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Webinar presented on March 26, 2014 for unSUMMIT U While a strong majority of hospitals are riding the current of bar-code medication administration (BCMA), only a few hundred have incorporated BCMP into their medication-use processes. This is about to change. The BCMP technology current is swelling, which we expect will sweep most hospitals into safer drug compounding practices within the next five years. Based on six months of research and site visits, we will share our observations and thoughts on the two main types of BCMP workflow technologies on the market—highly automated robotic to semiautomated-manual systems. We will give attention to workflow applications, product functions and features, similarities and differences, strengths and weaknesses. We will explain various approaches to scanner-assisted ingredient verification, scales-assisted volume verification, and image-assisted order verification and archiving.
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Jerry Fahrni, Pharm.D.Mark Neuenschwander
HELP NAVIGATING THE SEA OF BCMPBAR-CODE MEDICATION PREPARATION
Risk associated with Injectable Medications
Barker KN, Flynn EA, Pepper GA, et al. Medication errors observed in 36 healthcare facilities. Arch Intern Med. 2002;162:1897-1903.
Injectable medications have highest risk for error and most severe harm associated with error
High degree of complexity – multiple ingredients High-risk medications – chemotherapy, opioid analgesics High-risk routes of administration – epidural, intrathecal, ophthalmic High-risk populations – pediatrics, critical care
Image: Wikimedia Commons
Errors Associated with CSPs
1. American Journal of Health-System Pharmacy 1997 vol. 54 no. 8 904-9122. Qual Saf Health Care 2010 19:1-6
Wrong dose were the most common type of errors found in compounded sterile products (CSPs) 1
9% mean compounding error rate for CSPs (roughly 1 of every 11 preparations)1
2% of CSP errors were clinically relavent1
25% of CSP errors may have mild to catastrophic impact on patients2
18.4% minor 3.9% moderate 2.6% major 0.1% potentially catastrophic
Impact of CSP ErrorsImage: Wikimedia Commons
Proceedings from the ISMP Sterile Preparation Compounding Safety Summit 2011
So what‘s the solution?Recommendations from groups like ASHP and ISMP
Use of automation and technology like bar code verification, robotics, and workflow management software
Tighter control over the CSP process, and limiting manual compounding whenever possible
Standards from USP Sterility, stability, and quality assurance
Rules and regulations from the FDA and state BOPs
By the Numbers
2.5% used standalone robots [chemotherapy robots used in 0.1% of hospitals]3.6% used remote video supervision of pharmacy technicians’ i.v. preparation activities11.9% used bar-code verification during i.v. preparation12.5% used syringe filling device in the hood
8% of have adopted some form of IV workflow management toolMost commonly found in facilities greater than 200 beds
3% have installed a robotic device Primarily in facilities greater than 400 beds
Am J Health-Syst Pharm 69.9 (2012): 768-85 Pharmacy Purchasing & Products. State of Pharmacy Automation 2013 - Vol. 10 No. 8
BCMP Technology Today
8
Semi-Automated Manual Systems
Highly Automated Robotic Systems
Interfaced to Pharmacy Information System
Formulary Reference Files
Recipe Catalogues
Compounding and Reference Aids
BCMP Technology Today
Web Based
Remote Access
Telepharmacy
BCMP Technology Today
Workflow Software
BCMP Technology Today
Forcing Function Enforcing Function
Technology that will not allow one to proceed if something is not right.
Process put in place to help prevent one from proceeding if something is not right.
For example: An airplane that cannot start both engines if a door is not securely closed > the plane cannot take off until all doors are secured.
For example: The plane can take off if a passenger does not comply BUT flight attendants walk down the aisle looking for and reminding passengers who have not complied
Bar-Code Labels
Bar-Code Imagers
Image Archiving (flight recorders)
BCMP Technology Today
Methods for Measuring Drug Amounts
Traditional volumetric analysis
Image-assisted volumetric analysis
Scales-assisted gravimetric analysis
BCMP Technology Today
Space and Utility Requirements
Hospital Size
BCMP Technology Today
Patient safety
Caregiver protection
Documentation
Return on Investment
Potential Benefits
Jerry Fahrni, Pharm.D. | twitter: @Jfahrni
Mark Neuenschwander | twitter: @HospitalRx
