Mitigating risk with pharmacy automation

Posted on October 14, 2014

By Niels Erik Hansen, Ph.D.

Evidence shows the risk of patient injury from medication errors is substantial and costly – especially errors associated with injectable medications. A first-of-its-kind study published in American Health & Drug Benefits in 2012 uncovered some sobering facts:

• Adverse drug events (ADEs) from injectable medications kill up to 7,000 patients every year.

• Half of all ADEs are a result of medication errors and are preventable.

• Injectable medications are among those at highest risk for error.

• Preventable ADEs associated with injectable medications harm more than 1 million inpatients each year in the U.S.

• Preventable ADEs from injectable medications add more than $600 million a year in professional medical liability, needlessly costing the average hospital tens of thousands of dollars.

Do the factors that lead to these errors exist in your hospital? Despite the best efforts of the pharmacy team and safety committee, the answer is very likely yes. But more important, have you led yourself to believe the problem doesn’t really exist because it has not yet affected your patients or impacted your bottom line? If you’ve never tried to measure it – and most people haven’t – being lulled into a false sense of security is easy.

A new report in Hospital Pharmacy shows the cost of complacency. The study, “Estimated Cost Savings from Reducing Errors in the Preparation of Sterile Doses of Medications” shows a significant proportion of errors occurring in the IV compounding area. This study echoes the findings of others: mainly, humans make mistakes, in hospitals generally and in compounding specifically.

The technology to avoid these risks is available and can mitigate liability significantly. As a risk manager, COO, CEO or similar position within the hospital, you have to wonder to what extent you are liable for these mistakes – especially if they can be prevented.

Errors in manual compounding

An area of particular risk for medication errors that can result in patient harm is manual compounding. As a result, there have been several important technological developments to reduce pharmacy errors. Cleanrooms and laminar hoods, computerized order entry, automated barcoding and multiple quality control checks all help ensure the safety of manually compounded medications.

But despite such important safeguards, errors persist because humans are not perfect. While pharmacies may have reduced manual errors to a rate acceptable from an actuarial perspective, patient advocates likely see it differently: what rate of error is acceptable when only one can prove fatal?

To understand error risk in manual compounding, look at the numbers. Preparing a single syringe of Vancomycin entails, on average, 42 process steps from placing the order to administering the medication. At two daily doses per bed, a hypothetical 200-bed hospital would make 146,000 doses of Vancomycin annually – requiring more than 6 million manual process steps.

From a risk perspective, we must be concerned about the likelihood that all 6 million steps will be completed without error. What if an error is made in a step that has a high risk of patient harm – for example, selecting the wrong vial or miscalculating drug concentration? Perhaps ironically, process steps to check and recheck the accuracy of manually compounded medications not only cost time and money, but are also unreliable because they are dependent on humans. What can be done?

Automation reduces errors and cost

The fact is, the majority of IV medications no longer need to be compounded manually. Automated IV compounding systems have existed for more than a decade and are proven to enhance the safety of medications by removing the primary source of error – humans – from the compounding process.

More important, automated systems perform steps critical to safety with exacting precision – drawing a precise amount of medication from a vial, calculating and mixing exact concentrations or dilutions, labeling the syringe for a specific patient, and much more. The automated system also will complete these tasks with repeatability much greater than humans.

Using the Vancomycin example above, some automation systems can eliminate at least two-thirds of the 42 steps required to produce a single syringe, or more than 4 million steps over the course of a year.


Such a reduction in errors can also save money. For example, the study on cost savings mentioned earlier in this article found that using robotic compounding technology to prepare sterile medication doses could reduce hospital costs by more than $288,000 annually – compared to a manual system – by reducing medication errors.

Given the availability and cost benefit of automation technology, why would you continue to ask imperfect humans to perform these millions of operations – especially knowing errors are expensive, and some also will be critical or fatal?

Reducing liability

When assessing the legal ramifications of liability, hospitals are expected to employ every possible process to ensure patient safety at a reasonable cost. IV automation is commercially available, has proven benefits and can be implemented cost-effectively.

In fact, by reducing errors in the preparation of injectable drugs, automated compounding technology may reduce the number of error-related ADEs – substantially mitigating a known patient and liability risk.

Given the data and scope of the problem, can you afford not to invest in it?

Dr. Niels Erik Hansen is president and CEO of Intelligent Hospital Systems in Winnipeg, designer and manufacturer of RIVA a Fully Automated IV Compounding System.

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