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011000110110101011010101010000010101000101001001101010010001010101001 010000101011101011000110110101011100101010101000001010100010100100110 0100100010101010010010000101011101011000110110101010101010000010101000 010010011010100100010101010010010000101011101011001101001100101010101 000010101000101001001101010010001010101001001000010101110101100011001 1000001010100010100100110101001000101010100100100001010111010110001101 010101110010101010100000101010001010010011010100100010101010010010000 010111010110001100001010100010100100110101001000101010100100100001010 110101100011011011010100000101010001010010011010100100010101010010010 001010111010110010101010100000101010001010010011010100100010101010010 1000010101110101100011011010101101010101000001010100010100100110101001 001010101001001000010101110101100011011010101110010101010100000101010 0101001001101010010001010101001001000010101110101100011011010101010101 0000101010001010010011010100100010101010010010000101011101011001101001 001010101010000010101000101001001101010010001010101001001000010101110 011000110010100000101010001010010011010100100010101010010010000101011 010110001101101010111001010101010000010101000101001001101010010001010 010010010000101011101011000110000101010001010010011010100100010101010 100100001010111010110001101101101010000010101000101001001101010010001 101010010010000101011101011001010101010000010101000101001001101010010 010101010010010000101011101011000110110101011010101010000010101000101 010011010100100010101010010010000101011101011000110110101011100101010 010000010101000101001001101010010001010101001001000010101110101100011 110101010101010000010101000101001001101010010001010101001001000010101 101011001101001100101010101000001010100010100100110101001000101010100 0010000101011101011000110010100000101010001010010011010100100010101010 Now available 1001000010101110101100011011010101110010101010100000101010001010010011 with optional 101001000101010100100100001010111010110001100001010100010100100110101 camera for visual 0100010101010010010000101011101011000110110110101000001010100010100100 documentation 101010010001010101001001000010101110101100101010101000001010100010100 001101010010001010101001001000010101110101100011011010101101010101000 01010100010100100110101001000101010100100100001010111010110001101101010 110010101010100000101010001010010011010100100010101010010010000101 11101011000110110101010101010000010101000101001001101010010001010 010010010000101011101011001101001100101010101000001010100010100100 101010010001010101001001000010101110101100011001010000010101000101 01001101010010001010101001001000010101110101100011011010101110010 01010100000101010001010010011010100100010101010010010000101011101 11000110000101010001010010011010100100010101010010010000101011101 11000110110110101000001010100010100100110101001000101010100100100 010101110101100101010101000001010100010100100110101001000101010100 Elevating the standard in IV compounding BD Cato TM Medication Workflow Solutions 01010101010000010101000101001001101010010001010101001001000010101110101 00101011101011000110110101011100101010101000001010100010100100110101001 01101010010001010101001001000010101110101100110100110010101010100000101 01000101001001101010010001010101001001000010101110101100011011010101110 00011000010101000101001001101010010001010101001001000010101110101100011 0010101010100000101010001010010011010100100010101010010010000101011101 00001010111010110001101101010111001010101010000010101000101001001101010 10011010100100010101010010010000101011101011001101001100101010101000001 01010001010010011010100100010101010010010000101011101011000110110101011 11000110000101010001010010011010100100010101010010010000101011101011000 The state of IV compounding: It’s time for a new standard Today’s hospital pharmacy administrators are faced with multiple interconnected challenges1,2: • Improving medication safety and quality of care • Streamlining operations to reduce cost • Advancing pharmacy practices to meet changing times Evidence