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Kuitunen S, Airaksinen M, Holmström AR. Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence. J Patient Saf 2024; 20:e29-e39. [PMID: 38536101 DOI: 10.1097/pts.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals. METHODS This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews. RESULTS The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased. CONCLUSIONS This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.
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Affiliation(s)
- Sini Kuitunen
- From the HUS Pharmacy, Hospital Pharmacy of Helsinki University Hospital (HUS)
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Anna-Riia Holmström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Lombardo J, Coles J, Ryszka D, Roussel C, Smith W. Deviations From Best Practice: Findings From a Certified Patient Safety Organization Remote-Verification Observational Study of Intravenous Compounding of Chemotherapeutic and Ancillary Drugs. J Pharm Pract 2023; 36:1438-1447. [PMID: 36271614 PMCID: PMC10629256 DOI: 10.1177/08971900221134836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Chemotherapeutic and immunomodulatory medications can pose a serious risk to patient and healthcare provider safety because of complex processes, cytotoxicity, and prevalent medication use. Objective: To evaluate chemotherapeutic and ancillary medication compounding in hospital pharmacies using a remote verification system, focusing on pharmaceutical deviations from best practice, compounding time, medication waste, and cost. Methods: This retrospective, blinded observational study used a remote intravenous (IV) workflow verification system to examine IV chemotherapeutic compounding errors in large hospital systems. A Patient Safety Organization securely obtained >5000 compounding records and photos from the IV workflow system. Blinded pharmacists evaluated IV chemotherapy preparations using picture slide viewers to assess any deviations from best practice. Time variables, medication waste, STAT vs non-STAT orders, and cost were also evaluated. Results: The most frequently reported deviations from best practice included medications exceeding the >10% additive volume guideline (35.9%) and inaccurate dose labels (28.3%). Time flow analyses demonstrated a substantial increase in total compounding time per vial for 1 vs 2 vials. Most medications in this analysis had an average waste ranging from 0-.36 vials. STAT orders, accounting for 38.4% of all orders, wasted more medication than non-STAT orders. Gemcitabine cost analyses showed an association for number of vials and compounding time with overall cost per dose. Conclusion: Substantial inconsistencies between workflow stations were observed-highlighting the lack of standardization across chemotherapeutics, volume of medication waste during preparation, and the need to establish improved quality controls to safeguard patient and health care provider safety.
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Affiliation(s)
- Jeffrey Lombardo
- Empire State Patient Safety Assurance Network, Center for Integrated Global Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - John Coles
- Industrial and Systems Engineering, University of Buffalo, Buffalo, NY, USA
| | - Daniel Ryszka
- Oncology Pharmacy Services, PLLC, Wheatfield, NY, USA
| | - Christine Roussel
- Laboratory and Medical Research, Doylestown Health, Doylestown, PA, USA
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Mays A, Ayers P, Monczka J, Cober MP. Safety in parenteral nutrition compounding. Nutr Clin Pract 2023; 38:1253-1262. [PMID: 37584457 DOI: 10.1002/ncp.11064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Parenteral nutrition (PN) compounding is a complex process that requires knowledge and training to ensure the safety and efficacy of this form of nutrition support therapy. Unfortunately, errors and lack of adherence to safe PN compounding recommendations and sterile compounding requirements have resulted in patient injury and death. These lapses in the safe provision of PN have been the result of various factors, including a lack of understanding of PN compatibility, stability, and sterility requirements, as well as drug product shortages and order entry errors. This review will describe the current challenges with the education and training regarding PN compounding, compatibility and stability of PN admixtures, simultaneous administration of nonnutrient medications with PN admixtures, and specific challenges with special populations such as neonates, pediatrics, and those receiving home care.
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Affiliation(s)
- Andrew Mays
- Department of Pharmacy, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Pharmacy Practice, University of Mississippi, School of Pharmacy, Jackson, Mississippi, USA
| | - Phil Ayers
- Department of Pharmacy Practice, University of Mississippi, School of Pharmacy, Jackson, Mississippi, USA
- Department of Clinical Pharmacy Services, Mississippi Baptist Medical Center, Jackson, Mississippi, USA
| | - Jessica Monczka
- Option Care Health, Nutrition Support, Denver, Colorado, USA
| | - Mary Petrea Cober
- Department of Pharmacy, Akron Children's Hospital, Akron, Ohio, USA
- Department of Pharmacy Practice, Northeast Ohio Medical University, College of Pharmacy, Rootstown, Ohio, USA
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Yang C, Ni X, Zhang L, Peng L. Intravenous compounding robots in pharmacy intravenous admixture services: A systematic review. Medicine (Baltimore) 2023; 102:e33476. [PMID: 37171327 PMCID: PMC10174346 DOI: 10.1097/md.0000000000033476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND There is a lack of best evidence of intravenous compounding robots for hospital decision-makers. This study aimed to conduct a systematic review of intravenous compounding robots. METHODS A comprehensive search of relevant professional health technology assessment websites and electronic databases was conducted from inception to February 3, 2022. Current studies related to intravenous compounding robots were included in this systematic review. Two reviewers independently screened the literature, extracted data, and assessed quality. The results were reported by qualitative description because of heterogeneity in the characteristics of the data in the included studies. RESULTS Thirty-three studies were included. Effectiveness: The robots improved production efficiency compared with usual/manual preparation; however, the intravenous preparation process requires further optimization. Additionally, robots reduced the incidence of medicine residues, preparation errors, and preparation failures. The solution properties of intravenous admixture medicines were satisfactory, and the robots also contributed to error recognition. Safety: The robots reduced product pollution and environmental pollution, but vigilance is still required to ensure that pollution stays low. The robots also reduced the incidence of health damage to technicians. Economy: The robots reduced material costs in these studies; however, whether they can reduce labor costs remains unclear. Social suitability: Technicians had a high degree of satisfaction with the robots, but few relevant studies focused on this aspect. CONCLUSIONS Intravenous compounding robots have certain advantages in terms of effectiveness, safety, economy, and social adaptability.
