Should Pittsburgh pharmacies purchase robots to prepare your IV antibiotics and chemo drugs?

    It appears that Japan may not be the only country in the world filling its streets with robots that collect garbage from garbage dumps, assigning cyborgs in businesses to greet customers or even using robots as models to walk on the catwalk to showcase designers' clothes. Among other intriguing  but practical robotic inventions in Japan include a fancy robotic exoskeleton  suit designed to help people with neuromuscular disabilities or arthritis walk and climb with ease. This robot frenzy is apparently invading North America to help in many aspects of society including the health care industry.

   Automation in the health care industry is not entirely novel since the use of automated pill counters and efficient automated label stampers have been used in pharmacies about ten years ago. However, the whole manual process of counting pills, preparing intravenous (IV) doses of antibiotics and chemotherapeutic drugs, sterilizing bottles and vials, labeling and neatly tucking and packaging your prescription drugs can all be done under one robotic system called Robotic IV Automation.

 Intellingent Hospital Systems  , an infant Canadian based in Winnepeg, Canada, has been looking for ways to combat the rising incidence of medication errors and consequent malpractice law suits. This company has developed RIVA (Robotic IV Automation) which gives hospital pharmacies a significant competitive edge in order to avoid medical errors by using a combination of complicated robotic platforms,  sophisticated software, sterilizing ultraviolet modules and mechanical arms used to prepare IV antibiotics and resuspend cytotoxic admixtures in an efficient, reliable and apparently “fool-proof” manner.  

  The software used by RIVA platforms employs a Windows friendly interface encoded in C++ language that allows the pharmacist to store the data of prescription drugs, patient information, the dimensions of the product and other parameters. As automated solutions for preparing chemo and antibiotic IV solutions is usually complex and difficult to maintain in a sterile and safe manner, the software and database employed by the RIVA system    combines flexibility, reproducibility and reliability to ensure that IV solutions are automatically prepared in a reliable and safe manner. In other words, the RIVA system has learning algorithms that enables the robot to learn, recognize and handle a wide range of dimension parameters for many different input products including syringes, IV bags and vials.  For instance, the software allows the robot to quickly readjust different parameters and data in a real-time manner depending on the size of the product it handles without sacrificing time or reprogramming the system to do other fine-tuned jobs.

   The RIVA software retrieves useful product and patient information by using a database that contains a small footprint. The database used by RIVA not only stores data in a secure and reliable manner but also hold crucial data for determining dynamic robot movements necessary to handle vials, bags and bottles. The database, which was designed and marketed by SQL Anywhere,  can be complicated for this system as it can store information on the viscosity, fluid dynamics, pressure, atmospheric pressure, and temperature of individual, batches or lots of  bottles and vials. By retrieving the 3D coordinates and path references of every input product and by employing motion sensors, RIVA knows exactly where each vial of drug is stored, knows what vial to retrieve by scanning a bar code on the product and knows exactly where to puncture the rubber lid of the vial at exactly the same angle and spot the same way every time.
 

    The only tasks  required to be performed by a pharmacist are to acquire and relay the drug prescription order to the RIVA machine, ensure product verification before and after processing of the prescription and of course, the machine is not going to ring your order but only a pharmacist can do this.

   As put in the words of Thom Doherty, chief technical officer at Intelligent Hospital Systems "RIVA systems are revolutionary in that they are able to either automate the current workflows or completely change the way that the hospital pharmacy is currently preparing their IVs," says Doherty. "Partnering with Sybase has allowed us to focus on providing our customers with an exceptional solution. SQL Anywhere provides the reliability and high availability that RIVA requires".

   Currently only three  few hospitals in the United States have purchased and installed the one million dollar RIVA platform. Apparently, this long term investment pays itself out after two years by trimming  a few lower level pharmacist jobs, reducing the number of medication errors and potential medical malpractice lawsuits, reducing wastes of doses and batches and avoiding disastrous cross contaminations of fluids. Of course, the added business advantage of owning a RIVA system is that it fully automates the  preparation of IV antibiotics and chemo drugs in a reliable, safe, reproducible and economical manner.

   As of right now, UPMC does not own a RIVA system but it might be a great idea to install a few RIVA systems to work at select hospital pharmacies located at oncology centers, where thousands of IV chemo doses are prepared each day. The RIVA system may cut down on costs and IV preparation time about 10-20 fold compared to conventional human preparation of IVs. It is not unfeasible that UPMC could get its own RIVA system given their tax-free status and millions of dollars in revenue it rakes in every year. Other hospitals such as West Penn oncology units may be well served by one a RIVA system or other systems such as Cytocare from Health Robotics, another Canadian company that manufactures IV admixture robots based in Toronto.

   There are a few disadvantages of owning a RIVA system. For instance,  hospitals located in a region that lack a nearby satellite Intelligent Hospitals company will have to wait longer for a technician to  calibrate, maintain or troubleshoot a RIVA system. In addition to the huge monetary investment, these robotic units recapitulate anthropomorphic motions and handling of IV mixtures in a very complicated manner  that can otherwise be performed by a few well-trained and disciplined pharmacists. Dosage errors sometimes may not only occur by fatigue but in most cases are performed by incompetent or undertrained pharmacists. Ensuring sterility and safety of prepared admixtures can all be performed by well trained pharmacists that use a calibrated and efficient laminar flow hoods to prepare IV drugs.

   On a personal thought, these systems might be more useful in third world countries were a lack of well-trained personnel, lack of appropriate safety controls and a shortage of pharmacies is very evident.

For more information:

Company website describing the technical aspects of the RIVA system:

http://http://www.rivasystem.com/news.html

Children's Orange County Hospital, one of three US hospitals using the RIVA system:

http://http://www.choc.org/publications/articles.cfm?id=P00303&pub=AR&aid=492

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