suggests room for improvement in IV compounding workflow RESULTS FROM A STUDY OF HOSPITAL COMPOUNDING ERRORS 3 91% CORRECT 9% ERROR 0% PHARMACY TECHNICIAN 7% 69% 16% 3% 5% WRONG DRUG WRONG DOSE WRONG FLUID OMISSION WRONG TECHNIQUE Dose variations with the visual-based volumetric method for chemotherapy compounding have been documented PHARMACIST NURSE • Dose variations ranging from -64.9% to 94.2% were recorded4 SELECTS ADMIXTURE COMPONENTS PREPARES ADMIXTURE AND AFFIXES TEMPORARY LABEL NUMBER OF VOLUMETRIC DOSES (DOSED IN SYRINGES) PERCENT DIFFERENCE FROM PRESCRIBED CHEMOTHERAPY DOSE 4 250 TRANSPORTS ADMIXTURE OUTSIDE 200 CLEAN ROOM VISUALLY CHECKS COMPONENTS AND VOLUMES; PULL-BACK VOLUMES • Nearly 13% of preparations failed to meet the 10% acceptable tolerance threshold4 150 100 50 100% -100% 2 CHECKS VISUALLY COMPONENTS AND VOLUMES ADMINISTERS ADMIXTURE -64.9% VISUALLY CHECKS PATIENT NAME, DRUG, AND VOLUME VS ORDER AND CALCULATIONS 94.2% RESULTS FROM A 91% CORREC 11000110110101011010101010000010101000101001001101010010001010101001001 10001010101001001000010101110101100011011010101010101000001010100010100 10100010100100110101001000101010100100100001010111010110001100101000001 00101010101000001010100010100100110101001000101010100100100001010111010 10110110101000001010100010100100110101001000101010100100100001010111010 10110001101101010110101010100000101010001010010011010100100010101010010 00100010101010010010000101011101011000110110101010101010000010101000101 10101000101001001101010010001010101001001000010101110101100011001010000 11001010101010000010101000101001001101010010001010101001001000010101110 01101101101010000010101000101001001101010010001010101001001000010101110 The typical clean room is far from state of the art RESULTS FROM A STUDY OF HOSPITAL COMPOUNDING ERRORS 3 PERCENT DIFFERENCE FROM PRESCRIBED CHEMOTHERAPY DOSE 4 250 200 150 100 50 Although technologic advancements such as the implementation of Computerized Provider Order Entry and Bar Code Medication Administration have been adopted to prevent errors across the medication management continuum, these efforts have been conspicuously absent in the realm of IV compounding. 91% CORRECT 9% ERROR 100% % -64.9 % 94.2 % 7% 69% 16% 3% 5% WRONG DRUG WRONG DOSE WRONG FLUID OMISSION WRONG TECH Workflow processes may be inefficient, often involving multiple transitions among personnel PHYSICIAN PHARMACIST PHARMACY TECHNICIAN GENERATES MEDICATION ORDER RECEIVES AND APPROVES ORDER SELECTS ADMIXTURE COMPONENTS PRINTS LABELS FOR IV ADMIXTURE VISUALLY CHECKS COMPONENTS AND VOLUMES PHARMACIST NURSE PREPARES ADMIXTURE AND AFFIXES TEMPORARY LABEL TRANSPORTS ADMIXTURE OUTSIDE CLEAN ROOM ADMINISTERS ADMIXTURE VISUALLY CHECKS COMPONENTS AND VOLUMES; PULL-BACK VOLUMES VISUALLY CHECKS PATIENT NAME, DRUG, AND VOLUME VS ORDER AND CALCULATIONS PLACES PERMANENT LABEL ON PRODUCT 3 01010101010000010101000101001001101010010001010101001001000010101110101 00101011101011000110110101011100101010101000001010100010100100110101001 01101010010001010101001001000010101110101100110100110010101010100000101 01000101001001101010010001010101001001000010101110101100011011010101110 00011000010101000101001001101010010001010101001001000010101110101100011 0010101010100000101010001010010011010100100010101010010010000101011101 00001010111010110001101101010111001010101010000010101000101001001101010 10011010100100010101010010010000101011101011001101001100101010101000001 01010001010010011010100100010101010010010000101011101011000110110101011 11000110000101010001010010011010100100010101010010010000101011101011000 BD Cato™: Where safety meets efficiency BD Cato™ Medication Workflow Solutions is a software system that was developed to advance the process of IV compounding. With its real-time gravimetric and bar code verification—in tandem with a step-by-step guidance system—BD Cato™ is designed to simultaneously minimize errors while improving efficiency. BD Cato TM Medication Safety—Designed BD Cato to minimize probability of errors PRESCRIBE TRANSCRIBE PREPARE DISPENSE TM ADMINISTER BD Cato