BD CATO™ Medication Workflow Solutions

1. BD CATO™Medication Workflow Solutions Presented by: Robyn Bryson, PharmDPardee Oncology Infusion Pharmacy Manager Date: April 2, 2018

2. What is a Hazardous Medication? • The medication is deemed as hazardous if one or more of the following characteristics is found in humans or animals1: • Carcinogenicity • Teratogenicity or other developmental toxicity • Reproductive toxicity • Organ toxicity at low doses • Genotoxicity • Structure/toxicity profile of a new med that mimics an existing med that is considered hazardous 1. Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. NIOSH ALERT. DHHS. CDC. Sep 2004.

3. Our Current Practice for Hazardous Medication Sterile Compounding • Pharmacist verifies electronic physician order. • Checking for appropriate dose based on patient weight. • Checking for appropriate lab results to be within range. • Production label is generated and passed to pharmacy technician in the hazardous clean room. • Pharmacy technician locates the appropriate base solution bag, vial(s) of medication, and supplies needed for preparation. • Tech records medication lot number and expiration date on the production label, then uses the label as a guide on drawing up the appropriate amount of medication. • Pharmacist must don PPE, wash hands, don remaining PPE, and enter the clean room to prepare final check. • Verifies correct med, concentration and base solution. • Verifies correct volume in syringe. • Visually confirms that tech places the med into the correct base and applies final label.

4. Examples of Volumetric Compounding

5. Possible Factors That Lead to Errors • Wrong medication concentration in inventory. • Not performing manual NDC check. • Medication vials/packaging may look similar. • Medication names may sound similar. • Miss-reading syringe increments. • Choosing incorrect diluent for reconstitution. • Choosing incorrect base solution product/volume. • Compounding area overwhelmed with supplies/labels.

6. BD CATO™ Medication Workflow Solutions • Technology that replaces volumetric compounding with gravimetric compounding. • Volumetric compounding is using the compounder’s vision to check the volume of product. • Limitations on volume to prepare based on the syringe’s minimum measurements. • Visual error is possible. • Gravimetric compounding is using an electronic scale that determines the volume of solution based on the known specific gravity and weight of the product. • Ensures accurate compounding by measuring the weight of the medication being drawn up into the syringe as it relates to the dose ordered.

7. BD CATO™ Medication Workflow Solutions • Utilizes the electronic scale, camera, scanner, and monitor inside of the hazardous clean room. • Utilizes CATO™ software for pharmacist verification. • Utilizes barcode scanning for inventory maintenance. • Program is compatible for interfacing with current Electronic Medical Record.

8. BD CATO™ Medication Workflow Solutions • Order verified by Pharmacist. • The order is sent into the BD CATO™ work queue. • Technician opens new order and is prompted by software to choose specific medication(s) and base solutions needed. • Software will recommend smallest inventoried vial in order to reduce waste. • Technician scans each barcode of product and BD CATO™ confirms products. • There are hard stops that prevent the tech from moving forward until the error is corrected. • BD CATO™ provides step-by-step instructions on how to prepare the compound and takes pictures throughout the process. • RPh verifies final compound through software program utilizing the pictures taken during compounding.

9. 2. BD CATO™ Medication Workflow Solutions Brochure. 2015 BD

10. BD CATO™ Prevents: • Wrong medication strength in inventory. • Not performing manual NDC check. • Medication vials/packaging may look similar. • Medication names may sound similar. • Miss-reading syringe increments. • Choosing incorrect diluent for reconstitution. • Choosing incorrect base solution product/volume. • Compounding area overwhelmed with supplies/labels.

11. BD CATO™ Medication Workflow Solutions • M. D. Anderson Cancer Center implemented BD CATO™ I.V. workflow system in October 2012. • Over 12 month period post implementation: • Baseline preparation cycle time for a dose prepared by pharmacy technician seen a 34% time decrease. • Baseline cycle time to verify each prepared dose by the pharmacist seen a 37% time decrease. 3. Reece KM, Lozano MA, Roux R, Spivey SM. Implementation and evaluation of a gravimetric i.v. workflow software system in an oncology ambulatory care pharmacy. Am J Health-Sys Pharm. 2016; 73: 165-73.

12. BD CATO™ Medication Workflow Solutions • Pardee Oncology Infusion Pharmacy will be the first pharmacy in the WNC region to utilize a gravimetric compounding software for compounding sterile hazardous medications.

13. BD CATO™ Medication Workflow Solutions • Contract Totals: • Annually: $42,948 • 60 month contract: $214,740