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
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
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:
- reduced staff exposure to hazardous chemicals
- lowered the risk of repetitive strain injuries among pharmacy staff
- meant that less than 1% of doses were rejected due to inaccuracies in 2018.5
- An article about the implementation of IV compounding robots in a major cancer centre in Pennsylvania.
- A video of a sterile compounding robot.
- Dana-Farber Cancer Institute. 2018. How is chemotherapy prepared? [Updated 06/12/18]. Available here: https://blog.dana-farber.org/insight/2018/12/how-is-chemotherapy-prepared/
- nstitute for Safe Medication Practices. 2015. Technology and error-prevention strategies: Why are we still overlooking the IV room? [Updated 15/01/15]. Available here: https://www.ismp.org/resources/technology-and-error-prevention-strategies-why-are-we-still-overlooking-iv-room?id=98
- Boyd M, Bruce AWC. 2019. Critical Evaluation of Pharmacy Automation and Robotic Systems: A Call to Action. Hospital Pharmacy 54(1): 4-11
- Buckley B. 2021. Allegheny Makes a Case for IV Robotics. [Updated 16/02/21]. Available here: https://www.pharmacypracticenews.com/Pharmacy-Technology-Report/Article/02-21/Allegheny-Makes-a-Case-for-IV-Robotics/62604
- Wild D. 2019. Multifaceted approach to IV robot systems. Available here: https://www.pharmacypracticenews.com/Pharmacy-Technology-Report/Article/12-19/Multifaceted-Approach-to-IV-Robot-Systems/56467
- Leventhal R. 2016. In the IV room, robots come to the rescue. [Updated 12/08/16]. Available here: https://www.pharmacypracticenews.com/Pharmacy-Technology-Report/Article/08-16/In-the-IV-Room-Robots-Come-to-the-Rescue/36629
- Yaniv AW, Knoer SJ. 2013. Implementation of an i.v.-compounding robot in a hospital-based cancer center pharmacy. Am J Health Syst Pharm 70(22): 2030-7
- Poppe LB, Savage SW, Eckel SF. 2016. Assessment of final product dosing accuracy when using volumetric technique in the preparation of chemotherapy. Journal of Oncology Pharmacy Practice 22(1): 3-9
- MacDonald V, Keir PJ. 2018. Assessment of Musculoskeletal Disorder Risk with Hand and Syringe use in Chemotherapy Nurses and Pharmacy Assistants. IISE Transactions on Occupational Ergonomics and Human Factors 6(3-4): 128-42
- Institute for Safe Medication Practices. 2020. ISMP survey provides insights into pharmacy sterile compounding systems and practices. [Updated 22/10/21]. Available here: https://ismp.org/resources/ismp-survey-provides-insights-pharmacy-sterile-compounding-systems-and-practices
- Peeples L. 2020. Sterile compounding in the time of COVID-19: What to expect when the FDA comes to inspect. [Updated 08/06/20]. Available here: https://www.pharmacypracticenews.com/Covid-19/Article/06-20/Sterile-Compounding-In-the-Time-of-COVID-19/58408
- Bhakta SB, Colavecchia AC, Coffey W, et al. 2018. Implementation and evaluation of a sterile compounding robot in a satellite oncology pharmacy. Am J Health Syst Pharm 75(11 Supplement 2): S51-s57
At the Allegheny General Hospital Pharmacy, use of an IV compounding robot reduced the average preparation time for chemotherapies from 64 to 53 minutes between June 2016 and February 2017.12
Manufacturers of IV compounding robots are working closely with pharmacies in the US to further improve the automated systems based on the needs of pharmacy staff and people living with cancer.5