title: Implementation of an i.v.-compounding robot in a hospital-based cancer center pharmacy.
abstract: OBJECTIVE
  The implementation of a robotic device for compounding patient-specific chemotherapy doses is described, including a review of data on the robot's performance over a 13-month period.
  
  
  CONCLUSIONS
  The automated system prepares individualized i.v. chemotherapy doses in a variety of infusion bags and syringes; more than 50 drugs are validated for use in the machine. The robot is programmed to recognize the physical parameters of syringes and vials and uses photographic identification, barcode identification, and gravimetric measurements to ensure that the correct ingredients are compounded and the final dose is accurate. The implementation timeline, including site preparation, logistics planning, installation, calibration, staff training, development of a pharmacy information system (PIS) interface, and validation by the state board of pharmacy, was about 10 months. In its first 13 months of operation, the robot was used to prepare 7384 medication doses; 85 doses (1.2%) found to be outside the desired accuracy range (±4%) were manually modified by pharmacy staff. Ongoing system monitoring has identified mechanical and materials-related problems including vial-recognition failures (in many instances, these issues were resolved by the system operator and robotic compounding proceeded successfully), interface issues affecting robot-PIS communication, and human errors such as the loading of an incorrect vial or bag into the machine. Through staff training, information technology improvements, and workflow adjustments, the robot's throughput has been steadily improved.
  
  
  CONCLUSIONS
  An i.v.-compounding robot was successfully implemented in a cancer center pharmacy. The robot performs compounding tasks safely and accurately and has been integrated into the pharmacy's workflow.
authors.affiliation: Angela W. Yaniv, B.S.Pharm., Pharm.D., is Assistant Director of Pharmacy; and Scott J. Knoer, M.S., Pharm.D., FASHP, is Chief Pharmacy Officer, Cleveland Clinic, Cleveland, OH.
authors.forename: Angela W
authors.initials: AW
authors.lastname: Yaniv
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Knoer
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000737:chemistry; D016303:Clinical Pharmacy Information Systems; D004339:Drug Compounding / Q000379:methods*; D001330:Electronic Data Processing; D006801:Humans; D007262:Infusions, Intravenous; D008508:Medication Errors / Q000517:prevention & control; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000458:organization & administration*; D057285:Precision Medicine; D012371:Robotics; D054928:Validation Studies as Topic; D057188:Workflow
chemical_list: D000970:Antineoplastic Agents