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September 23, 2020

Manual IV Compounding – a Potential Recipe for Disaster?

Dennis Killian, PharmD, PhD 
Vice President of Clinical Operations, TidalHealth

Early on in my hospital pharmacy career, I had the pleasure of working with several tenured pharmacy leaders who were winding down their careers as staff pharmacists. One of these pharmacists had served as the CEO for a local hospital. When we talked about IV room compounding, I’ll never forget them telling me, “Making IVs is not like making pizzas at the local sub shop.” It’s not a big deal if you mix up sausage and pepperoni on a pizza, but one misstep in manual IV compounding could be absolutely devastating to a patient.

Simply put: manual IV compounding is dangerous—there’s just too much risk for things to go wrong. It’s one of the riskiest processes in the pharmacy department.

A recent Institute for Safe Medication Practices (ISMP) article breaks the numerous risks associated with manual sterile compounding processes into three main categories:

  • Potential for contamination, leading to possible patient infections.
  • Exposure of healthcare personnel and patients to potentially hazardous drugs.
  • Inaccuracies during preparation (e.g., wrong drug, wrong base solution, wrong diluent, wrong concentration), resulting in harmful or fatal medication errors.

The recommendation for IV workflow management system technologies that incorporate barcoding to verify ingredients and finished compounded sterile products (CSP) volumes, especially with chemotherapy and pediatric infusions, is very clear. The article goes on to specifically state, “We urge healthcare leaders to support the acquisition and implementation of IV workflow management systems as soon as possible in organizations with CSP processes that lack these technologies. The next patient’s life could depend upon the decisions healthcare leaders make (or fail to make) today.”

There are other reasons why IV compounding automation makes sense. There’s increasing disruption and uncertainty in the supply of compounded IV medications from outsourced compounding facilities. When outsourcing IV compounding, many health systems experience significant delays, long turnaround times, and unexpected closure of vendors that can leave hospitals feeling helpless. That’s why we made the decision to take greater control of our drug supply by adopting IV compounding robot to support in-house sterile compounding. This has led to:

  • Decreased reliance on 503B vendors
  • Greater savings on our drug spend
  • Improved quality and sterility in our compounding process

When it comes to the financial benefits of insourcing and automating IV compounding processes, the numbers speak for themselves: a 66% reduction in IV costs compared to outsourcing (based on ROI modeling) and 50% to 90% greater CSP production with a subscription model compared with a capital purchase.

In 2016, we implemented our first non-hazardous compounding robot to support automated production of ready-to-administer (RTA) syringes. Through a just-in-time inventory management process, we immediately experienced better control of inventory needs, improving efficiency while better forecasting product demand.   Because 503B vendors charge a premium for their products, TidalHealth Peninsula Regional also realized significant savings through insourcing. Insourcing with Omnicell’s IV robot has also given us greater control over inventory, quality, and drug spend.

The migration from manual processes to an automated IV compounding system is simple, and ISMP outlines a strategic plan for implementing sterile compounding technology. My recent case study also describes how your pharmacy can improve the safety and reliability of IV medications through sterile compounding automation.

Making the conclusion that IV robotics are necessary to support patient safety and better business outcomes becomes easy once you juxtapose it with the risks associated with manual compounding. In the pharmacy world, we are not simply making pizzas, we are compounding critical medications where one mistake can cause significant harm.


The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.

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