Errors in sterile compounding can occur at any time, stemming from a variety of causes. Streamlining pharmacy operations is critical to mitigating the potential for errors and offers the added benefit of increasing staff members’ time to provide patient care. When managing limited resources and staff, an effective equipment solution can improve efficiency and productivity while helping to reduce compounding errors.

Bristol Regional Medical Center, a tertiary care facility under Ballad Health, is a 348-bed facility serving an economically diverse patient population across Tennessee and Virginia. The facility recently implemented the Smarthood by GermFree to help manage its unique patient needs, minimize the opportunity for error, and increase efficiency in the compounding suite.

Implementation Goals

Hospitals and infusion centers face staffing shortages, surges in patient volumes, and IT-related downtimes, while under simultaneous pressure to support a reliable and consistent medication delivery process that does not impede the workflow of other areas in the hospital. Pharmacy’s primary goal in implementing the Smarthood is to ensure safety and efficiency amidst the challenges that result from these limited resources.

A Single Streamlined System

Although Bristol’s electronic health record (EHR) offers an IV workflow management system, the third-party components required to implement the platform led to a hodgepodge system of software and hardware. The time required from information services (IS) to maintain this amalgamation of tools led to unexpected downtimes and challenges during various software upgrades. As compounding volume and capabilities continued to expand, this was no longer a sustainable model to implement across an entire healthcare system.

In response, the pharmacy team worked with Germfree to implement the Smarthood. Because this project involved both a physical hardware installation and support from IS, it was important to involve all stakeholders at the outset of the implementation process to ensure a smooth transition. Pre-implementation work included building new label templates, restructuring existing workflows in the cleanroom suite, reviewing the hardware components with IS, and scheduling the physical installation and ensuing certifications of the equipment. Compounding volume was minimally affected during the implementation due to the availability of a secondary compounding location.

System Advantages

Upon go-live, the most notable workflow improvement enabled by the system is that a technician can complete a preparation from start to finish without leaving the hood. This capability keeps the technician’s hands inside the hood and reduces distracting interruptions. As such, technicians are more productive and focused on their work, and this greater attention leads to a reduction in errors.

The system inspired the pharmacy to develop a label routing system to support the streamlined workflow enabled by the Smarthood. Using the EHR, printers are assigned locally based on the computer generating the print order. Thus, compounding technicians can print sterile, plastic-backed, intermediate labels directly within the hood without having to leave. A final label is affixed to the product after validation by a pharmacist. This creates an added element of security and accuracy to avoid labeling errors.

The Smarthood allows the flexibility to adapt to changing conditions in order to prepare a variety of medications, from small doses required in a NICU to time-sensitive compounds needed quickly in a trauma center. Offering visibility into dispenses, the system allows for closer inventory management to reduce waste. This is particularly helpful for medications experiencing a shortage. For security and verification, a camera is included with the system, which allows the pharmacist to observe and verify the preparation without having to enter the cleanroom.

Future Developments

Germfree continues to support the facility beyond initial implementation, including considering suggestions based on our use of the system. We worked with them to re-engineer the label printer and door, and to reposition the trash chute/motorized door.

Future capabilities already in production include enabling a live video feed of the technician in the hood. If an unexpected roadblock occurs, the pharmacist can view the preparation in real time, allowing them to confirm the compounder’s technique without having to interrupt their work to garb up and enter the cleanroom. The camera also brings the potential to involve AI technology to monitor the compounding and trigger alerts should techniques need to be adapted or corrected.

Conclusion

Workflow standardization leads the way to error reduction and efficiency. Ongoing manufacturer support helps pharmacy staff adapt to a new system, and a platform-agnostic system allows flexibility for IV compounding software. With the capabilities of the Germfree Smarthood, pharmacy can enhance the compounding workflow and operations while ensuring increased patient and medication safety.

Daniel Rose, PharmD, MBA, BCPS, is the pharmacy clinical & operations manager at Bristol Regional Medical Center in Bristol, Tennessee.