PRESCRIBE TRANSCRIBE PREPARE DISPENSE ADMINISTER in IV compounding through a combination of gravimetrics and PRESCRIBE TRANSCRIBE PREPARE DISPENSE ADMINISTER bar code verification PHARMACY TM INFORMATION SYSTEM DOSE ORDER PRIORITIZATION BD Cato PHARMACY DOSE ORDER INFORMATION PRESCRIBE PHARMACY TRANSCRIBE PREPARE PRIORITIZATION DISPENSE SYSTEM INVENTORYINFORMATION PICK LIST AND DOSE ORDER MANAGEMENT SYSTEM INVENTORY PRIORITIZATION TM Workflow Efficiency —Standardizes workflow and removes SOFTWARE RECOMMENDATION redundant steps to help lower costs $ INVENTORY PHARMACY MANAGEMENT INFORMATION SOFTWARE INVENTORY SYSTEM $ $ ADMINISTER MANAGEMENT SOFTWARE $ $ $ $ $ $$ INVENTORY MANAGEMENT PHARMACY SOFTWARE INFORMATION SYSTEM RECOMMENDATION PICK LIST AND INVENTORY RECOMMENDATION FINAL PHARMACIST VERIFICATION IV ADMIXTURE IV ADMIXTURE Inventory Optimization —Helps reduce waste by optimizing use PREPARATION of drugs in the preparation of IV admixtures $ $ PICK LIST AND DOSE ORDER INVENTORY PRIORITIZATION RECOMMENDATION PICK LIST AND IV ADMIXTURE INVENTORY PREPARATION PHARMACY INFORMATION SYSTEM PHARMACY INFORMATION SYSTEM PREPARATION IV ADMIXTURE FINAL PHARMACIST PREPARATION VERIFICATION FINAL PHARMACIST Documentation, Compliance, and Analytics— VERIFICATION PHARMACY step to enable compliance and leverages data analytics Documents every FINAL PHARMACIST INFORMATION VERIFICATION SYSTEM to monitor productivity in the clean room Support for the use of gravimetrics is gaining momentum • ASHP and USP <797> support the use of gravimetrics as a validation technique in the IV compounding process5,6 4 • Latest guidelines from the Institute for Safe Medication Practices (ISMP) state that the syringe pull-back method of verification should NOT be used in the compounding of chemotherapeutic or pediatric/neonatal therapies7 11000110110101011010101010000010101000101001001101010010001010101001001 10001010101001001000010101110101100011011010101010101000001010100010100 10100010100100110101001000101010100100100001010111010110001100101000001 00101010101000001010100010100100110101001000101010100100100001010111010 10110110101000001010100010100100110101001000101010100100100001010111010 10110001101101010110101010100000101010001010010011010100100010101010010 00100010101010010010000101011101011000110110101010101010000010101000101 10101000101001001101010010001010101001001000010101110101100011001010000 11001010101010000010101000101001001101010010001010101001001000010101110 01101101101010000010101000101001001101010010001010101001001000010101110 BD Cato™: Step-by-step guidance for your clean room BD Cato TM PRESCRIBE TRANSCRIBE PREPARE PHARMACY INFORMATION SYSTEM DOSE ORDER PRIORITIZATION INVENTORY MANAGEMENT SOFTWARE PICK LIST AND INVENTORY RECOMMENDATION DISPENSE ADMINISTER IV ADMIXTURE PREPARATION PHARMACY INFORMATION SYSTEM FINAL PHARMACIST VERIFICATION 5 010101010100000101010001010010011010100100010101010010010000101011101011000110110101011 10101010100000101010001010010011010100100010101010010010000101011101011 10111010110011010011001010101010000010101000101001001101010010001010101 00100100001010111010110001101101010111001010101010000010101000101001001 01000101010100100100001010111010110001101101101010000010101000101001001 ™ 11010100100010101010010010000101011101011000110110101011010101010000010 01010101010000010101000101001001101010010001010101001001000010101110101 01011101011001101001100101010101000001010100010100100110101001000101010 10010010000101011101011000110110101011100101010101000001010100010100100 00100010101010010010000101011101011000110110110101000001010100010100100 01101010010001010101001001000010101110101100011011010101101010101000001 00101010101000001010100010100100110101001000101010100100100001010111010 10101110101100110100110010101010100000101010001010010011010100100010101 01001001000010101110101100011011010101110010101010100000101010001010010 10010001010101001001000010101110101100011011011010100000101010001010010 • Market-tested product 00110101001000101010100100100001010111010110001101101010110101010100000 with