title: A three-year study of a first-generation chemotherapy-compounding robot.
abstract: OBJECTIVE
  Results of a performance evaluation of an automated system for compounding antineoplastic preparations are reported.
  
  
  METHODS
  Three years after the pharmacy department of a hospital in Saudi Arabia installed an i.v.-compounding robot (CytoCare, Health Robotics), data captured by the pharmacy information system and the machine's integrated software were analyzed to assess the performance of the robot in terms of compounding accuracy, days of operation, and downtime.
  
  
  RESULTS
  The robot was used to prepare 3.82%, 10.80%, and 13.79% of selected antineoplastics compounded in 2010, 2011, and 2012, respectively. The robot failed to meet the specified dose accuracy range of ±5% in compounding 3 of 337 chemotherapy preparations (0.9%) in 2010, 349 of 1516 preparations (23%) in 2011, and 460 of 2993 preparations (15%) in 2012. The robot was operational on 40%, 39%, and 61% of available workdays in 2010, 2011, and 2012, respectively. Robot throughput relative to the pharmacy's manual compounding process was low, with substantial medication waste resulting from dose preparation failures. Implementation challenges included workflow disruptions due to robot downtime, mechanical issues (e.g., robot arm-clamping failures), difficulty obtaining gravimetric data for some drugs, and the need to recalibrate the device to accept i.v. bags, syringes, and medication vials incompatible with manufacturer specifications.
  
  
  CONCLUSIONS
  The introduction of a chemotherapy-compounding robot for preparation of patient-specific i.v. antineoplastic drugs had a limited eﬃciency impact in practice. This solution, with its numerous limitations and technical diﬃculties, is not yet mature enough for universal adoption.
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Zubeir
authors.initials: Z
authors.lastname: Nurgat
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Dima
authors.initials: D
authors.lastname: Faris
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Maher
authors.initials: M
authors.lastname: Mominah
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Arris
authors.initials: A
authors.lastname: Vibar
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Abdulrazaq
authors.initials: A
authors.lastname: Al-Jazairi
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Sheena
authors.initials: S
authors.lastname: Ewing
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ashour
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Shrouq Kamel
authors.initials: SK
authors.lastname: Qaisi
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC.
authors.forename: Sakra
authors.initials: S
authors.lastname: Balhareth
authors.affiliation: Zubeir Nurgat, B.Pharm., M.Sc., BCOP, is Manager; Dima Faris, B.Sc.Phm., is Pharmacist; Maher Mominah, B.Sc.Phm., is Specialist, Pharmacy Automation and Support Services; Arris Vibar, B.Sc.Phm., is Pharmacist; and Abdulrazaq Al-Jazairi, Pharm.D., M.B.A., BC PS, is Head, Medical/Critical Care, Pharmaceutical Care Division, King Faisal Specialist Hospital & Research Centre (KFSH&RC), Riyadh, Saudi Arabia. Sheena Ewing, B.Sc., M.Sc., RG N, OCN, is Program Director, Nursing, KFSH&RC. Mohammed Ashour, B.Sc., M.Sc., is Manager, Ambulatory Care Oncology Pharmacy; Shrouq Kamel Qaisi, Pharm.D., is Clinical Pharmacy Specialist, Ambulatory Care; and Sakra Balhareth, Pharm.D., BCPS, BCAC P, is Clinical Pharmacy Specialist, Drug Information Center, Pharmaceutical Care Division, KFSH&RC. Ahmed Al-Jedai, Pharm.D., M.B.A., BCPS, is Director, Pharmaceutical Care Division, and Associate Professor, College of Medicine, Alfaisal University, KFSH&RC. jedai@kfshrc.edu.sa.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Jedai
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001331:Automation; D004339:Drug Compounding / Q000379:methods* / Q000592:standards; D006801:Humans; D007262:Infusions, Intravenous; D010607:Pharmacy Service, Hospital / Q000379:methods*; D012371:Robotics; D012529:Saudi Arabia; D012984:Software; D057188:Workflow
chemical_list: D000970:Antineoplastic Agents