title: Impact of robotic antineoplastic preparation on safety, workflow, and costs.
abstract: OBJECTIVE
  Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices.
  
  
  METHODS
  We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period). The primary outcomes were serious medication errors and staff safety events with the potential for harm of patients and staff, respectively. Secondary outcomes included medication accuracy determined by gravimetric techniques, medication preparation time, and the costs of both ancillary materials used during drug preparation and personnel time.
  
  
  RESULTS
  Among 1,421 and 972 observed medication preparations, we found nine (0.7%) and seven (0.7%) serious medication errors (P = .8) and 73 (5.1%) and 28 (2.9%) staff safety events (P = .007) in the baseline and intervention periods, respectively. Drugs failed accuracy measurements in 12.5% (23 of 184) and 0.9% (one of 110) of preparations in the baseline and intervention periods, respectively (P < .001). Mean drug preparation time increased by 47% when using the robot (P = .009). Labor costs were similar in both study periods, although the ancillary material costs decreased by 56% in the intervention period (P < .001).
  
  
  CONCLUSIONS
  Although robotically prepared antineoplastic and adjuvant medications did not reduce serious medication errors, both staff safety and accuracy of medication preparation were improved significantly. Future studies are necessary to address the overall cost effectiveness of these robotic implementations.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Seger
authors.forename: William W
authors.initials: WW
authors.lastname: Churchill
authors.forename: Carol A
authors.initials: CA
authors.lastname: Keohane
authors.forename: Caryn D
authors.initials: CD
authors.lastname: Belisle
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Wong
authors.forename: Katelyn W
authors.initials: KW
authors.lastname: Sylvester
authors.forename: Megan A
authors.initials: MA
authors.lastname: Chesnick
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Burdick
authors.forename: Matt F
authors.initials: MF
authors.lastname: Wien
authors.forename: Michael C
authors.initials: MC
authors.lastname: Cotugno
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Rothschild
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration; D000970:Antineoplastic Agents / Q000191:economics / Q000592:standards*; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D004339:Drug Compounding / Q000191:economics / Q000379:methods; D006801:Humans; D008404:Massachusetts; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D012371:Robotics / Q000191:economics / Q000379:methods*; D017751:Safety Management / Q000379:methods; D057188:Workflow
chemical_list: D000970:Antineoplastic Agents