(Management Case Study) Using an IV Chemotherapy Compounding Robot Within a Comprehensive Cancer Center

Purpose: The increasing demand for cancer care is outpacing the capacity of oncology treatment centers, resulting in significant treatment delays. The staffing and workload constraints further compounded by the COVID -19 pandemic have resulted in widespread pharmacist burnout across the country, along with severe labor shortages of chemotherapy infusion nurses and oncology pharmacy technicians. This case describes the methods in which one cancer center implemented an IV chemotherapy compounding robot to enhance cancer treatment capacity, mitigate the negative impacts of staffing shortages, and improve compounding accuracy to optimize safety.

Methods: An enterprise-wide committee completed a strategic plan and identified the need to focus on pharmacy automation as key area of growth within the Department of Pharmacy. The Cancer Center was also planning to expand the existing infusion center resulting in an addition of up to 12 new chairs. To support the additional chairs, the automation initiative of the strategic plan, and to help mitigate some of the impacts of the COVID-19 pandemic, an IV chemotherapy compounding robot was implemented within a large cancer infusion treatment center.

A large interdisciplinary team was formed to evaluate each process of implementation. To determine what chemotherapy would be prepared using the IV chemotherapy compounding robot, data for all chemotherapy dispensed in the previous calendar year was pulled and evaluated using a standardized weighted scoring system. All chemotherapy that was scored as simple was then prioritized for implementation based upon the order volumes.

Workflow processes were created to optimize the number of preparations the IV chemotherapy compounding robot was able to produce, which included designing a standardized orders workflow and data integration process, a pharmacy technician-driven operation, and pharmacist-supported advanced order preparation workflow. Detailed policies and operating procedures were drafted, thoroughly reviewed, and received regulatory approval. The results of these processes were shared with internal and external stakeholders.

Results: The IV chemotherapy compounding robot was implemented over the course of six months. During the initial phase of implementation, the IV compounding robot had six chemotherapy medication records available and was able to produce on average 28 preparations per day. The second phase of the implementation added an additional six chemotherapy medication records, allowing the IV compounding robot to produce an average of 44 preparations per day. The third phase of implementation added eight chemotherapy medication records and brought the average daily preparations up to 62.

During the continual optimization phase, pharmacy technician workload and FTE were analyzed.  The impact analysis showed that one full-time equivalent pharmacy technician operating the robot was able to produce at least the same number of preparations as standard manual compounding. The drugs the robot can compound will continue to be optimized to maximize output and accommodate chair expansion.

Additionally, this study looked at the impact on accuracy and safety. The IV compounding robot uses a combination of barcode scanning, picture-taking technology, and gravimetric weights to ensure preparation integrity. The average error percent was less than 1.25% per 1,000 chemotherapy preparations, with 2.5% per 1,000 orders rejected per the pharmacist or technician’s discretion

Conclusion: The implementation of an IV chemotherapy compounding robot within a large cancer center helped enhance treatment capacity, reduce technician workday stress, and improve compounding accuracy and safety. The use of pharmacy automation should not be viewed to replace staff, but instead to give staff additional resources to improve workflows and enhance accuracy and safety. This report provides useful context for the important ongoing discussion around the capabilities of IV workflow management systems and IV compounding robots that could ultimately be superior to traditional compounding techniques and therefore may become the new gold standard for many practice sites moving forward.