IV robotics produces reliable source of ready-to-administer (RTA) syringes at Moses Cone

Moses H. Cone is a 625-bed, acute-care hospital, the flagship institution of the five-hospital Cone Health located in Greensboro, NC. Like many healthcare providers, supply chain disruptions left it feeling vulnerable. Drug shortages, cost spikes, shipping delays, recalls, and other factors have a profound effect on the ability to take care of patients.

In order to take control of and protect its supply chain, Moses Cone conducted a detailed evaluation and subsequent implementation strategy for IV robotic insourcing of compounded sterile products.

The Challenge

When pre-mix, RTA (ready-to-administer) drugs go on shortage, it results in having to resort to other sourcing or production methods. This increases complexity and risk, both in preparation and administration of IV drugs. 

Supply chain disruptions were causing issues for Moses Cone caregivers. Outsourcing for some products led to restricted catalogs, look-alikes, limited labeling options, restricted allocations, and other issues. “It was very frustrating for the staff,” said Kevin Hansen, assistant director of pharmacy. “One day our anesthesia staff would have a syringe in the tray, the next day they’d have a vial. It was very disruptive and potentially unsafe.” 

When pre-mix, RTA (ready-to-administer) drugs go on shortage, it results in having to resort to other sourcing or production methods. This increases complexity and risk, both in preparation and administration of IV drugs. 

Supply chain disruptions were causing issues for Moses Cone caregivers. Outsourcing for some products led to restricted catalogs, look-alikes, limited labeling options, restricted allocations, and other issues. “It was very frustrating for the staff,” said Kevin Hansen, assistant director of pharmacy. “One day our anesthesia staff would have a syringe in the tray, the next day they’d have a vial. It was very disruptive and potentially unsafe.” 

The Solution

Activated Omnicell Product(s) 

Central Pharmacy IV Compounding Service with i.v.STATION™ and IV Care intelligence solutions 

The solution included two IV robots with two dedicated technicians as part of Omnicell’s subscription model. Moses Cone also assigned an IV specialist technician and a quality assurance pharmacist to the operation.   

Evidence-based Approach 

Moses Cone sought to meet the ISMP (Institute for Safe Medication Practices) best practice recommendations to provide RTA syringes. Pharmacy leaders followed an evidence-based approach to take greater control of the supply chain and to standardize wherever possible on RTA drugs. 

The main drivers were: 

  • Ensure highest quality and safety of compounded sterile preparations 
  • Meeting patient need where FDA premixes don’t exist 
  • Consistent supply chain 
  • Flexible product preparation 
  • Flexible label preparation 
  • Cost savings to fund the main drivers 

The team reviewed a year’s worth of IV drug administration data, examining a variety of medication, dosing sizes, drug cost, and wasting patterns. They benchmarked against hundreds of other institutions using Omnicell’s REINVENT global registry of IV preparations. And they determined what medications were commercially available versus what they could produce internally by IV robotics. 

The analysis led the team to focus efforts on batch (non-patient specific) production of 18 non-hazardous RTA preps that would have the greatest impact to patient safety. 

Explains Hansen, “It was important to evaluate the goals of the program and ensure that each preparation included was meeting those goals. This required us to review how these drugs are used throughout the institution and determine the value each brings. With this, we identified an initial list of ‘must have’ preparations and a future expansion ‘want’ list with an estimated production of over 9,800 RTA syringes per month on average.” 

ROI Proof 

While evaluating the current medication use process throughout the operating room (OR) settings, Hansen uncovered an opportunity to benefit practice with implementation of RTA drugs. As a traditional practice, many syringes in the OR are drawn up in advance of them being needed in case of emergency. If they were not used within an hour’s time they were wasted. Hansen believed insourcing with robotics to provide RTA drugs could substantially reduce waste since the syringes would not need to be wasted if they were not used right away. 

To build the business case, pharmacy teamed with internal financial analysts. They built a cost accounting model to show a percent return at the drug level. This included a process for recording, classifying, analyzing, summarizing, and allocating costs associated with each step of the sterile compounding process. All costs were included, including drugs, materials, labor, overhead, and other expenses. 

Robotic insourcing also made it possible to begin an extended BUD (beyond-use dating) program with sterility testing of each batch. Considerations included: 

  • Decreasing waste 
  • Alternative storage condition 
  • Operational efficiency 
  • Quality/safety 

The Impact

Key Outcomes:

  • Enhanced patient safety
  • Reduced IV medication costs—50% cost savings for select IV preparations
  • Improved operational efficiency
  • Stabilized supply chain of RTA drugs

Customer Benefits:

    • Regained control over the quality and quantity of IV dose preparation 
    • Significant decreases in drug waste 
    • Improved turnaround times in many OR case procedures 
    • Prevented prep work by anesthesiologist/CRNAs 
    • Extended BUD for select IV products 

    "IV robotic insourcing allows us to protect our supply chain, to continue providing ready-to-administer products, and to avoid switching to other products requiring manipulation that could be less safe."

    Kevin N. Hansen, PharmD, MS, BCPS, BCSCP, Assistant Director of Pharmacy, Moses H. Cone Memorial Hospital 

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