Increased pediatric patient safety by integrating robotics into the IV medications workflow management

by Matteo Federici

Coauthors: Noemi Ombrosi

Pediatric Nanomedicine or Robotics

The management of intravenous (IV) medications is a crucial component of pediatric patients care. Children vary in weight and body surface area and experience unique differences from adults. The lack of standardized dosage forms and the need for highly personalized therapies can carry significant risks of producing adverse events. Children in intensive care units are even more prone to risk because of the frequent use of IV medications with a narrow therapeutic index. As a consequence, the preparation of IV medications represents a complex and labor-intensive process which includes multiple calculations and product manipulations. The manual preparation has been associated with a number of issues, such as variable operator performances, assumed rather than proven accuracy, and limited traceability. Therefore, it can contribute to increase the likelihood of errors, especially when performed without adequate process controls.
The Institute for Safe Medication Practices (ISMP) recommends the use of technology and automation to prepare and verify sterile IV products. Hospital pharmacies are moving towards the automated preparation of IV medications with robotic systems in order to minimize the risk of human errors, increase working efficiency, and guarantee high quality standards. Studies have assessed these technologies in adult settings, however the implementation of robotics in pediatric pharmacies is still lacking.
Given the context described above, the APOTECAped project was born with the aim of extending the benefits of robotics to the preparation of IV medications intended for pediatric patients. The project specifications were defined by an international community of hospital pharma¬cists, opinion leaders in aseptic processing, physicians, and technology developers. The community was committed to (1) fostering the co-de¬sign of robotic solutions based on the users’ needs, (2) sharing best practices for optimal use of technologies, and (3) engaging in collaborative scientific research related to pharmacy robotics.
APOTECAped consists in a robotic system for fully-automated preparation of sterile IV medications that allows pediatric pharmacists to control the whole medication process from the prescription to the administration. APOTECAped comprises a production management software, which can be completely interconnected with the electronic prescribing system and the medical record. The system is designed to integrate in-process checks using position sensors, vision systems, and gravimetric verifications to guarantee product quality and patient safety.
To assess the feasibility of implementing APOTECAped in the clinical pediatric pharmacy practice, IV medications dispensing data were collected and analyzed from various children’s hospitals in US and Europe, especially focusing on pediatric and neonatal intensive care units as well as pediatric haemato-oncology units. Medications were evaluated based on dosage range, frequency of doses dispensed, and current preparation methods. The feasibility analysis demonstrated that robotic systems can be utilized to prepare a large percentage of pediatric IV medications.
As next objective, the project aims at enlarging the international user group to drive the continuous engineering of the technology as well as to advance clinical evidences resulting from the implementation of robotics.