While sterile compounding is a crucial part of the drug preparation process, it can be complicated to ensure it is done in a cost effective, time efficient, and accurate manner.

Intermountain Health, a medical group based in Utah, set out to improve sterile compounding by centralizing it with the help RIVA IV automation systems. Recently, the medical group published a whitepaper detailing the implementation, testing, and findings of centralized sterile compounding at their facility.

The 5 year project began with the construction of a new Intermountain facility, The Supply Chain Center Acute Care Pharmacy (SCC ACP). The facility was conceptualized in 2010 and began compounding in the fall of 2012 with the help of 3 ARxIUM RIVA units. These automation systems enabled Intermountain to standardize the production of compounds and improve accuracy by eliminating human error.

“We wanted to make sure we were able to minimize variation and minimize errors and patient harm, and also ensure the potency and sterility of compounded sterile products use in our system,” said Rob Muelleck, RpH, MBA, Director of Pharmacy at Intermountain Health SCC ACP.

For the first 2 years of the project, Intermountain focused on the standardization of batch compounds to reduce variation and create a transparent sterile compounding process; reduce the amount of full-time employees used for sterile compounding and transfer them to higher value positions; reduce human error through automation; and reduce costs by eliminating the need for ready to dispense compounds from outsourced providers, according to the whitepaper.

After the first 2 years, issues with the RIVA systems were assessed. Some of these issues include a lack of comprehensive software system to manage inventory, orders, and deliveries; hardware and software issues that decreased efficiency of the RIVA systems; supply issues for certain diluent solutions; and process design flaws that impacted turnaround time on orders.

In year 3, a committee of Intermountain Healthcare Pharmacy Leadership and ARxIUM Consultants was formed to optimize the RIVA systems by designing solutions to these issues.

As more than half of the problems were attributed to hardware and software errors, the committee created a 3-phase plan to improve the automation system. The plan involved addressing issues with mechanics and software, optimizing automated compounding processes, and executing a plan to expand the drugs compounded at SCC ACP, according to Intermountain.

By the end of year 3, the number of bags rejected due to hardware/software error was reduced from 167 bags to 32, while the number of overall bags produced increased from 10,942 to 14,952. The amount of rejected syringes also decreased from 159 to 8, and the overall number produced decreased from 8614 to 7819.

In years 4 and 5, Intermountain focused on the continued growth of the supply chain facility. They expanded the amount of drugs compounded from 6 to 14 over the last 2 years of the project, and made SCC ACP the sole provider of certain sterile compounds.

In a statement, Intermountain noted that centralizing sterile compounding at SCC ACP, with the help of the RIVA automation systems, has returned significant value to the medical group, both clinically and financially.

“Automating sterile processing is one the things you can do to improve quality and also efficiency and productivity, and the combination of those three things leads to a financial gain,”
said Craig A. Boyce, RpH, Director of Professional Services at ARxIUM.

In the future, the company plans to adapt to a changing market while upholding high quality standards. They are also looking to add more drugs, such as paralytics and vasopressors to the facility.


Five Years Experience in a Centralized Sterile Compounding Service with RIVA IV Automation System. Intermountain Healthcare Supply Chain Center Acute Care Pharmacy.  https://www.arxium.com/wp-content/uploads/2018/09/IHC-SCC-ACP-FIve-Years-Experience-in-Centralized-Sterile-Compounding-....pdf?rel=0" ?rel=0"