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Benefits and Challenges of Implementation 

There are many benefits that can be seen with the use of sterile compounding robotic devices.  Some of these benefits include enhanced safety, supply chain stabilization, and cost reduction.   These devices can improve both patient and employee safety.  Patient safety improvements are seen through reduction in preparation errors.  A reduced risk of accidents and occupational exposure help improve employee safety.¹¹ Another major benefit is supply chain stabilization, as many health systems use 503B outsourcing for medications which have had both quality issues and shipping delays.  The use of sterile compounding robotics can help ensure the availability of these items by preparing them in-house.¹²  Cost savings with sterile compounding robotic devices can be recognized in two main areas.  First, by preventing medication errors, there is the potential to decrease healthcare costs.  Second, there are material savings costs with using the robot.¹³   

While there are many potential benefits to using sterile compounding robotic devices there are also several challenges.  Some of these challenges include upfront cost, time investment, and workflow changes.  While there is the potential for cost savings, it can take many years to break even.¹³  In addition, there is a significant initial time investment during implementation.   Lastly, large scale workflow changes may be needed in order to ensure the robot meets the needs of the organization.¹⁴     

When considering sterile compounding robotic devices it is important to understand best practices around their implementation and use.¹⁵  ISMP has released a set of best practices that include: completion of a failure mode and effects analysis (FMEA), development of an overarching technology infrastructure, use of human factors engineering principles, completion of preventative maintenance, assessment of staff competency, and regular event review.  Prior to implementation of sterile compounding robotic devices, an FMEA with appropriate stakeholders should be performed.  This will help ensure that proper safeguards are implemented to prevent unintended consequences and improve overall reliability. Development of an overarching technology infrastructure will help ensure that new products are properly added to all technology systems and ensures that all systems are updated prior to use.  New workflows should be designed using human factors engineering principles to help reduce the potential for human error.  Regularly scheduled preventative maintenance will reduce potential downtime and ensure medication safety benefits are optimized.  Staff competency should be assessed at a minimum with initial training and then annually.  Close call compounding events should be reviewed at least quarterly to help with error analysis and process improvement.   

Strategies for Success  

Several strategies can help to ensure success when rolling out new robotics for sterile compounding. One of the most important, noted by sites leveraging these technologies, is to plan early for the change management process, understanding that workflows will be impacted by the new technology. To effectively manage change, it’s first important to ensure executive buy-in. This underpins both the financial investment required for both the initial robotics implementation,¹⁶ as well as the leadership structure which will be needed to set expectations for performance and utilization. A leadership executive who champions the project will smooth the way as buy-in spreads throughout the organization.¹⁷  

Additional recommendations include defining the staffing model for the robot. Strategies here vary among organizations, with some sites recommending dedicated staff to decrease the number of staff needed to train. This additionally frees up resources to engage in other activities.¹⁷ Conversely, some sites recommend cross-training all staff. This carries the benefit of ensuring that staff are always available to operate the robot, maximizing its output and the return on the financial investment for the technology.¹⁸  

Finally, implementation of a sterile compounding robot presents both the opportunity to standardize compounding practices and the challenges of doing so. Utilizing standard concentrations ensures easily repeatable workflows, which helps to maximize efficiency for the technology by decreasing interruptions due to the need to swap products and processes when switching from one preparation type to another.  

Once the initial adoption phase is complete, organizations may wish to seek further success by optimizing their production with the compounding robot. Both robot output and staff utilization can be increased with purposeful choice of medications which can be smoothly prepared by the machine.¹⁷ In the same vein, anticipating the robot’s needs will help to ensure that it operates smoothly and efficiently, with as little downtime as possible. This can be accomplished by performing reconstitutions in advance, ensuring that compounding items are well-stocked, and that staff coverage during breaks is provided. Finally, medication information changes must be proactively managed. Thorough integration testing of new medication items is recommended to ensure that they perform as desired.¹⁸ These strategies can help to ensure success in implementation of compounding robot technologies, supporting maximization of investment and staff adoption.  

Conclusion  

 Over the past two decades, adoption of  automated workflow technologies in healthcare institution pharmacies for sterile compounding has increased.^1,19-21  This came about after several significant patient safety events and the realization that there was a void in manual sterile compounding oversight.^22-23  Like many other technologies used in health-system pharmacy, we must keep in mind that these are tools that need to be used as intended and monitored to address potential workarounds.  Teams need to be deeply involved in the testing, maintenance, support and training of such technologies to ensure that they are accurate and being used properly.  Such teams should also ensure that these systems are kept current with downtime processes in place for when that need arises.¹⁵ This blog only scratches the surface on the current state of robotics in sterile compounding.  For additional information on this subject please consult the many resources available from ASHP, ISMP and others in this blossoming field. 

For more information on real-world experiences in utilizing sterile compounding robotics, see part two of this blog where Angela Yaniv, PharmD, BCSCP shares how Cleveland Clinic has leveraged this technology.  

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