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

Moses H. Cone is a 536-bed, acute-care hospital, the flagship institution of the six-hospital Cone Health located in Greensboro, NC. Like many health care 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 and other issues. “It was very frustrating for the anesthesiology staff,” said Kevin Hansen, assistant director of pharmacy. “One day they’d have a syringe in the tray, the next day they’ve 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 product 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 start with product because we need to know the average amount of drugs per month that we needed to produce. We landed on 9,800 RTA syringes per month on average.”

ROI Proof

While evaluating the Anesthesiology Department, Hansen uncovered a large savings opportunity. As a normal practice, many syringes were drawn up in case of emergency. If they were not used within an hour’s time they were wasted. Hansen believed insourcing with robotics could help ensure the syringes were ready to administer while substantially reducing waste.

To build the business case, pharmacy teamed with internal financial analysts. They build a cost accounting model to show a percent return at the drug level. This included a process for recording, classifying, analyzing, summarizing and allocated costs associated throughout 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. Considerations included:

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

The Impact

Key Outcomes:

  • Enhanced patient safety
  • Reduced IV medication costs
  • Improved operational efficiency

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

KPIs:

  • 50% cost savings for select IV preps

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

Kevin Hansen, PharmD, MS, MCPS, Assistant Director of Pharmacy, Moses H. Cone Memorial Hospital