In an ASHP Midyear 2022 Clinical Meeting & Exhibition Management Case Study titled “Using an IV Chemotherapy Compounding Robot Within a Comprehensive Cancer Center,” presenters from Mayo Clinic and other organizations described how one cancer care center implemented an IV chemotherapy compounding robot to enhance cancer treatment capacity, mitigate staffing shortages, and improve compounding accuracy and safety.
For background, Mayo Clinic’s Clayton Irvine, PharmD, MBA, MS, senior manager, oncology cancer care, and Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director, cancer care pharmacy, described how the increasing demand for cancer care is outpacing the capacity of oncology treatment centers, “resulting in significant treatment delays.” The staffing and workload constraints further compounded by the COVID -19 pandemic, they add, have “resulted in widespread pharmacist burnout across the country, along with severe labor shortages of chemotherapy infusion nurses and oncology pharmacy technicians.”

To address these shortfalls at Mayo Clinic, an enterprise-wide committee completed a strategic plan and identified the need to focus on pharmacy automation as key area of growth within the Department of Pharmacy. The Cancer Center was also planning to expand the existing infusion center, resulting in an addition of up to 12 new chairs. To support the additional chairs, the automation initiative of the strategic plan, and to help mitigate some of the impacts of the COVID-19 pandemic, an IV chemotherapy compounding robot was implemented.

A large interdisciplinary team was formed to evaluate each process of implementation. To determine what chemotherapy would be prepared using the IV chemotherapy compounding robot, data for all chemotherapy dispensed in the previous calendar year were pulled and evaluated using a standardized weighted scoring system. All chemotherapy that was scored as simple was then prioritized for implementation based upon the order volumes.

After determining the workflow processes needed to optimize the number of preparations the IV chemotherapy compounding robot was able to produce, the IV chemotherapy compounding robot was implemented over the course of 6 months. During the initial phase of implementation, the presenters report, the IV compounding robot had six chemotherapy medication records available and was able to produce an average of 28 preparations per day. The second phase of the implementation added an additional six chemotherapy medication records, allowing the IV compounding robot to produce an average of 44 preparations per day. The third phase of implementation added eight chemotherapy medication records, which brought the average daily preparations up to 62.

During the continual optimization phase, pharmacy technician workload and full-time equivalent (FTE) were analyzed. The impact analysis showed that one FTE pharmacy technician operating the robot was able to produce at least the same number of preparations as standard manual compounding. The drugs the robot can compound, they say, will continue to be optimized to maximize output and accommodate chair expansion.

Additionally, this study looked at the impact on accuracy and safety. The IV compounding robot uses a combination of barcode scanning, picture-taking technology, and gravimetric weights to ensure preparation integrity. The average error percent was less than 1.25% per 1,000 chemotherapy preparations, they reported, with 2.5% per 1,000 orders rejected per the pharmacist or technician’s discretion

The case study presenters concluded that an IV chemotherapy compounding robot within a large cancer center “helped enhance treatment capacity, reduce technician workday stress, and improve compounding accuracy and safety.”

The use of pharmacy automation should not be viewed to replace staff, they added, but should instead give staff additional resources to improve workflows and enhance accuracy and safety. Ultimately, they added, IV workflow management systems and IV compounding robots could be superior to traditional compounding techniques and may become the new gold moving forward.

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