Following the widespread contamination problems at several compounding facilities, hospitals and pharmacies have begun to reevaluate the potential options for improving sterility and quality of compounded IV fluids and related products.
One potential option is the use of robots in lieu of pharmacists or technicians. One such robot is called RIVA, a fully automated IV compounding robot. The vice president of marketing at the company which sells RIVA stated that hospitals were already expressing an interest in their product prior to the contamination issues, but that interest had piqued following the incidents.
The primary draw of such automated systems is the fact that it minimizes the potential for human error, given the fact that there is very little human manipulation involved in the process. In essence, an individual inputs the stock drug vials, the bags to be filled, empty syringes, and whatever other components may be required, sets the parameters for production, presses the start button, and then takes the finished and labeled mixed bags or syringes from the output chutes. Thus, in addition to lowering the chance for human error in actually compounding the drugs, there is also a considerably lower chance of contamination, since the robots contain an aseptic environment, and the only touching happens before and after the mixing has occurred.
Additionally, the RIVA machine in particular has multiple accuracy checks in place. These include:
- weighing of drug vials before and after use
- weighing of syringes prior to and following filling
- comparison of photos of drug labels with file photos, and
- bar code scanning
Preparations failing any of these tests are automatically rejected by the machine. Additionally, pulsed ultraviolet light flashes at vials throughout various sanitation points. Throughout periodic testing for contamination following installation of a RIVA unit has failed to produce a single positive culture thus far.
The unit operates 18 to 22 hours daily, during which time it can fill approximately 400 to 500 syringes. The robot can be programmed to produce batches of individualized patient specific doses, or larger batches of the same drug and dose. According to IHS, the company who sells RIVA, preparing 350 syringes for the machine requires approximately three hours of a technician’s time.
The major advantage of hospital pharmacies implementing these machines is the potential for increased accuracy, speed, and sterility. The machine works more quickly and accurately than a human can, since it operates with precise measurements, with an internal checking system. This can lead to a cost savings in personnel, and can also make up for drug shortages when they arise.
Major downsides include the cost and the real estate space necessary to house the units. That being said, at least one hospital that purchased one of the machines stated that it had recouped the cost within three years, due to the higher productivity and the lower amount of waste that the robots created, as compared with their human counterparts. Additionally, as machines, the robots do occasionally malfunction. This generally leads to prolonged rest times, which researchers indicated were due to the products’ software being in beta mode. Additionally, the down times were generally no longer than one day, and occurred not more than once a quarter.
However, the one factor that was not addressed in the report, was the potential for human error in inputting the wrong drugs, or in inputting the wrong dosage instructions for the robot to carry out. Whenever people are involved in a process that has the potential to be done improperly, there is always the possibility that such an error will occur. Additionally, machines are not infallible. Problems may arise in compounding that mirror the potential errors a human counterpart might make. Medication compounding errors do occur, and victims are potentially entitled to receive compensation for the injuries or other harms that they suffer as a result.
Errors in compounding intravenous medications can be serious. In addition to causing potentially irreparable damage, which can lead to pain and suffering, lost wages, or permanent disability, they can also sometimes lead to death.
If you or a loved one has been injured or killed as a result of a medication or pharmacy error, such as with the improper compounding of intravenous medications, contact the experienced Maryland pharmacy error attorneys at Lebowitz & Mzhen. Our attorneys have extensive experience in advocating on behalf of individuals who have been harmed by medication errors, whether they were improperly prescribed, dispensed, or administered. Contact us today through our website, or by calling us at (800) 654-1949, in order to schedule your complimentary initial consultation.
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Florida Considers Bill Potentially Impacting Patient Safety, Pharmacy Error Injury Lawyer Blog, published May 13, 2013
Young Girl Narrowly Survives Morphine Overmedication in Hospital, Pharmacy Error Injury Lawyer Blog, published May 6, 2013