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Medication is healthcare’s workhorse, serving as the main treatment modality for numerous conditions. Even though the hospital pharmacy is primarily responsible for preparing medications and distributing them throughout a facility, health systems have not historically prioritized investments in this area—missing key opportunities to optimize workflows, reduce costs, prevent supply disruptions, and enhance safety across the organization.
There are risks involved in curbing pharmacy investments. Take sterile compounding, for example. Many hospitals still rely on manual processes, even though automating sterile compounding is considered a best practice. Manual preparation of IV admixtures increases the potential for error and contamination. It’s estimated that one in ten manually compounded sterile products contains an error. Although many of these missteps will never impact patients, the ones that do can cause significant patient harm or death.
In addition to the patient safety risks, there are cost implications when the pharmacy does not function as efficiently or effectively as it could. Manual processes can be time-consuming, and as patient volume increases, the ability of pharmacy staff to rapidly meet demand decreases.
To improve efficiency, a health system may opt to purchase pre-prepared drugs from an outside compounder. But this strategy has ramifications as well. FDA inspections, recalls and other actions are driving up the price of outsourced drugs. As a result, they can cost approximately three times as much compared to an organization compounding the same drug within the hospital pharmacy.
Waste is also a concern. For example, a hospital may purchase vials of critical operating room (OR) drugs instead of pre-prepared syringes. In the OR, anesthesiologists will draw one dose out of a vial and waste the rest. This can lead to thousands of dollars of wasted medication per year, which is not only bad for the hospital’s bottom line but the environment as well.
Current supply chain challenges, including plant closures, 503B pharmacy closures, and raw material shortages, further complicate medication management efforts. This can lead to stock-outs that cause pharmacies to scramble to find a source for a medication, pay a higher price for the medications they do find, or see negative impacts on patient care if they’re not able to get critical medications in a timely manner.
If a pharmacy chooses to compound medications in-house, it must consistently comply with a myriad of regulations created to ensure medication safety and reliability. Over the years, the regulatory environment has become increasingly complex, making it difficult to remain compliant using manual compounding. Once again, this may prompt organizations to work with outsourced compounders, leading to an ongoing cycle of recurring challenges.
While the potential ramifications of an inefficient pharmacy are substantial, they are not new. Healthcare organizations have been wrestling with these problems for years. Unfortunately, improvement strategies to date have fallen short and have seen low adoption.
However, recent technology innovations present new opportunities for hospital pharmacies. The shift to cloud-based platforms, advancements in robotic technology, and integrated business intelligence solutions allow the pharmacy to automate in ways that can improve efficiency while ensuring reliability and reducing risk.
For sterile IV preparation in particular, robotic technology has advanced to the point it can compound faster than humans without the contamination or accuracy risks associated with manual compounding . With certain design features, such as re-imagined robotic arms, autonomous substations that enable parallel drug processing, and enhanced dynamic loading and unloading, robotic compounding can deliver the throughput to meet the evolving needs of patient care.
These robotic solutions also standardize workflows, helping to improve dose accuracy and increase therapeutic effectiveness. In-process barcode scanning confirms the right ingredient. Gravimetric verification confirms the right dose. Built-in safety features stop production if there is an error, either waiting until the error is fixed or failing the dose, avoiding patient harm.
Technology can also help with compliance. Solutions that automatically create a digital master compounding record that includes lot number and expiration date can ensure consistent and comprehensive documentation. If there is a recall, a pharmacy can easily go back to a specific lot number and see which patients received medications from that lot, speeding the pharmacy’s response and avoiding the need to search through paper logs and hand-written notes.
Although robotic solutions can eliminate many of the risks that manual processes introduce, they work best when coupled with analytics and insights. For instance, a pharmacist can look at a hospital’s patient mix, the services it provides, and the current drug shortages and determine which drugs to make using the robot and how to prioritize making them to speed throughput and minimize downtime. This can be especially helpful during emergencies, such as the pandemic, where hospitals could re-task a robot to make critical medications, such as heparin, if they are in short supply.
Given all the conflicting priorities in healthcare, it may be tempting to continue the status quo in the pharmacy. However, healthcare leaders are finding it more difficult to ignore the escalating risks. By implementing an intelligent infrastructure of technology designed to improve efficiency, reliability, and agility, organizations can go a long way toward ushering in the pharmacy of the future and enabling safer, more efficient, more consistent care.
Dennis Wright is Senior Director, Product Marketing for Omnicell.
Listen to Pharma Commerce‘s new podcast with Dennis Wright, Re-evaluating the Role of the Pharmacist.