Maximize Benefits of IV Workflow Systems

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Health-System Edition, July 2021, Volume 10, Issue 4

Institute for Safe Medication Practices advocates technology solutions, such as barcode scanning of ingredients

Intravenous (IV) workflow systems using technology have been available for years to those who compound sterile products. The Institute for Safe Medication Practices (ISMP) has emphasized the value of tech solutions applied to sterile compounding, including barcode scanning of ingredients and volumetric/gravimetric verification of drug and diluent volumes.

The ISMP has noted that these systems help reduce errors in the IV workflow process.1 Previous literature also documents the value of IV workflow and automation systems as related to medication safety, productivity, and standardizing IV compounding processes.2-5

Even with results from several studies demonstrating the value of IV workflow systems, health systems have been slow in adopting these safety tools that help standardize the IV workflow and detect medication events.4 The adaptation rate is much different among large facilities with more than 400 beds. These facilities tend to use IV workflow systems at a rate greater than 50%, whereas 20% or less of smaller hospitals use these systems.4 Labor and safety continue to be emphasized through accreditation and regulatory bodies, and technology is touted as improving both. So what are the barriers hindering adoption? For those who have moved toward using these tools, have they obtained the benefit they had anticipated?


A survey was developed and sent to 200 recipients between May 2020 and May 2021 to determine barriers to implementation and results obtained from those who have implemented the IV workflow system. The survey was also distributed via direct email to 350 pharmacy administrators or pharmacy staff members with direct supervisory roles for IV rooms across the United States through targeted email invitations. Additionally, to increase participation, respondents were targeted using anonymous participation requests and links on the American Society of Health-System Pharmacists medication safety officer, pharmacy informatics, and pharmacy practice management discussion boards, and additional databases containing pharmacy management information for mid- to large-size hospitals were used. A survey question was included to identify whether respondents had adopted IV automation technology. Those who answered that they had not implemented the technology were asked questions about identifying barriers to adoption and why they did not embrace the technology. The survey instrument consisted of 24 questions targeting the following key areas: purchasing decision methodology, justifications for making a purchase or not, and considerations related to financial impact. Demographic information and the respondents’ practice settings were also included. The survey was administered using the Qualtrics survey platform and data were recorded anonymously. An Institutional Review Board approved the research.


A total of 68 responses were received, with a breakdown of compounding/outpatient pharmacy (5.88%); for-profit health system or hospital pharmacy (7.35%); nonprofit health system or hospital pharmacy (72.06%); state, Veterans Affairs, or other government-affiliated health system or hospital (7.35%); or other (7.35%).

Of note, 25% of respondents stated that they have not considered IV workflow systems previously and do not plan to. Although 20% had implemented IV workflow systems, another 7% had purchased but not completed implementation. In addition, 32% of respondents were considering making a purchase.

Of those that have implemented IV workflow products, 50% did not obtain any financial savings from the purchase, and 65% outsourced some portion of sterile compounding, whereas 35% did not. The majority of those who implemented IV workflow systems did not anticipate reducing outsourcing (68%).

Barriers identified toward purchasing IV workflow systems were based upon a 5-point Likert scale, with 1 being not a barrier and 5 indicating it prevents any movement on the project. The most frequently cited barriers and percentages stating a significant barrier toward or preventions of movement to purchase were the cost of automation (3.84, 76%), other competing capital projects (3.36, 60%), resources required for the project (3.12, 44%), lack of perceived return on investment (2.88, 36%), and time to take on project implementation (2.88, 16%). Other barriers reviewed that did not show a large impact on purchasing decisions were board of pharmacy approval, level of staffing or staff resistance to change, and upcoming renovation projects.


Medication safety is an essential driving factor in the implementation of IV room automation. However, the significant cost and difficulty of monitoring systems value has presented barriers for health systems to implement technology, even though these tools have been shown to reduce medication errors and streamline workflow. Facilities that wish to pursue technology for their IV rooms should engage in formal return on investment analysis and ensure that critical goals can be met and are monitored. In addition, health-system administrators should be engaged early and often with staff to build buy-in, consensus, and support for the project.


Kenneth Maxik, MBA, MBB, FACHE, is vice president of operations support at CompleteRx Ltd in Houston, Texas.

Craig Kimble, PharmD, MBA, MS, BCACP, is director of experiential learning, manager of clinical support services, and associate professor of pharmacy practice, administration, and research at Marshall University School of Pharmacy in Huntington, West Virginia.

Alberto Coustasse-Hencke, DrPh, MD, MBA, MPH, is a professor of health care management and administration at Marshall University Lewis College of Business in Huntington, West Virginia.


1. Deng Y, Lin AC, Hingl J, et al. Risk factors for i.v. compounding errors when using an automated workflow management system. Am J Health Syst Pharm. 2016:73(12):887-893. doi:10.2146/ajhp150278

2. Moniz TT, Chu S, Tom C, et al. Sterile product compounding using an i.v. compounding workflow management system at a pediatric hospital. Am J Health Syst Pharm. 2014;71(15):1311-1317. doi:10.2146/ajhp130649

3. Current state of IV workflow systems and IV robotics. American Society of Health-System Pharmacists. Accessed June 23, 2021.

4. Shah HM, MacDonald C. Implementing an IV workflow management system. Pharmacy Purchasing & Products. September 2020. Accessed June 23, 2021.

5. Talley CR. Sterile compounding in hospital pharmacies. Am J Health Syst Pharm. 2003;60(24):2563. doi:10.1093/ajhp/60.24.2563