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IV Automa*on Experience at Duke University Hospital Udobi C. Campbell, PharmD, MBA Associate Chief Pharmacy Officer Duke University Hospital Duke Children’s Hospital and Health Center Duke Children’s Hospital & Health Center is
dedicated to the advancement of pediatric
healthcare by providing compassionate care to
children of all ages, from newborns to young
adults, in a family-friendly environment.
Duke University Hospital •  Endowed in 1925 by James B. Duke to meet the health care needs of the Carolinas •  Provide care across the life con*nuum including highly specialized, complex care, such as: – 
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Stem cell/bone marrow transplant Pediatric cardiac intensive care Comprehensive Cancer Center Level 1 Trauma Center Solid Organ Transplant TJC Disease specific accredita*on for VAD and stroke Duke University Hospital •  Part of the Duke University Heath System which includes 3 acute care hospitals as well as services such as primary care, home care and hospice, diagnos*c services, and health & wellness •  Provides an environment for research and educa*on ac*vi*es as a service to our pa*ents, their loved ones and each other •  Over 7,000 employees inclusive of 950+ residents, 29 hospitalists and over 2,000 volunteers •  In partnership with 1,400 physicians that we consider part of the workforce Duke University Hospital • 
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25 care delivery sites Over 45,000 discharges/957 beds Over 37,000 surgical procedures 1.2 million outpa*ent visits 67,000 ED visits 400 solid organ transplants Duke Pharmacy Mission To work collabora*vely with other healthcare professionals to provide op*mal pharmaceu*cal care to all pa*ents, to advance pharmaceu*cal knowledge through educa*onal and scholarly ac*vi*es, and to promote posi*ve pa*ent outcomes. Duke Pharmacy Sta*s*cs •  Opera*ng Expense of $199 million –  $28 million personnel –  $158 million pharmaceu*cals •  Total of 350 FTEs, including 148 pharmacists & 162 pharmacy technicians Duke Pharmacy Inpa*ent Sterile Prepara*on Opera*ons Cleanroom established in 2007 Provides 24/7 services Approximately 1800 doses prepared daily Physical separa*on of adult and pediatric prepara*on areas •  Available technologies • 
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Compounders Workflow / BCMP sobware IV robo*cs automa*on Dose tracking sobware Page 10
IV Robo*cs Experience at Duke Pharmacy •  Why did we consider it? –  Enhanced accuracy of compounded sterile prepara*ons (CSPs) •  BCMP/Gravimetric –  Support transi*on from high volume and expensive select premixed products •  $1.6 million annual spend •  Pharmaceu*cal u*liza*on management program •  What did we do? –  Installed 2 i.v. robots •  Named Elvis & Ivana •  Non pa*ent-­‐specific prepara*ons •  ~70,000 prepara*ons to-­‐date •  Non-­‐hazardous IV Robo*cs Experience at Duke Pharmacy Contributed to $167K Drug Savings with TransiDon from Premixed Products $50,000 $180,000 $45,000 $160,000 $40,000 $140,000 $35,000 $30,000 $25,000 $20,000 $15,000 $120,000 Pip-­‐Tazo 4.5g $100,000 Pip-­‐Tazo 3.375g $80,000 Pip-­‐Tazo 2.25g $60,000 $10,000 $40,000 $5,000 $20,000 $-­‐ Vanco 1 g $-­‐ Savings Total Savings IV Robo*cs Experience at Duke Pharmacy Hospital award earned for financial benefits released through
transition from premixed products and implementation of
IV robotics.
Key Considera*ons & Tac*cs with IV Robo*cs Implementa*on •  Governance structure –  Who has oversight of the process? • 
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Quality assurance Drug addi*ons Specific gravity collec*on Product performance Staff training Repor*ng capability Key Considera*ons & Tac*cs with IV Robo*cs Implementa*on •  Facility assessment –  Where should it be located? •  Cleanroom vs non-­‐
cleanroom •  Travel path from loading dock •  Ceiling height •  Door space •  Data ports •  Power outlets •  Work space •  Device accessibility for rou*ne maintenance Key Considera*ons & Tac*cs with IV Robo*cs Implementa*on •  Staffing plan –  How will staff be trained? • 
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Training plan Training valida*on Shib assignments Troubleshoo*ng and support service communica*on Key Considera*ons & Tac*cs with IV Robo*cs Implementa*on •  Change management –  Resistance at *mes is unavoidable –  Requires leadership –  Use staff feedback to improve performance –  Provide frequent updates –  Partnership with vendors to remove obstacles and improve product Next Steps for IV Robo*cs at Duke Pharmacy •  Interface development –  Support pa*ent-­‐specific dose prepara*ons –  Primer for further deployment of robo*cs technology Thank You