMC found that onboarding “requires significantly less time, as the device itself provides stepwise instruction to the user on the embedded digital screen, which increases process consistency and facilitates training.”
From a patient safety perspective, URMC saw substantial benefits in dose accuracy through gravimetric verification performed by the robot—an extraordinarily accurate method of weighing components to ensure measurements are exact. In addition to this, bar coding is used to verify individual ingredients, creating a system of checks and balances that help prevent medication errors similar to those that happened at the New England Compounding Center in 2012.
Beyond the safety benefits, URMC valued the flexibility of their IV automation, which provided newfound ability to produce standardized doses that are not commercially available. Additionally, as the registry of available industry benchmarking data for medications expands over time, more information will be accessible to technicians who are weighing and comparing compounds. This is where the cost savings begins—hospitals can dictate the quantities needed at their facility, as opposed to purchasing in bulk from a supplier—eliminating risk of waste and the likelihood that materials may expire before use. This level of insight into inventory control can also help with shortage management and product allocation.
Recent regulatory changes have created even tougher hurdles for providers, largely in response to national headlines that call for safer methods of medication compounding. It is anticipated that insourced automated IV compounding will become the standard for patient safety, as it makes significant gains in removing the risk of human error from the medication preparation process. A 2013 report from the Department of Health and Human Services Inspector General found that of the 92% of acute care facilities using compounded medications, about 75% of these outsource some part of their compounding. However, this number is anticipated to dwindle quickly as insourced options become almost critical for complying with new regulation.
With so many benefits, it’s hard to understand why providers would not opt for insourced automated compounding—but as with any disruptive technology, adoption will take time. In the interim, you can learn more about the benefits of insourcing on the Omnicell website.