THRIV is a coalition of healthcare providers and consumers seeking to protect patients from unintentional harm from IV preparation errors.
Compounding errors are reaching patients. Nearly one-third of facilities disclosed that a patient incident involving a compounding error had transpired within their institution in the last five years. That number has not changed in the last 17 years.* Pharmacy Purchasing & Products' State of Pharmacy Compounding 2024
(1) Using technology during IV compounding reduces the chances for IV compounding errors. (2) Intravenous Workflow Management Systems (IVWMS) incorporate any combination of the following technology: barcode scanning, photo capture (volumetric) for verification, specific gravity or density (gravimetric) for verification, and standardized compounding steps. (3) An IVWMS that includes ISMP’s recommendations will reduce potential compounding errors and increase patient safety. When considering implementing an IVWMS at your facility, the THRIV Coalition recommends five criteria that technology should meet or exceed. (4)
1. Workflow management software
An IVWMS that interfaces with the electronic health record provides our patients the safest and most up-to-date preparations. The interface eliminates the need to transcribe ordered doses from the electronic health record into a compounding record. Through this interface, STAT or emergency doses can be recognized by the IVWMS and sorted at a higher priority than doses due in the future. This allows the compounding staff to focus on the critical and potentially complicated compounding steps.
An interface between the electronic health record and IVWMS provides real-time information to the compounding staff. Discontinued, modified, and rescheduled doses are removed from the queue before compounding is initiated, reducing drug waste.
IVWMS, with guided workflows, directs compounding personnel step-by-step through the compounding process, providing consistency across an organization. Guided workflows ensure compounders complete the previous steps before proceeding to the following steps, keeping compounding staff on task when working in a busy, high-paced environment.
2. Barcode scanning
One of the fundamental steps in the compounding process is using the correct ingredients and materials. Serious injury can occur if a preparation is compounded with incorrect ingredients and reaches the patient. Utilizing barcode scanning of ingredients and materials, including drugs, diluents, bags, and materials, ensures the products used during compounding are correct. Barcode scanning identifies wrong ingredients scanned and records these occurrences, allowing for complete transparency in the compounding process.
USP <797> requires the recording of the vendor, lot number, and expiration date for all components on the compounding record for many preparations. Barcode scanning technology pulls in NDC, vendor, lot numbers, and expiration dates (future) from GS1 barcodes on components, confirms correct ingredients, and reduces the chance of transcription-related errors associated with the manual recording of this information.
3. Volume verification
Ensuring the correct volume of medications is essential to patient safety. Inaccurate volumes of drugs or diluents used during compounding can place patients at risk through underdosing or overdosing. Compounded doses are more accurate and safer for patients when volume verification technologies are utilized, including any one or combination of the following:
In-process image capture (or live video):
Still image or live video capture documents each step in the compounding process. Images and video become part of the compounding record, allowing pharmacist verification to occur remotely. Remote verification reduces staff movement into the cleanroom, protecting the sterile compounding environment from increased bioburden. Still images and video that are part of the compounding record allow for pharmacist verification of all steps in the compounding process, including ingredient verification, lot numbers and expiration dates, preparation steps, and final products. Using this technology, pharmacists can know without a doubt if the preparation was compounded correctly or if it needs to be reworked.
Gravimetric analysis:
Gravimetric analysis allows for precisely measuring the exact volumes of ingredients by analyzing the mass of the ingredients used during compounding. Because gravimetric analysis relies on measuring mass rather than volume, it is a valuable tool when dispensing high-potency medications, specialty medications, or medications for a highly susceptible patient population like pediatrics.
Volumetrics:
Volumetric technologies that automatically draw, release, measure, and verify delivered volumes allow for highly accurate measurement of liquids, ensuring the correct volume of ingredients every time. Utilizing volumetric technologies reduces the potential for human error in calculations and measuring while increasing efficiency through faster compounding.
Optical volume recognition:
Optical volume recognition is an advanced technology that measures and verifies the volume of liquid measurements in the compounding process using high-resolution cameras and advanced software algorithms. This automated technology works with IVWMS to provide automatic documentation and traceability while minimizing the risk of human error associated with manual measurement techniques.
4. Auto labeling
Labels applied to compounded preparations must be legible and have all the required information per USP <797> to prevent storage, dispensing, and administration errors. IVWMS, which incorporates auto labeling, utilizes advanced technologies to streamline the labeling process during compounding. IVWMS that use pre-defined templates for labels that comply with regulatory standards and organizational protocols and are automatically populated with real-time data from the electronic health record provide increased safety. Labels include a barcode that uniquely identifies the compounded preparation, allowing for tracking and verification. High-quality, colored labels ensure durability and legibility, alerting personnel handling or administering the preparation to the drug class and storage requirements.
5. Auto documentation
Documentation of the compounding process is an important step outlined in USP <797>. And must comply with all laws and regulations of the applicable jurisdiction. Auto documentation captures real-time data throughout the compounding process, ensuring all information is up to date and consistent every time. Every preparation step is recorded and time-stamped, reducing the need for manual logging, allowing the pharmacy staff to focus on patient care, and ensuring all documentation is completed accurately and completely for every preparation. Auto documentation can also capture errors intercepted by the technology during the compounding process to increase visibility and assist with quality improvement efforts. Comprehensive and organized documentation of the compounding process facilitates easier audits and inspections, as all documentation is readily available and complete.