more than 1001010101010000010101000101001001101010010001010101001001000010101110 200 global customers 000010101110101100110100110010101010100000101010001010010011010100100 000101010100100100001010111010110001101101010111001010101010000010101 • Robust interface engine 010010011010100100010101010010010000101011101011000110110110101000001 that enables data import 0010101000101001001101010010001010101001 00101010101000001010100010 and export 000101010001010010011010100100010101010010010000101011101011000110110 101110101100011011010101010101000001010100010100100110101001000101010 • 24/7 technical and 100100010101010010010000101011101011000110010100000101010001010010011 customer support 010101000101001001101010010001010101001001000010101110101100011000010 00000101010001010010011010100100010101010010010000101011101011 0010 110110101011010101010000010101000101001001101010010001010101001001000 000101010100100100001010111010110001101101010101010100000101010001010 010101000101001001101010010001010101001001000010101110101100011001010 101011100101010101000001010100010100100110101001000101010100100100001 11010110001101101101010000010101000101001001101010010001010101001001000 001000010101110101100011011010101101010101000001010100010100100110101 010001010010011010100100010101010010010000101011101011000110110101010 BD Cato™ Medication Workflow Solutions is designed to minimize 101001100101010101000001010100010100100110101001000101010100100100001 the probability of errors in IV compounding through the use of an 010101110101100011011010101110010101010100000101010001010010011010100 interactive display, bar code scanner, and gravimetric scale. 10101010010010000101011101011000110110110101000001010100010100100110101 1010100100010101010010010000101011101011000110110101011010101010000010 • Uses real-time gravimetric verification that alerts pharmacist of 1001010101010000010101000101001001101010010001010101001001000010101110 potential errors 000010101110101100110100110010101010100000101010001010010011010100100 • Features bar code technology designed to detect dosing errors 000101010100100100001010111010110001101101010111001010101010000010101 related to incorrect selection of drug, diluent, and final container 010010011010100100010101010010010000101011101011000110110110101000001 0010101000101001001101010010001010101001 00101010101000001010100010 • Calculates drug and diluent quantities needed to compound Medication 000101010001010010011010100100010101010010010000101011101011000110110 prescribed admixtures Safety 101110101100011011010101010101000001010100010100100110101001000101010 • Provides immediate notification of errors and provides steps on 100100010101010010010000101011101011000110010100000101010001010010011 how to correct a mistake 010101000101001001101010010001010101001001000010101110101100011000010 00000101010001010010011010100100010101010010010000101011101011 0010 • Verifies that doses are prepared within institutional tolerances 110110101011010101010000010101000101001001101010010001010101001001000 • Enables pharmacist to verify admixture preparations remotely 000101010100100100001010111010110001101101010101010100000101010001010 • Does not print patient label until all steps are completed correctly 010101000101001001101010010001010101001001000010101110101100011001010 101011100101010101000001010100010100100110101001000101010100100100001 • Allows pharmacist to view final label and validate that admixture 11010110001101101101010000010101000101001001101010010001010101001001000 was prepared correctly 6 001000010101110101100011011010101101010101000001010100010100100110101 010001010010011010100100010101010010010000101011101011000110110101010 101001100101010101000001010100010100100110101001000101010100100100001 BD Cato : Elevating the standard in IV compounding 101010101000001010100010100100110101001000101010100100100001010111010110001101101010111 10001101101010101010100000101010001010010011010100100010101010010010000 10010010000101011101011000110010100000101010001010010011010100100010101 