First Steps to Compounding Technology

Episode Highlights

Q: You’re a highly sought compounding expert and have provided input to multiple authoritative bodies. What updates should we expect?

Kevin Hansen: In IV compounding, the velocity of change just continues to increase. There are draft FDA guidance documents, pending ISMP guidelines, ASHP recommendations, drug shortages, and more.

The Institute for Safe Medication Practices (ISMP) is scheduled to release new compounding guidelines in early 2022. I joined the panel with a number of practitioners nationwide where ISMP wanted to really understand current practice, the advantages of technology, and even push us to rethink what types of technology will be needed in the future. ISMP gets it. I think the new guidelines will be well received.

ASHP also is expected to come out with new compounding guidelines once the new USP 795 and 797 standards are official. ASHP also has a very active Section Advisory Group (SAG) solely focused on the compounding practice. For instance, when a sterile injectable is on shortage, it can affect all compounding leaders across the country. The SAG connection helps us to work together to solve the same problems.

Also, I recommend following the ASHP Connect community. It’s a great forum to learn from one another. I review the updates when they hit my inbox every morning.

Q: What makes you optimistic that compounding technology adoption is growing?

Kevin Hansen: I’m seeing more hospitals adopt compounding technology. I’m hopeful that it will really take off. But where some pharmacies struggle is thinking they need to have all of the technology right away. They don’t. They can take a stepped approach, recognizing where they are today, and where they want to go, one step at a time.

My focus is on changing the perspective of compounding technology, from a best practice to a standard practice. Start with scanning the barcodes of ingredients during compounding. That would be a simple first step. And it could be lifesaving.

Think of it as BCMA (barcode medication administration) for pharmacy – BCMP or Barcode Medication Preparation.

A few years ago, BCMA wasn’t even a thing. Today, it’s standard practice. Talk to your nursing colleagues. It’s not best practice. It’s not minimum practice. It’s required. And most hospitals are tracking their percent compliance and are audited against it.

It’s time pharmacies take that same approach to compounding. That barcode scanning to ensure you’re using the appropriate, intended ingredients is the bare minimum standard across the board when compounding. BCM-P.

Q: What were the main drivers for implementing IV automation at Moses Cone?

Kevin Hansen: It was a project started several years ago. We were motivated by ISMP recommendations to use for ready-to-administer (RTA) syringes compared to compounds. We saw the efficiencies to be gained in the perioperative space, the reduction of waste, especially for emergency-use-only drugs, and in helping with compliance. So we could avoid bedside compounding and having to deal with labeling and one-hour beyond-use dates.

But we found 503B vendors couldn’t keep up with demand for RTA products. It was very problematic from an operational perspective. If we didn't get our RTA syringes shipment, we had to figure out a backup plan. That could be swapping out syringes for vials in the automated dispensing cabinets. Or, in some cases, an alternative medication. None of those practices is best for patients.

The RTA program was our launch pad to exploring IV robotics.

Q: How do you determine which medications to compound with IV robots?

Kevin Hansen: It starts with patient value, and that includes quality, safety, and cost reduction. Quality and safety are the numerator of the value equation.

Cost reduction is not our main driver, but it is essential because we need to pay for the technology and recognize the quality and safety benefits it brings to our patients. We spent a lot of time educating our C-Suite on that concept.

Whenever possible, we buy an FDA conventionally manufactured premix. Otherwise, to determine which products we make in the IV robots, we start with a wish list and work our way back. Our decision rationale:

1. Can we stabilize our 503B supply chain?
2. Can we buy a large bulk vial and aliquot it appropriately into smaller amounts?
3. Can we avoid a drug shortage?
4. Can we decompress volume off our main clean room?

Q: What benefits are you seeing from your IV robotics?

Kevin Hansen: It’s really helped on the front end of our perioperative services space. Our anesthesia colleagues tell us the IV robotics program has been very successful for them. They’re turning over the procedure rooms faster, and they have the medications they need when they need them. And we continue to work closely with the anesthesia teams to establish which products are on their wish list.

From a cost savings perspective, it’s been an obvious benefit. It requires careful balance and data monitoring, so that we’re not under-producing products that could lead to stockouts, or overproduction that could lead to waste.

Maybe most importantly, we’ve minimized 503B supply chain disruptions by making products internally. That’s been a significant lift. And it’s a major reason why we invested in a third IV robot. Through the pandemic, with increases in ICU infusions, our robots have been instrumental in helping us get through those crises.

DISCLAIMER

The Future of Pharmacy Podcast is produced and distributed by Pharmacy Podcast Network. The views and opinions expressed in this podcast 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.