Inside the pharmacy at Seattle Cancer Care Alliance (SCCA), the latest and greatest in technology is on display as two new robots compound the life-saving but hazardous drugs often used to treat cancer.
SCCA is one of just three other sites in the U.S. that uses the KIRO Oncology robots to compound drugs and the only location on the West Coast.
The robots—which resemble a mechanical arm far more than, say, the beloved Star Wars droid R2-D2—are a cost-effective way of boosting capacity to meet the growing demands of drug compounding in the South Lake Union clinic. Each year, the SCCA pharmacy compounds about 66,000 IV doses, an amount expected to increase significantly once a new six-story, 150,000-square-foot outpatient clinic building opens next year.
The typical technician can compound 60 drugs a day. The robots are working up to compounding a similar amount; the drugs they are tasked with are simpler formulations while technicians still tackle the more complicated medications.
The robots batch certain drugs, preparing multiple doses of the same medication for use throughout the week. “If we can make the drugs ahead of time so we have them ready when a patient comes rather than mixing them after they arrive, it saves time,” says Raquel Barrack, Infusion Pharmacy Operations Manager.
But the benefits of using robots go far beyond increasing efficiency. Because the robots do the heavy lifting of combining and mixing components, they save technicians from getting repetitive stress injuries that are common due to the hundreds of times they need to draw up syringes and inject medications into infusion bags. “Compounding involves a lot of swirling and shaking of drugs and a lot of fine manipulation,” says Barrack, who has overseen the implementation of the robots in the pharmacy. The robots also reduce the risk that technicians could experience needle stick injuries and unnecessary exposure to hazardous drugs while increasing pharmacy output.
The robots have additional benefits too. Automating the mixing of drugs can improve safety thanks to various safety features such as barcode scanning. And the robots are equipped with a self-cleaning function that requires technicians to simply load them with cleaning solution. Working under a lab hood that sucks away fumes, technicians typically need to decontaminate their workspace in a multiple-step process after each drug is compounded.
The path to incorporating robots into the seventh-floor pharmacy began in 2007, when Rick LaFrance, Director of Pharmacy, first looked into the idea. “At that point, we decided it didn’t have all the functionality we felt was needed to provide the necessary safety precautions,” he says. “We continued to look at robotic technology over the years. After we had a hands-on opportunity to look at a robot in use at a national meeting, we felt the technology was ready for prime time.”
With patient safety as the top priority, LaFrance wanted a robot that could meet the same features and safety checks that are performed by human technicians. These include the ability to interface with the electronic health records system as well as optical recognition, which means the robot looks for a picture of a specific vial of a specific drug to ensure accuracy. “The brains of the robot have images of all these different products and vials so it is an additional check to make sure they are mixing the correct components,” says LaFrance. “The robot recognizes every vial.”
The robot also features gravimetric technology, which allows it to weigh the product as a final check to make sure the correct amount of medication is incorporated into the final product.
The robots increase the amount of medication the pharmacy can compound, considering that one technician can run two robots, “feeding” them with the relevant chemotherapeutics and removing the final product. “We can double our production by use of this technology,” says LaFrance.
Whether drugs are prepared by a human technician or a robot, there are multiple confirmation steps before a drug reaches a patient: After a physician writes an order for a drug, the order is verified by a clinical pharmacist. Once the order is sent to the IV room, it undergoes a second verification check by another pharmacist. Only then does it go to production, after which it is verified once again.
Anthony Ordonez, the IV Lead Pharmacy Technician, has been compounding drugs at SCCA for more than 10 years. He likes working with the robots because it eases the burden on technicians such as himself. “It relieves us from repetitive motions that cause injuries. It also reduces compounding errors and increases dosing accuracy with the use of gravimetric verification,” he says. “Instead of having to repeatedly draw up large amounts of fluid from vials or IV bags, the robot helps us do that in an accurate and efficient manner.”
Using the robot adds an additional layer of safety by helping prevent needle stick injuries and the risk of contamination. The robot also features a self-cleaning mechanism that frees up technicians to work on other tasks while the cleaning process takes place.
“This is definitely the future of IV compounding and a step forward in protecting employees who compound hazardous drugs,” says Ordonez.
