Comparison of BD Pyxis IV Prep and Epic Dispense Prep with Gravimetric Checking for Production of Hazardous Compounded Sterile Preparations at a Cancer Care Center



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BACKGROUND: The Institute for Safe Medication Practices recommends gravimetric analyses during production of all CSPs with known specific gravity for institutions that regularly prepare parenteral chemotherapy.1. Gravimetric-based IV workflow software allows for electronic confirmation of the ratio of expected ingredients.. The study institution utilizes two technology systems to support preparation of CSPs. The ambulatory care pharmacy uses BD Pyxis™ IV Prep, which is a software developed as a dispensing system with gravimetric capabilities. The inpatient pharmacy uses Epic Dispense Preparation does not utilize a gravimetric analysis but has the capability to have gravimetric checking configured. The purpose of this study was to systematically assess gravimetric-based IV workflow software systems in inpatient and ambulatory care pharmacies at the study institution.

METHODS: Dispense reports were obtained from both software systems. The data was filtered to include preparation start and stop times orders composed of ten chemotherapy agents. The gravimetric checking feature was incorporated into the drug build of the pre-specified agents in the Epic test environment. Pharmacy technicians prepared doses in the test environment and production times were assessed. To evaluate safety, a report from the institution’s Safety Intelligence system was assessed and a failure modes and effects analysis was performed for both software systems.

RESULTS: The average preparation time for all drugs prepared in the ambulatory care and inpatient pharmacies was 3.98 minutes and 2.33 minutes. The p-value for the pharmacy variable was less than 0.0001 indicating statistically significant differences in preparation time between the two pharmacies while controlling for drug. The ambulatory care pharmacy preparation times were greater than inpatient pharmacy preparation times by 1.63 +/- 0.085 minutes per CSP while adjusting for drug utilized.
CONCLUSION: The difference in preparation times between the inpatient and ambulatory care pharmacies emphasizes the variation in sterile compounding configuration between Epic Dispense Preparation without gravimetric checking and BD Pyxis IV Prep. The results of this study should be evaluated with other variables, including financial considerations and personnel resources available to build and maintain the technology, to reflect a more comprehensive method of determining the best gravimetric technology to meet the needs of the pharmacy.



Pharmacy, Gravimetric