11010100100010101010010010000101011101011000110000101010001010010011010 11010100100010101010010010000101011101011 BD Cato™ Medication Workflow 001010101010000010101000101001 Solutions can help you improve your 01010001010010011010100100010101010010010000101011101011000110110101011 pharmacy’s workflow efficiency in various ways: 11000110110101010101010000010101000101001001101010010001010101001001000 01001001000010101110101100011001010000010101000101001001101010010001010 • Standardizes IV compounding processes through structured and Workflow 01101010010001010101001001000010101110101100011000010101000101001001101 uniform protocol 011010100100010101010010010000101011101011 00101010101000001010100010100 Efficiency • Helps reduce the number of manual quality-control checks that may 10101000101001001101010010001010101001001000010101110101100011011010101 be required in the preparation process 01100011011010101010101000001010100010100100110101001000101010100100100 • Captures digital data on preparation times and drug waste to help 10100100100001010111010110001100101000001010100010100100110101001000101 you identify and analyze areas where improvement is needed 00110101001000101010100100100001010111010110001100001010100010100100110 0011010100100010101010010010000101011101011 0010101010100000101010001010 01010100010100100110101001000101010100100100001010111010110001101101010 0101100011011010101010101000001010100010100100110101001000101010100100 001010101001001000010101110101100011001010000010101000101001001101010 100010100100110101001000101010100100100001010111010110001100001010100 101010001010010011010100100010101010010010000101011101011001010101010 01001001101010010001010101001001000010101110101100011011010101101010101 • Helps track and manage your inventory— 010101110010101010100000101010001010010011010100100010101010010010000 including partially used vials—to minimize waste 010010010000101011101011001101001100101010101000001010100010100100110 101010010001010101001001000010101110101100011011010101110010101010100 • Determines and recommends the best vial sizes for 010100010100100110101001000101010100100100001010111010110001101101101 Inventory preparation before your staff enters the 01010101000001010100010100100110101001000101010100100100001010111010110 clean room Optimization 001010111010110001101101010111001010101010000010101000101001001101010 • Designed to reduce waste of expensive drugs 001001101010010001010101001001000010101110101100110100110010101010100 during the IV compounding process by minimizing 000001010100010100100110101001000101010100100100001010111010110001101 workflow errors and reworks 101011101011000110000101010001010010011010100100010101010010010000101 00101011101011 0010101010100000101010001010010011010100100010101010 100100010101010010010000101011101011000110110101011100101010101000001 010101000001010100010100100110101001000101010100100100001010111010110 101011101011000110010100000101010001010010011010100100010101010010010 010001010101001001000010101110101100011000010101000101001001101010010 100100010101010010010000101011101011 0010101010100000101010001010010 0101000101001001101010010001010101001001000010101110101100011011010101 0101100011011010101010101000001010100010100100110101001000101010100100 BD Cato™ Medication Workflow Solutions provides automated 001010101001001000010101110101100011001010000010101000101001001101010 data capture that enables documentation, compliance, and 100010100100110101001000101010100100100001010111010110001100001010100 production analytics. 