Aug. 12, 2022

Mayo Clinic in Rochester, Minnesota, began using the state's first robotic intravenous compounding system in March 2022. While the concept of and technology for automated chemotherapy compounding has been around for nearly 10 years, advancements in the tools available have increased uptake of chemotherapy robots in the US in the last five years.

"We're really seeing that it's a wave," says Scott A. Soefje, Pharm.D., M.B.A, director of pharmacy cancer care at Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota. "We're in the first wave of this type of technology, and we'll get to the point where there is a second wave and more things are handled by automation."

The long-term goal of automation programs like these is that no human would have to handle potentially harmful chemotherapy drugs and could therefore focus their time and skills on working more directly with patients.

A compounding process guided by checks and balances

The system compounds chemotherapy with a series of checks and balances incorporated. The machine uses barcode technology and interfaces with Mayo Clinic's electronic health record (EHR) to receive orders directly from a patient's chart.

The system knows and has access to exactly what is needed to create the chemotherapy compound, including vials and bags. The robot is even preloaded with syringes. Before it gets to work, however, a staff technician confirms the medications.

After scanning the appropriate barcodes, the technician loads the medication into the machine. The robot uses additional checks and balances by way of gravimetric analysis as it compounds the medication.

When the compound is complete, the technician unloads it from the machine and scans the barcode again, which generates the final product label. A pharmacist conducts the final verification before the chemotherapy is ready to be administered. Throughout the process, the robot is continuously capturing information should any verification be needed later.

"At Mayo Clinic, we value developing and using innovative technologies," says Clayton C. Irvine, Pharm.D., M.B.A., a senior manager for oncology cancer care at the Cancer Center in Minnesota. "This is one way we're using technology to its fullest."

Growing capacity and caseload

Depending on the preparation needed for each medication, the robot can compound a chemotherapy dose in 4 to 7 minutes on average. This is comparable to the time spent on the same process by a human. For some drugs, the robot is faster than a human.

Theoretically, the robot can compound any chemotherapy for any indication because it is totally customizable, but efficiency is key with the use of this technology, explain Drs. Irvine and Soefje.

"It wouldn't make sense to use the robot for some cancer drugs because they take a long time," says Dr. Irvine. "So those may be drugs that would be better suited to be made manually."

Right now, the Cancer Center is using the chemotherapy robot for 18% to 20% of the site's total chemotherapy volume. Dr. Soefje explains that the goal is to administer one quarter of the total volume using the robot, and eventually ensure all the most hazardous drugs are compounded in this way.

The right person for the right job

For Mayo Clinic, one of the most important benefits of a chemotherapy robot is ensuring the right person is able to do the right job at the right time. With capacity made available, pharmacy staff can be more interactive with patients.

"As care models are changing, it's important that we find different ways to meet the needs of our patients," says Dr. Irvine. "We use technology and tools not because we don't think people can be as safe and effective but because it gives us the chance to provide care in new ways."

The robot also enhances safety for both staff and patients. While technicians have been incredibly accurate as well, the chemotherapy robot consistently has less than 1% margin for error, taking accuracy in compounding to a whole new level. This ensures patients are getting the exact therapy ordered for their indications with no mistakes.

Similarly, staff safety can be greatly improved by removing handling of hazardous materials. Without the robot, these medications would be compounded by a technician. Appropriate precautions are taken to protect people who need to handle these medications, but limiting handling of the drugs is far safer.

"This is a tool that helps us work better," says Dr. Soefje. "It allows us to do our jobs better."

For more information

Refer a patient to Mayo Clinic.