At Jackson Health System in Miami, RIVA compounds pediatric medications. At the University of Kentucky Medical Center in Lexington, Ky., RIVA compounds antibiotics and medications used in surgery. The versatile RIVA can produce batches of sterile intravenous (IV) solutions in syringes and bags, or individualized dosages for specific patients.
RIVA is a fully automated system for compounding IV medications, enclosed aseptically in an ISO class 5 environment. So effective is RIVA that the healthcare research firm KLAS has recognized it as the best IV robot for the third year in a row. This recognition was made on the basis of surveys and interviews with healthcare providers and administrators.
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Bradley Robinson“We run the admixtures every single day, and we have four different batches every single day, seven days a week. We’ve done just short of 5,000 doses since the beginning of 2016,” said Bradley Robinson, PharmD, assistant director of pharmacy operations at Miami’s Jackson Health System, late in February. Jackson Health System comprises three hospitals, including Jackson Main, where the RIVA system is used to prepare pediatric IV medications for that hospital.
Ashlee Klevens“We have one RIVA unit that operates out of our central pharmacy,” said Ashlee Klevens, PharmD, associate director, central operations – sterile products and perioperative services, University of Kentucky Medical Center, which includes an academic medical center with 825 beds and a smaller community hospital.
“We compound primarily antibiotics and medications that are used in the operating room,” she said. "Our products are batched and used in both the academic and the community hospital."
The RIVA unit has been in place for more than a year at the UK Medical Center, Klevens said. It is in use for 10 hours a day, generally 20 to 80 hours a week. Before the system was installed, the center either compounded by hand or outsourced its IV compounding, she said.
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Jackson Health System also had either outsourced or compounded sterile injectables by hand, said Robinson. “There was certainly a cost issue for us to have it outsourced. There was cost savings to bring it back in-house,” he said. In the past, the hospital frequently was left waiting for the outside compounding pharmacy to deliver, “whereas if there is a missing dose, now you have everything right here,” he said.
One of the biggest reasons to bring robotic IV compounding in-house was to ensure that the facility has control over the process, collects data, and meets all USP 797 regulations, Klevens said. After contamination at outside compounding pharmacies became public in recent years, more people have become aware of the safety issues, she added.
“Physicians want to make sure we are doing everything we can to protect the patients,” she said. With RIVA, the medical center buys the drugs and has complete control over the entire compounding process, she noted.
Both Klevens and Robinson said that training on the RIVA system did not take long.
“It took me about a week to get the basic stuff down,” Robinson said. “The system is straightforward and intuitive.” UK Medical Center has two pharmacy technicians dedicated to the RIVA, Klevens said.
For the most part, physicians and nursing staff have seen no differences with medications prepared by the RIVA, Robinson said. “I go to the floor and ask, and they can’t even tell the difference.”
At UK Medical Center, anesthesiologists were engaged in making decisions on dosage sizes for certain medications and were excited about the increased safety, said Klevens. “Other than that though, they don’t want to know.”
Around the country
There are 38 RIVA systems currently in place in 28 healthcare facilities around the country, according to ARxIUM, which was formed last year when Intelligent Hospital Systems Inc., which developed RIVA, acquired AutoMed Technologies Inc. Facilities that use RIVA include pediatric hospitals, oncology centers, and centralized pharmacies for healthcare systems that have more than one site.
With continuing improvements in hardware and software, the 2016 model RIVA is considered a sixth-generation system.
Valerie DeBenedette is a medical news writer in Putnam County, N.Y.