ASHP Midyear: Automated Compounding Workflows and Comprehensive Record-Keeping Reduce Errors

Pharmacy errors and near-misses can happen in compounding, with a wide range of potential failure points during the compounding process—from the wrong drug or patient, to the wrong dose, concentration, or diluent. While the adoption of IV workflow technology and automation like robotics and gravimetrics has increased, only about 30% to 40% of pharmacies currently utilize these solutions to help catch these types of errors, said Annie Lambert, PharmD, BCSCP, clinical program manager, of compliance solutions at Wolters Kluwer. Barcode scanning can prevent some wrong drug and patient mismatches, but it's just one piece of the puzzle. The compounding record, which documents all the critical details of the preparation process, is essential for tracking medication errors and recalls.

Pharmacy Times: What are the common causes of compounding errors, and how can they be prevented?

Annie Lambert: As much as we focus on patient safety, accidents happen, errors happen, near misses happen. I was recently explaining what are actually our new workflok partnership product does, and all of the things that can happen during compounding, there are actually so many failure points. It's scary to think about it. So we can obviously have the wrong drug; we can have the wrong patient; we can have the wrong dose; we can have the wrong concentration. [It] can be even the wrong time; it can be the wrong diluent. There's so many things that can go wrong, and with our manual processes, which many pharmacies still have, it's harder to catch those things, and we have seen the increase in adoption of IV workflow technology and various automation whether that's robotics or gravimetrics, things like that. But it's it's not as high as we'd like to see. It only about a third, 30% to maybe 40% of pharmacies have some piece of that technology to help catch those types of errors. Barcode scanning is a way to really prevent that wrong drug and sometimes the wrong patient mismatch. So more more compounding pharmacies do have that technology, but that's only really one piece of it. So ways to try to prevent and eliminate those errors is really using the technology that we're not relying on our human manual processes to remember all of those things. So that's IV workflow solutions like our Simplifi+ IV Workflow with sure track are really super to help catch those things, and then you can also report on them too. So going back to some of those quality metrics and quality control processes, you can go back and look for trends and issues in particular, either personnel or products or processes, to then inform how you're going to make things better.

Pharmacy Times: What are the essential elements of a comprehensive compounding record, and how do you ensure its accuracy and completeness?

Lambert: The compounding record is the document of what was prepared, and all of those elements, there's a lot of required elements in the USP chapter. I'm not going to regurgitate them here, and then your states may also have some more specific items that are required, but there's some basic things like the patient name and the drug and the container that's in and who was involved in that compounding process. There are other elements also that might include release inspections or when you're that pharmacist that puts the initial on the final product, whether that's your physical signature or your documentation in a remote verification system you, are attesting to all of these elements being correct. They're also really important for tracking things like, again, medication errors. But if there's a recall, needing to know what the lot and expiration date of that component that you put in there, maybe there's a recall on that, and so that is a required element of the compounding record as well, so that you could go back and find out what happened with that compound, and even if it's already been administered to the patient, you can then alert the patient, alert the prescriber, and things like that.