101010001010010011010100100010101010010010000101011101011001010101010 01001001101010010001010101001001000010101110101100011011010101101010101 • Provides fully automated documentation and a complete 010101110010101010100000101010001010010011010100100010101010010010000 audit trail of each compounding procedure 010010010000101011101011001101001100101010101000001010100010100100110 • Maintains a database of all prepared medications and features 101010010001010101001001000010101110101100011011010101110010101010100 010100010100100110101001000101010100100100001010111010110001101101101 Documentation a bar code–based tracking system for easy access 01010101000001010100010100100110101001000101010100100100001010111010110 and Analytics • Stores key preparation details, including actual dose used, 001010111010110001101101010111001010101010000010101000101001001101010 preparer’s name, and products used, as well as each product 001001101010010001010101001001000010101110101100110100110010101010100 NDC number, lot number, and expiration date 000001010100010100100110101001000101010100100100001010111010110001101 • Offers step-by-step guidance and multiple safety checks to help 101011101011000110000101010001010010011010100100010101010010010000101 you comply with the USP guidelines (<797> pharmaceutical 00101011101011 0010101010100000101010001010010011010100100010101010 compounding—sterile preparations)6 7 100100010101010010010000101011101011000110110101011100101010101000001 010101000001010100010100100110101001000101010100100100001010111010110 101011101011000110010100000101010001010010011010100100010101010010010 010101010100000101010001010010011010100100010101010010010000101011101 1000110110101011010101010000010101000101001001101010010001010101001001 001010111010110001101101010111001010101010000010101000101001001101010 0001010101001001000010101110101100011011010101010101000001010100010100 0110101001000101010100100100001010111010110011010011001010101010000010 100010100100110101001000101010100100100001010111010110001100101000001 0100010100100110101001000101010100100100001010111010110001101101010111 1010101010000010101000101001001101010010001010101001001000010101110101 001100001010100010100100110101001000101010100100100001010111010110001 110110101000001010100010100100110101001000101010100100100001010111010 BD Cato™: Elevating the standard in IV compounding Medication Safety More than 15 million gravimetric doses compounded worldwide*8 Workflow Efficiency Inventory Optimization Documentation and Analytics Interoperability • Provides data messaging between existing HIS and BD Cato™ Medication Workflow Solutions software via HL7 interface Support • Comes with dedicated 24/7 technical and customer support • Backed by BD, a company dedicated for more than a century to helping all people live healthy lives Ready to elevate your pharmacy’s standards? Call 1.855.489.CATO E-mail BDCatoUS@bd.com. Visit www.bd.com/cato to see BD Cato™ Medication Workflow Solutions in action! *All admixtures prepared using gravimetric verification. Total estimated preparations, as of 9/30/14. References: 1. ASHP Strategic Plan. Bethesda, MD: American Society of Health-System Pharmacists; 2013. 2. Pharmacy Automation: Technologies and Global Markets. Wellesley, MA: BCC Research; March 2014. Report IAS026D. 3. Flynn EA, Pearson RE, Barker KN. Observational study of accuracy in compounding i.v. admixtures at five hospitals. Am J Health Syst Pharm. 1997;54(8):904-912. 4. Poppe LB, Savage SW, Eckel SF. Assessment of final product dosing accuracy when using volumetric technique in the preparation of chemotherapy [published online ahead of print September 2, 2014]. J Oncol Pharm Pract. doi:10.1177/1078155214549489. 5. American Society of Health-System Pharmacists. ASHP guidelines on the safe use of automated compounding devices for the preparation of parenteral nutrition admixtures. Am J Health Syst Pharm. 2000;57(14): 1343-1348. 6. The United States Pharmacopeial Convention. <797> pharmaceutical compounding—sterile preparations. 2008. http://www.pbm.va.gov/linksotherresources/docs/USP797PharmaceuticalCompoundingSterileCompounding.pdf. Accessed November 17, 2014. 7. Institute for Safe Medication Practices. Proceedings from the ISMP Sterile Preparation Compounding Safety Summit: guidelines for SAFE preparation of sterile compounds. 2013. http://www.ismp.org/tools/guidelines/IVSummit/IVCGuidelines.pdf. Accessed November 17, 2014. 8. Data on file. BD. BD, BD Logo and BD Cato are trademarks of Becton, Dickinson and Company. ©2014 BD MSS0581 11/14 BD Medical 1 Becton Drive Franklin Lakes, NJ 07417 USA www.bd.com
