IV Admixture Automation
Previous State
› As IV compounding became more prevalent in the hospital
pharmacy environment. More staff resources were needed to
perform IV admixtures.
– These activities are highly repetitive and create a large workload for
staff.
– Documentation of each step of the compounding process required
manual checks and calculations by both the pharmacy technician and
the pharmacist.
– Paper compounding logs and documentation of IV admixtures was a
tedious process and was not conducive to audit reporting.
– A new decentralized pharmacist workflow limited the availability of
staff to check products being prepared in central pharmacy.
Phase 1 - Doseedge
› The decision was made to install an
IV workflow manager which allowed
for documentation of the IV
admixture process from start to finish
via camera technology.
› This allowed the pharmacist to
validated the process remotely while
logging important regulatory
information along the way.
› It also automated the calculations
necessary and enabled bar code
validation of products which helped
reduce costly mistakes and
miscalculations.
Phase 2 – Outsourcing
› Despite having technology to streamline the IV compounding
process, our IV admixture volume was only increasing and we
were seeing staff preparing product in batches at an increased
volume.
› The decision was made to outsource to a compounding
pharmacy for standard doses of many medications.
– These drugs, while expensive, have longer shelf lives(45-90 days vs 714 days) resulting in less waste and allowed us to pivot technicians
and pharmacists to more value added tasks.
Current State
› With increasing regulations regarding USP797 and the coming
USP800, we’re looking to minimize risk to both patients and
workers while ensuring compliance with these regulations.
– While outsourcing is crucial because increasing our production
capacity is difficult while keeping staffing resources static, there are
options available.
› We’ve also seen delays and allocations from our outsourcing
pharmacies recently as they struggle to meet demand. This
has forced us to increase in house manufacturing without
increasing staffing levels.
Phase 3 – IV Automation
Phase 3 – IV Automation
› How do we bring back the manufacturing of premixed IVs to
the hospital without straining tight staff resources and in a
cost efficient manner?
– We leverage our 340B and GPO purchasing power for raw ingredients
which will in turn cover the cost of leasing the equipment.
– We analyze our current waste of premixed products and show how
we can get by with lower par levels of stock while still serving the
hospital with the product it needs, when it needs it.
Phase 3 – IV Automation(cont.)
– Fact Sheet
› Annual spend of approx. $330,000 on outsources premix products.
› Analysis shows if we bring this back inhouse, our cost for ingredients would run
around $76,000.
– This leaves us with a delta of approx. $254,000.
ServiceDescription
5 mg/mL Morphine Sulfate (Preservative Free) (Contains Sulfites) in
0.9% Sodium Chloride 50 mL in 60 cc Monoject Syringe
4% Sodium Citrate (Preservative Free) 3 mL in 5 mL BD Syringe No
Overwrap
20 mg/mL Succinylcholine Chloride Injection (Preserved) 5 mL in 5 mL
BD Syringe
NDCNumber
Latest
Total Units Pharmedium Unit Total Pharmedium Est. Production cost
Est. total
Cost Savings with
2016
Price
Price
per unit [GPO/340b] production cost
production
% of Delta
61553-625-75
130
$
10.32
$
1,341.60
$
-
0.0%
61553-481-34
2208
$
3.15
$
6,955.20
$
-
0.0%
61553-357-33
2725
$
19.39
$
52,837.75
$
0.05
$
136.25
$
52,701.50
21.8%
40 mcg/ml Phenylephrine HCl (Preservative Free) (Contains Sulfites) in
0.9% Sodium Chloride 10 mL in 10 mL BD Syringe
61553-312-65
3900
$
5.01
$
19,539.00
$
0.13
$
507.00
$
19,032.00
7.9%
5 mg/mL Ephedrine Sulfate (Preservative Free) in 0.9% Sodium
Chloride 5 mL in 5 mL BD Syringe
61553-301-33
3800
$
38.21
$
145,198.00
$
12.54
$
47,652.00
$
97,546.00
40.4%
2 mcg/mL Fentanyl Citrate and 0.1% Bupivacaine HCl (Preservative Free)
in 0.9% Sodium Chloride 250 mL in 250 mL Intravia Bag
61553-131-02
60
$
23.14
$
1,388.40
$
5.07
$
304.20
$
1,084.20
0.4%
61553-123-48
545
$
17.03
$
9,281.35
$
2.17
$
1,182.65
$
8,098.70
3.4%
61553-397-72
725
$
25.70
$
18,632.50
$
3.92
$
2,842.00
$
15,790.50
6.5%
61553-149-78
130
$
36.27
$
4,715.10
$
18.23
$
2,369.90
$
2,345.20
1.0%
61553-009-02
1104
$
14.53
$
16,041.12
$
4.81
$
5,310.24
$
10,730.88
4.4%
61553-078-02
1128
$
18.70
$
21,093.60
$
6.42
$
7,241.76
$
13,851.84
5.7%
61553-163-75
950
$
10.34
$
9,823.00
$
1.25
$
1,187.50
$
8,635.50
3.6%
61553-167-75
1185
$
14.95
$
17,715.75
$
6.23
$
7,382.55
$
10,333.20
4.3%
61553-498-39
285
$
13.93
$
3,970.05
$
-
61553-649-75
170
$
8.83
$
1,501.10
$
71.40
2 mcg/mL Fentanyl Citrate and 0.1% Bupivacaine HCl (Preservative Free)
in 0.9% Sodium Chloride 100 mL in 150 mL Intravia Bag
10 mg/mL Methohexital Sodium (Preservative Free) in Sterile Water
for Injection 10 mL in 10 mL BD Syringe
10 mg/mL Methadone HCl Injection 1 mL in 3 mL BD Syringe
1.25 g Vancomycin HCl (Preservative Free) added to 0.9% Sodium
Chloride Injection USP 250 mL in 250 mL Viaflex Bag
1.5 g Vancomycin HCl (Preservative Free) added to 0.9% Sodium
Chloride Injection USP 250 mL in 250 mL Viaflex Bag
0.2 mg/mL HYDROmorphone HCl in 0.9% Sodium Chloride 50 mL in 60
cc Monoject Syringe
1 mg/mL HYDROmorphone HCl in 0.9% Sodium Chloride 50 mL in 60 cc
Monoject Syringe
1 mg/mL Morphine Sulfate (Preservative Free) in 0.9% Sodium Chloride
100 mL in 150 mL Intravia Bag
1 mg/mL Morphine Sulfate in 0.9% Sodium Chloride 50 mL in 60 mL BD
Syringe
**Bold = 340b Pricing**
Total
$
0.42
0.0%
$
1,429.70
Pharmedium
Inhouse
Difference
$
$
$
330,033.52
76,187.45
241,579.22
0.6%
100.0%
Phase 3 – IV Automation(cont.)
– Other Factors
› Decreased reliance on compounding pharmacies isolates the institution from
product allocations and some supply chain problems.
› We now have complete control over the accuracy of compounding and have a
very visible documentation process so we can more easily look for signs of
variance should an adverse event occur.
› We also have a mechanism to further comply with coming regulations as a result
of USP 800 and have another means of isolating the compounding process as it
relates to hazardous drug prep without costly physical construction.