Allegheny General Hospital saves $1.2 million with IV robotics


2021-07-31 00:00:16 Healthcareitnews


For a very long time, hospital pharmacies have relied on 503B Compounding facilities to outsource to or from which to purchase a variety of supplies, such as ready-to-use critical care drips, OR syringes and high-use medications. THE PROBLEM The problem is, the supply of medications from these 503B facilities is not reliable, and shortages make it challenging to maintain the demand required for proper patient care, said Arpit Mehta, PharmD, director of pharmacy at Allegheny General Hospital, a 650-bed academic medical center in Pittsburgh, Pennsylvania.  Mehta says he has seen situations where 503B facilities reduce or outright stop the allocation of medications without advanced notice, making the mitigation of the shortages quite challenging. "Ensuring the product is truly safe and sterile for our patients is another aspect for 503B facilities. We have to ensure the facilities are safe to use," he explained. "This requires review of the FDA inspection reports, QA data, site-visits, etc. – all of which requires time and effort. With shortages, health system pharmacies generally partner with multiple 503B facilities, requiring thorough review of all such partner facilities. And even then, there still can be problems. "Beyond the issues around potential shortages and verification of quality, there also is a significant financial burden on the organization as the health systems pay a premium price to procure these medications as ready-to-use with extended room-temperature beyond-use-dating," he added. PROPOSAL Allegheny General's idea for a solution was centered on finding a way to in-source the purchased medications, using IV robotics via an RIIS program (service program). Vendor Omnicell offered this service in a way that was not just leveraging robotics (a device) to compound the product, Mehta observed. Specifically, the Omnicell service offered a technician team that would help run the robot – a team of experts on the device and its operations – that is fully dedicated to compounding these medications. "Both IV bags and OR syringes could be compounded on the robot, with the same extended room temperature BUD," he noted. "Most important, we would have control over our inventory, allowing us to adjust as needed based on usage, thus reducing waste and mitigating shortages. "We also would have data and control over the sterility of compounded products as we would be doing so in our own clean rooms," he continued. "Financially, this meant we would see a significant savings, since we would in-source and compound these medications ourselves and not pay the premium price to 503B facilities." MEETING THE CHALLENGE Allegheny General worked with Omnicell to implement the IV RIIS robotics program to meet its challenges. Omnicell helped the hospital draft an ROI, which the hospital validated and presented to its leadership. Once approved, hospital staff began working on the project with Omnicell throughout the entire implementation. "As the details were being finalized, we worked with Omnicell to recruit pharmacy technicians to run the robotics," Mehta recalled. "These would be the vendor's technicians who would work with us every day to compound our needed medications, dedicated to our hospital. They would be part of our team. "We worked with the vendor in identifying the medications that we would begin compounding on the robot, medications that were on shortage, and we had critical need for them," he added. "We began with one IV Robot at our flagship hospital to begin compounding some of the medications that were critical for our needs, in order to ensure steady supply. We produced OR syringes, critical care drips and the like, to mitigate all our concerns on availability of these vital components." During all of this, staff worked closely with the trainer, engineer and team from Omnicell to ensure successful go-live – and then tweaks and optimizations to ensure they had the best yield of the products they were compounding. The goal in mind was centered on minimizing waste and increasing efficiencies. Staff met at a scheduled cadence to continue to discuss the program; evaluate opportunities, growth capacity and cost savings; and continue to improve yield. Staff soon are adding a second device to help increase the number of compounded products on the robot. RESULTS From May 2020 to April 2021, Allegheny General produced 46,909 products on the IV Robot, generating a total of $1.2 million in savings. Savings are calculated by taking into consideration the outsourced cost compared to in-sourced cost, which includes medication cost, supplies, cost for IV RIIS program, sterility testing, USP71 testing and shipping cost. ADVICE FOR OTHERS "Less than 6% of hospitals across the country use IV robotics, because there is a fear of the unknown. However, the program makes sense, and it is worth an evaluation by all medium to large facilities," Mehta advised. "It is important to engage all stakeholders early on – IT, facilities, etc. – to ensure that the hospital has the capability to take on the IV robotics. "Key things to consider beyond normal IT review are space and the availability of data and power in the sterile compounding area," he concluded.  "If this needs renovation or construction, that is a challenge and additional expense. If the pharmacy is not in the basement, there may also be need for structural support due to the size and weight of the robot, and so it is important for facilities to consider this. IV robotics may have specific data and power requirements, so reviewing this in advance as part of the project plan is crucial." Twitter: @SiwickiHealthIT Email the writer: Healthcare IT News is a HIMSS Media publication.
