Webinar presented on March 26, 2014 for unSUMMIT U While a strong majority of hospitals are riding the current of bar-code medication administration (BCMA), only a few hundred have incorporated BCMP into their medication-use processes. This is about to change. The BCMP technology current is swelling, which we expect will sweep most hospitals into safer drug compounding practices within the next five years. Based on six months of research and site visits, we will share our observations and thoughts on the two main types of BCMP workflow technologies on the market—highly automated robotic to semiautomated-manual systems. We will give attention to workflow applications, product functions and features, similarities and differences, strengths and weaknesses. We will explain various approaches to scanner-assisted ingredient verification, scales-assisted volume verification, and image-assisted order verification and archiving.

1. Jerry Fahrni, Pharm.D.
Mark Neuenschwander
HELP NAVIGATING THE SEA OF BCMP
BAR-CODE MEDICATION PREPARATION

2. Risk associated with Injectable Medications
Barker KN, Flynn EA, Pepper GA, et al. Medication errors observed in 36 healthcare facilities. Arch Intern Med. 2002;162:1897-1903.
 Injectable medications have highest risk for error and most severe harm
associated with error
 High degree of complexity – multiple ingredients
 High-risk medications – chemotherapy, opioid analgesics
 High-risk routes of administration – epidural, intrathecal, ophthalmic
 High-risk populations – pediatrics, critical care
Image: Wikimedia Commons

3. Errors Associated with CSPs
1. American Journal of Health-System Pharmacy 1997 vol. 54 no. 8 904-912
2. Qual Saf Health Care 2010 19:1-6
 Wrong dose were the most common type of errors found in compounded sterile
products (CSPs) 1
 9% mean compounding error rate for CSPs (roughly 1 of every 11 preparations)1
 2% of CSP errors were clinically relavent1
 25% of CSP errors may have mild to catastrophic impact on patients2
 18.4% minor
 3.9% moderate
 2.6% major
 0.1% potentially catastrophic

4. Impact of CSP Errors
Image: Wikimedia Commons

5. Proceedings from the ISMP Sterile Preparation Compounding Safety Summit 2011
So what‘s the solution?
Recommendations from groups like ASHP and ISMP
 Use of automation and technology like bar code verification, robotics, and
workflow management software
 Tighter control over the CSP process, and limiting manual compounding
whenever possible
Standards from USP
 Sterility, stability, and quality assurance
Rules and regulations from the FDA and state BOPs

6. By the Numbers
2.5% used standalone robots [chemotherapy robots used in 0.1% of hospitals]
3.6% used remote video supervision of pharmacy technicians’ i.v. preparation activities
11.9% used bar-code verification during i.v. preparation
12.5% used syringe filling device in the hood
8% of have adopted some form of IV workflow management tool
Most commonly found in facilities greater than 200 beds
3% have installed a robotic device
Primarily in facilities greater than 400 beds
Am J Health-Syst Pharm 69.9 (2012): 768-85
Pharmacy Purchasing & Products. State of Pharmacy Automation 2013 - Vol. 10 No. 8

7. BCMP Technology Today

8. 8
Semi-Automated Manual Systems

9. Highly Automated Robotic Systems

10.  Interfaced to Pharmacy Information System
 Formulary Reference Files
 Recipe Catalogues
 Compounding and Reference Aids
BCMP Technology Today

11.  Web Based
 Remote Access
 Telepharmacy
BCMP Technology Today

12.  Workflow Software
BCMP Technology Today

13. Forcing Function Enforcing Function
Technology that will not allow one to
proceed if something is not right.
Process put in place to help prevent one
from proceeding if something is not right.
For example: An airplane that cannot start
both engines if a door is not securely
closed > the plane cannot take off until all
doors are secured.
For example: The plane can take off if a
passenger does not comply BUT flight
attendants walk down the aisle looking for
and reminding passengers who have not
complied

14.  Bar-Code Labels
 Bar-Code Imagers
 Image Archiving (flight recorders)
BCMP Technology Today

15.  Methods for Measuring Drug Amounts
 Traditional volumetric analysis
 Image-assisted volumetric analysis
 Scales-assisted gravimetric analysis
BCMP Technology Today

16.  Space and Utility Requirements
 Hospital Size
BCMP Technology Today

17.  Patient safety
 Caregiver protection
 Documentation
 Return on Investment
Potential Benefits

18. Jerry Fahrni, Pharm.D. | twitter: @Jfahrni
Mark Neuenschwander | twitter: @HospitalRx