By Paul Sisson
UT San Diego
The recent fungal meningitis outbreak linked to an East Coast supplier has shined a new light on a trend among local health systems to bring more medicine compounding activities in house.
Three of the largest local hospital systems — Sharp HealthCare, Scripps Health and Palomar Health — are moving to centralized pharmacies that embrace automation as a way of both increasing quality and reducing cost.
All three systems are making big bets on technology, in the form of compounding robots that can prepare doses of needed medications with little human interaction, dramatically reducing the need to order from outside companies like New England Compounding Center, the company implicated in the meningitis outbreak that has killed 30 people nationwide and sickened more than 400.
Preliminary investigation results at the company’s East Coast facility showed a lack of sanitary conditions, and Virginia Herold, executive director of the California State Board of Pharmacy, said she believes health care providers will begin looking for ways to limit their reliance on outside compounding companies.
“I think that you’re going to see a lot more attention paid to what’s being compounded, how it’s being compounded and where it’s being compounded,” Herold said.
Compounding is the act of breaking up bulk drugs direct from the manufacturer into single doses for each patient. Because patients differ in terms of age, weight, sickness and many other factors, it is often necessary to tailor the dose each receives.
Traditionally, pharmacists have worked in sterile conditions to compound drugs by hand. That is changing at some local health systems.
Palomar Health is the latest hospital pharmacy in the county to put a compounding robot to work preparing intravenous medications.
Bots bring change
The new $956 million Palomar Medical Center in West Escondido, which opened in August, includes a huge pharmacy that centralizes all drug compounding for the three-hospital system, which operates in inland North County.
The facility includes a $1 million RIVA automatic compounding robot built inside its own sterile room right off the main pharmacy.
Dr. Cedric Terrell, Palomar’s director of pharmacy services, said that the robot uses ultraviolet light to sterilize both the bulk drug containers and intravenous bags or syringes during the compounding process. No human hands touch the drug containers until they are sealed and ready for delivery to patients. Terrell said the robot is efficient enough and precise enough that Palomar is automating as much of its compounding activities as possible, with a goal of 75 percent. He said Palomar expects to see a reduction in the number of pre-compounded drugs ordered from outside companies.
“We’re taking a hard look at the products we’re purchasing from compounding pharmacies and going down the line and saying, ‘OK, we can now compound this product in house,’” Terrell said.
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