all of these challenges would be to move to
automation for hazardous drug compounding.
The second is that in-house aseptic preparation is
expensive because of the need to buy, maintain
and replace equipment.
Lastly, and most importantly is the issue of
safety. The workers who compound hazardous
drugs, of whom the European Commission state
there are 20 million European healthcare
workers, are at risk of negative health outcomes. 4
Studies from the National Institute of
Occupational Safety and Health (NIOSH) have
shown that these can include abdominal pain,
nausea, vomiting, diarrhoea, coughing, facial
flushing, hair thinning, hair loss, dermatitis,
irritation of skin and eyes, irritation of mucous
membranes, menstrual cycle disruption, and
foetal loss, and even some forms of cancer. 5
With all of these issues facing the NHS, there is
a real need to look at new ideas and alternative
solutions. One potential approach that could solve
References
1 Source: NHS stakeholder
interviews; Aseptic Facility data
collection Jan 2018.
2 NHS Improvement (March
2018). Pharmacy Aseptic
Services Review Summary of Key
Findings.
3 Ibid.
4 European Federation of Nurses
Associations, European Expert
Group on Hazardous Drugs, May
8, 2017.
5 Centers for Disease Control
and Prevention, 2017; Centers for
Disease Control and Prevention,
2019
14
HHE 2019 | hospitalhealthcare.com
Automation for hazardous drug
compounding
The most important advantage of automation
is that it can keep healthcare workers safe as
robotic automation systems can physically handle
the drugs during the compounding process.
To further increase safety and contain hazards,
compounding systems that can incorporate the
use of a closed system transfer device (CSTD)
would provide a key layer of protection for staff,
which must be of paramount importance. It offers
the highest protection level, which is prevention
of exposure to hazardous drugs.
Robotic automation systems can also
compound drugs at a much faster rate compared
with manual compounding. This could potentially
free-up members of staff to attend to other
important tasks while still ensuring that the
drugs that are needed are being compounded,
while also lessening the element of human error
by preventing dosage and medication errors.
The fact that drugs could be compounded at
a faster rate could also reduce the overall cost
that facilities incur for paying for the machines
and their maintenance. Fewer machines would be
required and as a consequence, upkeep and
repairs would be lower than they currently are
– maintenance alone can cost tens of thousands
of pounds each year. Equally, one central service
could produce drugs for several facilities, allowing
for sharing of the overall cost.
While compounding centres stand to gain
significantly from automation technologies, it is
crucial that they have in place contingency plans,
as well. For example, if the automation system is
down, the centre must have sufficient personnel
to handle the compounding work in a safe
environment. Any facility considering a move to
automation should ensure that they also develop
protocols to handle unexpected mishaps with
these systems.
Notwithstanding the need for contingency
planning, the use of automation seems to be the
natural next step forward for the safer and more
efficient compounding of hazardous medicines.
Many other industries with mission critical
applications have embraced robotic automation,
allowing them to flourish and develop. With the
latest challenges in meeting ever increasing
demand and improving safety, it would seem like
the opportune time for chemotherapy
compounding followed suit and embrace
automation. The technology is now available, and
it is up to facilities to take full advantage of it to
improve the quality, efficiency and safety of
hazardous drug compounding.
About the author
Dr Paul JM Sessink studied organic chemistry and
toxicology at the University of Nijmegen in The
Netherlands, where he also completed a PhD
degree in Medical Sciences.
He is the founder of Exposure Control,
a consulting firm for the monitoring of hazardous
drugs and is co-author of approximately 40
scientific publications regarding environmental
and biological monitoring of occupational
exposure to cytotoxic drugs.