很长一段时间以来,医院药房一直依赖503B配制设备外包给或从其购买各种用品,如即用重症护理点滴、注射器和高使用率药物。 问题所在 宾夕法尼亚州匹兹堡拥有650张床位的学术医疗中心阿勒格尼总医院药剂科主任阿皮特·梅塔(Arpit Mehta)说,问题是,这些503B设施的药物供应不可靠,短缺使得维持适当病人护理所需的需求变得困难。 梅塔说,他看到过503B设施在没有提前通知的情况下减少或直接停止药物分配的情况,这使得缓解短缺相当具有挑战性。 “确保产品对我们的患者来说是真正安全和无菌的是503B设施的另一个方面。我们必须确保设施使用安全,”他解释说。“这需要审查美国食品和药物管理局的检查报告、质量保证数据、现场访问等。--所有这些都需要时间和精力。由于短缺,卫生系统药店通常与多个503B设施合作,要求对所有这些合作伙伴设施进行彻底审查。即使这样,仍然会有问题。 他补充说:“除了潜在的短缺和质量验证问题之外,该组织还面临着重大的财务负担,因为卫生系统支付了高价来购买这些即用药物,室温延长,超过使用日期。” 提案 Allegheny General的解决方案的想法集中在找到一种方法,通过RIIS程序(服务程序)使用静脉注射机器人来获得购买的药物。Mehta观察到,供应商Omnicell提供这项服务的方式不仅仅是利用机器人(一种设备)来复合产品。 具体来说,Omnicell服务提供了一个技术团队来帮助运行机器人--一个关于设备及其操作的专家团队--完全致力于混合这些药物。 “静脉注射袋和或注射器都可以在机器人上复合,具有相同的扩展室温芽,”他指出。“最重要的是,我们将控制我们的库存,允许我们根据使用情况根据需要进行调整,从而减少浪费和缓解短缺。 “我们还将掌握复合产品无菌性的数据和控制,就像我们在自己的洁净室里这样做一样,”他继续说道。“从财务上来说,这意味着我们将看到显著的节省,因为我们将自己采购和合成这些药物,而不是向503B设施支付溢价。” 迎接挑战 阿勒格尼将军与Omnicell合作,实施IV RIIS机器人项目,以应对其挑战。Omnicell帮助医院起草了一份投资回报率,医院进行了验证并提交给了领导层。一旦获得批准,医院工作人员就开始在整个实施过程中与Omnicell一起工作。 梅塔回忆说:“随着细节的敲定,我们与Omnicell合作,招募制药技术人员来运行机器人。”“这些将是供应商的技术人员,他们将每天与我们合作,配制我们所需的药物,献给我们的医院。他们将是我们团队的一部分。 “我们与供应商合作,确定了我们将开始在机器人上配制的药物,这些药物短缺,我们对它们有迫切的需求,”他补充说。“我们从旗舰医院的一个静脉注射机器人开始,开始混合一些对我们的需求至关重要的药物,以确保稳定的供应。我们生产注射器、重症监护点滴等,以减轻我们对这些重要部件可用性的所有担忧。” 在所有这些过程中,员工与来自Omnicell的培训师、工程师和团队密切合作,以确保成功上线--然后进行调整和优化,以确保他们所合成的产品的最佳产量。 心中的目标是最大限度地减少浪费和提高效率。工作人员按预定节奏开会,继续讨论该方案;评估机会、增长能力和成本节约;并继续提高产量。工作人员很快就增加了第二个设备,以帮助增加机器人上复合产品的数量。 结果 2020年5月至2021年4月,阿勒格尼通用在IV机器人上生产了46909件产品,共产生120万美元的节约。节省是通过考虑外包成本与内部成本的比较计算的,其中包括药物成本、用品成本、IV RIIS项目成本、无菌检测、USP71检测和运输成本。 对他人的忠告 “全国不到6%的医院使用静脉注射机器人,因为人们害怕未知。然而,该项目是有意义的,值得所有中型到大型设施进行评估,”梅塔建议道。“重要的是尽早让所有利益相关者参与进来--IT、设施等。以确保医院有能力接受静脉注射机器人。 “除了正常的IT审查之外,需要考虑的关键问题是空间、数据的可用性和无菌复合领域的电力,”他总结道。 “如果这需要翻新或建造,那是一项挑战和额外费用。如果药房不在地下室,由于机器人的大小和重量,也可能需要结构支持,因此设施考虑这一点很重要。IV机器人技术可能有特定的数据和功率要求,因此作为项目计划的一部分,提前审查这一点至关重要。” 推特:@SiwickiHealthit 给作者发电子邮件 Healthcare IT News是一个HIMSS媒体出版物。