How a robot can terminate medical errors for kids

RIVA the robot is ready with an IV and the right dosage

In a children's hospital, dispensing medicine is more complicated than putting pills in a bottle. Youthful patients come in a wide variety of ages and sizes, which means their dosages must be individually tailored.

Hundreds or thousands of medicines must be made up and delivered daily. Combine that with the breadth of not-always-easy-to-distinguish medicines and dosages and even careful pharmacists and other medical personnel can slip up when tired or distracted.

Now, technology has arrived that its makers promise can drastically cut down on drug-related errors. The Robotic Intravenous Automation (RIVA) device made by Winnipeg-based Intelligent Hospital Systems is a robotic arm that can prepare sterile IV syringes and bags behind its glass case.

RIVA's software is a custom-built .Net 2.0 app written in C# running on Microsoft's Windows XP Embedded operating system on an Intel processor. To make the code lean, RIVA relies heavily on scripts stored inside a Sybase Inc. embedded database, SQL Anywhere, Doherty said.

The $1.2 million system, released late last year, is already in use at three children's hospitals in the U.S., with another two facilities preparing to deploy it, according to Thom Doherty, CTO at Intelligent Hospital Systems. "We can never bring the risk down to zero, but with RIVA we are bringing the risk as low as possible," he said.

How? For repetitive-but-critical tasks like preparing medicines, it's a no-brainer that robots are better than people, Doherty said. "A machine doesn't lose attention or focus like a human does," he said.

The RIVA is more sterile and less prone to contamination than using human pharmacists, and it's built to be adept at spotting potential errors, said Doherty. After medications are loaded by a technician, the camera scans drug labels for names, doses and expiration dates. The balance weighs vials and syringes to establish their weights, while the robotic arm and laser sensor measures how large the syringes are.

All told, 3% to 4% of drugs being combined by RIVA are rejected before they are completed due to discrepancies, with data being captured in the software-equivalent of a black box in case of errors.

Drug-related errors sometimes bubble up into the news. In 2006, the newborn twins of actor Dennis Quaid almost died when they were accidentally given 1,000 times the dosage of a blood thinner called heparin. Quaid is suing heparin's maker, Baxter Healthcare, for negligence, arguing that its packaging did not differentiate enough between dosages. He's also testified before Congress on the topic ( download PDF).

So far, no hospitals have reported any incorrect doses created by RIVA, Doherty said. That's in part because live pharmacists remain the ultimate gatekeeper. "We will never replace having the pharmacist check the final order and approve the prescription," Doherty said.

To further cut down on the risk of errors, RIVA can connect with computerized physician order entry (CPOE) systems that require a doctor to choose and confirm a drug via computer rather than scribble the prescription on a notepad. And it works with bar-code medication administration (BCMA) systems that confirm when medicines are given, Doherty said.

Children's Hospital of Orange County in Southern California is one of RIVA's users. Rita Jew, executive director of the pharmacy, told the Orange County Register that RIVA helps reduce wasted medication and errors and will give pharmacists more time to work with doctors and nurses.

It's also a good investment, according to Doherty, who said RIVA buyers should be able to earn a return on their investment within two to three years.

While RIVA could threaten some pharmaceutical jobs, Doherty noted that it helps pharmacists avoid exposure to toxic chemicals, a major drug hazard. It can also relieve much of their stress, he said.

"This takes a weight off the shoulders of pharmacists, who tell me, 'Every day I go home and think, is this the day I made a mistake?'"

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