Setting new standards with robotic IV insourcing solution
"The smart pump project was the trigger point that changed our view of IV robotics and how we could use it. For us, it was the project where need and technology meet."
The challenge facing Gee Mathen and his Willow Team: Ensure constant availability of standardized IV products for pediatric patients to meet continuous infusion requirements for smart pump-EMR interoperability.
The team’s solution was to bring sterile compounding in house using the technology, tools, and technicians provided by Omnicell's Central Pharmacy IV Compounding Service . The insourcing center is located in the main hospital and serves all Texas Children’s acute care facilities.
Q: What interested you about the robotic IV insourcing solution?
A: The simple answer is we were not in the market for IV compounding. Our team was working on a project to increase patient safety by implementing smart pump integration and interoperability within our EMR.
Early on, we discovered some smart pump limitations—good limitations—that called for standard volumes. Standard volumes means that for some classes of medications that are continuous, we would have to draw up and provide the same standard volume for each patient.
Standard volumes was the key. With the robotic IV insourcing model, we can do batch preparations accurately and efficiently to provide just-in-time stock. In my view, it changes the landscape of EMR interoperability across the market, especially for pediatric hospitals.
Q: You considered IV robotics years before. What changed your mind?
A: The funny thing about technology is that sometimes it challenges your way of thinking about a problem to the extent that it changes your scope and the way you use the technology.
We acknowledged the robot's accuracy is going to be miles ahead of a human being. But for compounding patient-specific doses in a pediatric hospital, we didn’t think robotics systems were fast enough.
The smart pump project was the trigger point that changed our view of IV robotics and how we could use it. For us, it was the project where need and technology meet.
Q: In what ways did patient safety factor into your decision?
A: There are several ways. First, the robot's accuracy is 99.99 percent on volume and with greater stability. Second, the products are produced with minimal human touch and with the tamper-resistant capping to decrease contamination potential. Third, availability is an important safety consideration for smart pump continuous infusion. The products are made ahead of time and stored in our new Omnicell XT automated dispensing cabinets that have larger bins, larger capacities. Nurses can access pre-made syringes when needed rather than waiting for pharmacy. Fourth, pharmacy is in more of a proactive mode to focus on other critical medications. Those are huge wins for IV robotics.
Q: What surprised you the most about insourcing with IV robotics?
A: Probably I’m most surprised by the beyond-use dating (BUD) benefits. Because our babies need lesser concentrations, have smaller veins and so forth, we were spending a lot of time every day diluting the outsourced products we received. When humans do a dilution, the product has eight hours or less of use. That’s such a waste of drugs. We could take a 50-mL vial, dilute it down to 100 mL, for example, and use only 30-mL total in an eight-hour period. That means we're losing 20 mL of potential high-dollar drugs. That’s significant waste. The IV robot, based upon studies that we performed, can compound products with anywhere from 30-to-70 days BUD. In order for us to be more cost effective and increase safety to the patient, IV robotics was a no brainer for us. Just the economies of scale, the time it takes for the technician to make dilutions daily with the manual process has gone away. The robot produces these things in mass quantities. The robot creates easy-to-read labels with clear expiration dates on them. The barcodes tie into our dispensing system. All of these things are a huge added value that we discovered after we started implementation.
Q: Where do you see the future of IV safety moving?
A: I'm seeing a focus on IV safety. I can see a mandate coming in the next few years for proper IV technology interoperability. This would be a mandate similar in scope and impact to the unit-dose bar code mandate. From a supply perspective, after a shift to outsourcing to 503B compounding pharmacies, I’m now seeing a shift away from using them. Health systems are asking themselves, “If we can have robotics to do it cleanly, accurately, and consistently, why do we need to outsource?” They’re looking at what it takes to create their own just-in-time stocks, and to eliminate the uncertainty and cost that comes with outsourcing.
Q: Clearly, there is a culture of innovation within your Willow Team. Where does that originate?
A: Our Willow Team is made up of technologists within pharmacy. But we’re often asked to take on problems in radiology, in milk bank, and elsewhere. We call ourselves a think tank because our approach is to assess, diagnose, and recommend. We’ve also been told we follow a Team of Teams philosophy.
We’re fortunate to have courageous leaders who encourage us to be innovative. They give us the free reign to look at problems creatively. They trust our judgment and then it’s backed up by the institution. All of this helps to earn our loyalty. If we were innovators without the leadership support and institutional capability to invest in solutions, these projects would never happen.
- Central Pharmacy IV Compounding Service
- Omnicell XT Automated Dispensing Cabinets
- Performance Center
- Omnicell Analytics
- Pandora Analytics
- XR2 Automated Central Pharmacy System
- XT Anesthesia Workstation
- XT Controlled Substance Manager
- SinglePointe Patient Medication Management
- Anywhere RN Remote Medication Management
- Pharmacy Carousel
- Medication Packager