By Alex Reinhardt, P. Eng.

 

Inevitably, a discussion about what drugs to run with IV preparation automation will come up when a company is considering systems such as RIVA. There is no one right answer to this; it all depends on what the organization’s goals are. A couple of examples might best illustrate this.

 

Let’s assume that you are purchasing drugs from a third party that you could be making in-house (given current guidelines for purchasing manufactured items where possible). In this case, the first place to look is where most of the dollars are being spent – that is, dollars per dose multiplied by the number of doses per year. Next, determine what it would cost your organization to make these purely from the consumables perspective. In other words, what it would cost for just the drug itself and the syringes or bags, discounting factors such as extra staff or time. The purchase cost minus the in-house cost is then the total potential savings that could be realized by bringing that product back in-house. Determining the savings per year for all the outsourced products will then allow you to determine which ones merit being brought back in-house. That list may not be very long, possibly a mere five to ten products, but the savings may be substantial enough to provide the required return on investment for automation and the extra work required to handle those doses.

Another example would be making pediatric doses. In this case, the objective is likely not related to money at all, but more about improving safety and efficiency. From a safety perspective, ideally all doses would be made by automation, but this is generally not practical. In most cases, the 80-20 rule applies – 80% of the volume comes from 20% of the drugs. So, increasing the standard of care for the majority generally dictates that the higher volume drugs be first on the to-do list. Also, automation tends to perform better (from a speed and waste perspective) doing multiple quantities of similar products and, therefore, making drugs that require 30 or 40 doses per day is a much more effective route than making a drug that requires just one dose per day. In most cases, this approach will also help with improving efficiency in that the tech’s time can be spent running the automation and doing the lower volume production at the same time. One potential use of any gained capacity is to increase the number of label runs done per day. Doing four or more label runs per day can significantly reduce waste (largely due to a reduction in discontinued items), compared to only one or two per day. This exact scenario has occurred at some RIVA customer sites, always resulting in positive benefits.

One side note here for the pediatric environment is that RIVA can make and reload dilution bags. This provides a significant safety benefit even if the bags are used for manual dose preparation, although in most cases, these bags will be part of the 80-20 mix. The prime risk with dilution bags is in making the bag, not in checking that a syringe dose drawn from that bag has a certain volume in it. Therefore, using RIVA to make dilution bags at night, even if they will be used for manual draws, provides a good use of RIVA time when patient specific runs are not being done, and will increase the overall number of doses being “made” by automation.

So ultimately, the variety of drugs that are done in RIVA is really not the important point. Rather, what is important is that the drugs being made provide the benefit that you and your organization are after, be it direct dollar savings, safety improvements to reduce errors, or efficiency benefits to make better use of staff time and reduce waste. For some organizations RIVA may be running as few as five drugs, while others may run as many as 20, all while achieving each organization’s goals.

 

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Alex Reinhardt is Market Development Manager at Intelligent Hospital Systems, designer and manufacturer of RIVA – a Fully Automated IV Compounding System