Summary

Compounding refers to the mixing of different chemotherapy medications to tailor treatment to the specific needs of a patient.1 It is a complex process and if errors occur, medications have to be discarded.2 Pharmacy staff may also face increased workplace risk through exposure to potentially harmful chemicals.3 Two major cancer centres in the US have installed robotic systems to automate the compounding process.3-6 These robots reduced staff exposure to hazardous agents and improved the accuracy and efficiency of chemotherapy compounding.5 7

Challenge

Compounding involves creating a tailored treatment for a person living with cancer by mixing precise doses of different medications.1 Hospital pharmacists and pharmacy technicians usually compound cancer treatments, including chemotherapies, in hospital and outpatient units.

The compounding process is complex and errors can occur.2 Small inaccuracies in the mixing process can lead to medications being discarded. For example, one centre in the US found that up to 28% of compounded chemotherapy doses did not fall within the recommended range of the ordered dose and were therefore not used.8

Compounding can also increase workplace risk for pharmacy staff.3 Chemotherapy is an effective and safe cancer treatment, but repeated and uncontrolled exposure to the chemicals used can be harmful. In addition, strain injuries are common among pharmacy technicians working with chemotherapies, given the repetitive nature of the physical tasks involved in compounding.9 Guidelines to protect healthcare professionals exist, but the implementation of safety measures in compounding varies considerably in practice.10 The COVID-19 pandemic has led to a shortage of personal protective equipment typically used by pharmacy staff, further exacerbating these risks.11

Solution

Two large hospital pharmacies in the US, Allegheny General Hospital Pharmacy and Johns Hopkins Weinberg Pharmacy, have adopted robotic systems to automate their compounding processes.4-6 The intravenous (IV) compounding robots mix medications within a self-contained system to protect staff from potential exposure and improve the accuracy and efficiency of chemotherapy compounding.3

The robots are programmed with a drug library that includes information on how to compound common chemotherapies.5 They also contain highly precise scales that weigh ingredients and automatically reject any end products that fall out of the correct weight range.6 Pharmacy staff have to prime the system with clinical information, such as the number of doses required and the patient’s height and weight.7 They also have to load the system with infusion bags, syringes and medication needed to produce the chemotherapy.7 The robot then prepares individualised doses, which are ready to be administered.

IV compounding robots can keep an electronic record of all chemotherapies that have been prepared.4 Implementing these automated systems in oncology pharmacies requires considerable planning and knowledgeable pharmacy staff to calibrate the robots.5 Some pharmacies have hired automation specialists to ease the transition to automated processes and train staff appropriately.

What has been achieved

At Johns Hopkins Weinberg Oncology Pharmacy, the installation of two IV compounding robots has: