In the last few years, pharmaceutical technology has evolved. In the field of oncology pharmacy, robots for the preparation of anti-cancer drugs have appeared to progressively replace manual preparation. The objective of this study is to evaluate the contribution of the robot in reducing the risk of manual preparation.
Methods
The study was conducted at the pharmacy of the National Institute of Oncology in Rabat (May–August 2021). The method used to compare the two types of preparation is the method of analysis of failure modes, their effects and their criticality (FMECA). It will calculate the criticality index (CI = severity × frequency × detectability). The risks have been categorized into human, technical, and environmental risks.
Results
The anticancer drugs reconstitution step was the most critical in manual preparation (CI = 126.7) and robotic preparation (CI = 40.7). The robot has made it possible to reduce several CIs of manual preparation including: musculoskeletal disorders of pharmacy operators −93 (89%), error in cancer drug and diluent selection −72 (60%), as well as lack of traceability −145 (97%).
Conclusion
The preparation robot has made it possible to reduce many of the risks of manual preparation, and constitutes an important advance in the field of oncology pharmacy.
PedersenCASchneiderPJScheckelhoffDJ. ASHP National survey of pharmacy practice in hospital settings: dispensing and administration-2011. Am J Health-Syst Pharm2012; 69: 768–785.
2.
YanivAWKnoerSJ. Implementation of an iv-compounding robot in a hospital-based cancer center pharmacy. Am J Health-Syst Pharm2013; 70: 2030–2037.
3.
RisørBWLisbyMSørensenJ. An automated medication system reduces errors in the medication administration process: results from a Danish hospital study. Eur J Hosp Pharm2016; 23: 189–196.
4.
ChapuisCRoustitMBalG, et al.Automated drug dispensing system reduces medication errors in an intensive care setting. Crit Care Med2010; 38: 2275–2281.
5.
GilbertREKozakMCDobishRB, et al.Intravenous chemotherapy compounding errors in a follow-up Pan-Canadian observational study. J Oncol Pract2018; 14: e295–e303.
6.
PoppeLBSavageSWEckelSF. Assessment of final product dosing accuracy when using volumetric technique in the preparation of chemotherapy. J Oncol Pharm Pract2016; 22: 3–9.
7.
VolpeGCohenSCappsRC, et al.Robotics in acute care hospitals. Am J Health-Syst Pharm2012; 69: 1601–1603.
8.
SegerACChurchillWWKeohaneCA, et al.Impact of robotic antineoplastic preparation on safety, workflow, and costs. J Oncol Pract2012; 8: 344–349.
9.
YanivAWKnoerSJ. Implementation of an i.v.-compounding robot in a hospital based cancer center pharmacy. Am J Health-Syst Pharm2013; 70: 2030–2037.
10.
ChenWHShenLJGuanRJ, et al.Assessment of an automatic robotic arm for dispensing of chemotherapy in a 2500-bed medical center. J Formos Med Assoc2013; 112: 193–200.
11.
TerkolaRCzejkaMBérubéJ. Evaluation of real–time data obtained from gravimetric preparation of antineoplastic agents shows medication errors with possible critical therapeutic impact: results of a large–scale, multicentre, multinational, retrospective study. J Clin Pharm Ther2017; 42: 446–453.
12.
ReeceKMLozanoMARouxR,et al.Implementation and evaluation of a gravimetric i.v. workflow software system in an oncology ambulatory care pharmacy. Am J Health-Syst Pharm2016; 73: 165–173.
13.
CarrezLBouchoudLFleury-SouverainS, et al.Reliability of chemotherapy preparation processes: evaluating independent double-checking and computer-assisted gravimetric control. J Oncol Pharm Pract2017; 23: 83–92.
14.
MonizTTChuSTomC, et al.Sterile product compounding using an i.v. compounding workflow management system at a pediatric hospital. Am J Health-Syst Pharm2014; 71: 1311–1317.
SimseklerMCEKayaGKWardJR,et al.Evaluating inputs of failure modes and effects analysis in identifying patient safety risks. Int J Health Care Qual Assur2019; 32: 191–207.
18.
Cherif ChefchaouniAOuedraogoJMBecharH,et al.Retrospective analysis of failures of ambulatory elastomeric pumps containing 5-FU in a hospital pharmacy unit. J Oncol Pharm Pract2021. DOI: 10.1177/10781552211060290.
19.
SerafiniATroianoGFranceschiniE,et al.Use of a systematic risk analysis method (FMECA) to improve quality in a clinical laboratory procedure. Ann Ig2016; 28: 288–295.
20.
OuedraogoJMBenabbesMEl BarakaS,et al.Dose readjustment of sterile preparations to optimize the reuse of non-administered anticancer agents. Le Pharmacien Hospitalier et Clinicien2021; 56: 282–290.
21.
IwamotoTMorikawaTHiokiM, et al.Performance evaluation of the compounding robot, APOTECAchemo, for injectable anticancer drugs in a Japanese hospital. J Pharm Health Care Sci2017; 3: 12.
22.
NurgatZFarisDMominahM, et al.A three-year study of a first-generation chemotherapy-compounding robot. Am J Health-Syst Pharm2015; 15: 1036–1045.
23.
JobardMBrandely-PiatMLChastF,et al.Qualification of a chemotherapy-compounding robot. J Oncol Pharm Pract2020; 26: 312–324.
24.
SessinkPJLeclercqGMWoutersDM,et al.Environmental contamination, product contamination and workers exposure using a robotic system for antineoplastic drug preparation. J Oncol Pharm Pract2015; 21: 118–127.
25.
GeersingTHKlousMGFranssenEJF, et al.Robotic compounding versus manual compounding of chemotherapy: comparing dosing accuracy and precision. Eur J Pharm Sci2020; 155: 105536.
26.
MasiniCNanniOAntaridiS, et al.Automated preparation of chemotherapy: quality improvement and economic sustainability. Am J Health-Syst Pharm2014; 71: 579–585.
27.
Government of South Australia SH. Safe handing. cytotoxic drugs and related waste: a risk management guide for South Australian Health Services 2015, www.sahealth.sa.gov.au/hazardousdrugs (accessed 11 January 2022).
28.
Verdun-EsquerCAtgeBVideauNa. Exposition du personnel des établissements de soin aux médicaments anticancéreux: de l’évaluation à la prévention. Archives des Maladies Professionnelles et de l’Environnement2017; 78: 523–534.