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Affiliation(s)
- Chunsong Yang
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaofeng Ni
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lijuan Peng
- Department of Purchasing, West China Second Hospital, Sichuan University, Chengdu, China
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Alahmari AR, Alrabghi KK, Dighriri IM. An Overview of the Current State and Perspectives of Pharmacy Robot and Medication Dispensing Technology. Cureus 2022; 14:e28642. [PMID: 36196333 PMCID: PMC9525046 DOI: 10.7759/cureus.28642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/20/2022] Open
Abstract
It has been widely reported that a large number of patients die from cases of errors in the issuing of medication prescriptions. These cases occur due to a wide range of things, but the common denominator in all of the cases is humans. A hospital pharmacy has a very critical task, especially with growing patient numbers. The increasing number of prescriptions needed to be filled daily reduces the amount of time that the staff can use to focus on each individual prescription, which may increase the human error ratio. The need for robotic-assisted pharmacies is arising from here to distribute drugs to eradicate or substantially reduce human error. The pharmacy robot is one of the most significant technologies that play a prominent role in the advancement of hospital pharmacy systems. The purpose of this review paper is to cover the pharmacy robot concept and the published literature reporting on pharmacy robot technology as one of the most important applications of artificial intelligence (AI) in pharmacology. Although the outcomes of the impact of the pharmacy robot have been increasingly beneficial in overall improvement, staff morale, and functionality of pharmacies, there are still mechanical errors occurring. The errors, in turn, require human intervention. The key takeaway from this study is that robots or machines cannot replace human duties in their entirety. This in turn means that those human interventions will have an impact on the workflow and throughput.
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Teng R, Ding Y, See KC. Use of Robots in Critical Care: Systematic Review. J Med Internet Res 2022; 24:e33380. [PMID: 35576567 PMCID: PMC9152725 DOI: 10.2196/33380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/22/2022] [Accepted: 03/06/2022] [Indexed: 01/01/2023] Open
Abstract
Background The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=234162
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Affiliation(s)
- Rachel Teng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yichen Ding
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
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Geersing TH, Klous MG, Franssen EJF, van den Heuvel JJG, Crul M. Robotic compounding versus manual compounding of chemotherapy: Comparing dosing accuracy and precision. Eur J Pharm Sci 2020; 155:105536. [PMID: 32877721 DOI: 10.1016/j.ejps.2020.105536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/28/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cytostatic drugs are increasingly being prepared with a cytostatic robot, though it is not known whether the dose of the final product is more accurate after automated or manual preparation. This study is the first to compare accuracy and precision of automated preparations with manual preparations by measuring volumes and drug concentrations. METHODS The accuracy and precision of automated and manual preparations were compared by gravimetric and concentration measurements. During ten days 80 solutions were prepared; 40 robot preparations and 40 manual preparations. With both preparation methods, 20 methotrexate (MTX) and 20 cyclophosphamide (CP) bags were compounded. We simulated normal working conditions by performing the preparations on Monday till Friday. The MTX and CP concentrations were measured with validated ultra high performance liquid chromatography (UHPLC) methods on the last preparation day. RESULTS With UHPLC analysis, dose accuracy (mean dose error) of robotic or manual preparation of MTX were 1.70% and 0,96% respectively. With gravimetric analysis, these values were 0.50% and 1.96%. Precision (standard error) of the robotic preparation for MTX was significantly smaller than that of manual preparation (p < 0.001). Dose accuracy (mean dose error) of robotic or manual preparation of CP, with UHPLC analysis, were 6.10% and 5.20% respectively. With gravimetric analysis, these values were 0,67% and 0,18%. CONCLUSION We conclude that both robotic and manual compounding produce accurate cytostatic products in which the mean percentage of active substance differs by less than 10% from the prescribed amount. Both preparation methods are compliant with the Dutch Medicines Act and the European Pharmacopoeia.
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Affiliation(s)
- T H Geersing
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands.
| | - M G Klous
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands
| | - E J F Franssen
- OLVG, Department of Clinical Pharmacy, Amsterdam, the Netherlands
| | | | - M Crul
- Amsterdam University Medical Center, Department of Clinical Pharmacology and Pharmacy, Amsterdam, the Netherlands
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