Installation, calibration, updating and training can sometimes turn out to be a hidden burden with new technology demanding many hours of extra work. However, Pharmacolog has taken a number of steps to make these steps quicker and smoother. One of these is the compilation of a large database of calibrations or ‘fingerprints’ of the drugs that are commonly measured. “If you were to buy a system from us we can prepopulate it with maybe not every drug that you are using but …… most likely we can prepopulate the device with fingerprints that cover maybe 80% of the [drugs you are using]”, says Mr Högberg. Moreover, when a new drug is brought into use it is easy for the user to calibrate the device using a number of standard concentrations. In this way users can build up their own library of drugs and concentrations.

“The system is also designed a bit like an internet of things so every measurement, all the calibrations and the fingerprints you have are stored in the cloud so that if something happens with it we will send you a replacement system and things are being downloaded and you are up and running in maybe half a day …… So everything is backed up. We also perform service and support online because we can access the measurements and we can also access the system [with] permission, and guide you through. That is something that has really helped us throughout the pandemic. We are today shipping systems and installing training remotely and it works beautifully because of the technology that we have developed”, explains Mr Högberg.

In order for a drug to be measurable in DrugLog it needs to be a clear solution and absorb light of a wavelength between 200 and 800nm.

Next steps for Pharmacolog

Pharmacolog is currently involved in an exciting new development project together with the University in Uppsala.  Based on the company’s core technology, the objective is to develop a tool that can quickly determine antibiotic levels in blood. “Today it is important for a patient with sepsis or severe infection that they have the right level of antibiotics on the blood throughout the treatment and there are no easy ways to determine this. You can do it with HPLC but it is costly and it takes time. Our goal is to have a tool that would, in 20-30 minutes, provide an indication to the physician that yes, you have the right level or you are too low. Typically, they are too low today”, explains Mr Högberg. Because drug handling varies between patients it is important to be able to check every patient to ensure that drug levels are in the right therapeutic window. “It’s a future project but we have made some major progress over the past year”, he adds.

Reflections on developments

Two observations underline the place of DrugLog in the changing the landscape of injectable drug preparation:

“It’s almost as though the surrounding world has caught up with us…” says Mr Högberg. One development that stands out in his mind is the way that a community pharmacy in Germany advertises its injection compounding business by showing that they have a DrugLog to quality control the final products.

DrugLog appears to be a technology whose time has come. “When I first went to EAHP (European Association of Hospital Pharmacists Congress) in Vienna, you could read a lot of scientific papers ….that were about medication errors. There were several studies from Germany and France …3-4% of all the bags in chemo production were outside the tolerances. That is too much ……no industry would accept that error rate ….and now people are looking for solutions – so that’s interesting”, says Mr Högberg.

Visit the Pharmacolog website here.

Read and watch the full series on our website or on YouTube.

WasteLog

WasteLog is a device that is today sold only in the US where it is being used to screen drug waste that is returned to the pharmacy from operating theatres (operating rooms, ORs). In the US there is a strong focus on ‘drug diversion’ – “drugs that end up in the wrong hands or in the wrong pocket”, explains Mr Högberg. “When a half-filled syringe comes back from the OR, before it’s thrown away they also want to verify that no-one has tampered with the contents or replaced it with saline. That’s where WasteLog comes in. WasteLog is being used then to verify that this half-filled syringe that’s just been returned actually contains morphine or fentanyl and has not been tampered with”, he says.

WasteLog was developed after the company started to receive enquiries from US hospital pharmacists who had seen DrugLog in exhibitions and realised that it could be used to verify the contents of returned, part-used vials and syringes.  “When we realised that there is huge interest in the US market in this technology we developed some specially-dedicated software and created WasteLog”, says Mr Högberg. Today WasteLog is in operation in a number of hospitals in the US – in New York, Texas, Southern Illinois and California. Hospitals typically purchase several devices to install in separate facilities.  “We have tremendous growth and a great interest in WasteLog in the US market at the moment”, he added.

PrepLog

PrepLog is an integrated version of DrugLog. DrugLog is a manual device where you enter the expected drug identity and concentration manually. Mr Högberg describes how the WasteLog process works: “We have created completely new software that integrates with the hospital’s prescription system. If we take chemo as an example – the physician prescribes a chemo treatment, the prescription is then transferred over to the hospital pharmacy where they prepare the drug according to the prescription. The prescription is also transferred into PrepLog so when [the drug has been prepared] it shows a work list, they click on [the relevant] one and it re-populates the device with the expected drug identity and expected concentration. When you have the result and you have your label on the bag [confirming] that the preparation is OK, the information is also transferred back into the prescription system so that you have full traceability afterwards”.

PrepLog is also being used in paediatric settings where these preparations are done at the ward. This is possible because the basic workflow elements are the same – prescribing, preparation, checking and storage of the result in the electronic medication record or prescription system.

The use of PrepLog removes some of the stress experienced by ward staff in busy situations. “My wife is a nurse and she has told me many times that in a stressful situation at an ICU department you get interrupted in the middle of preparing or double-diluting a sensitive drug and you have to throw everything away because you weren’t sure if you did all the steps correctly. With PrepLog you can quickly verify that the delicate drug that you have prepared for a child or someone who is very sick is correct – and it takes away a lot of stress from the staff”, says Mr Högberg.

Software has been written to integrate PrepLog with the major prescription systems in France and in Spain. The PrepLog device has been running at a hospital in Barcelona for some time and a system is also in operation in a children’s hospital in Sweden.  In this case PrepLog is only used for “sensitive or dangerous” drugs. The system automatically alerts the nurse to the need for a check.

PrepLog is as yet in the early phase and the company expects to build more integrated systems as it expands its footprint in the European Market, says Mr Högberg.

Visit the Pharmacolog website here.

Read and watch the full series on our website or on YouTube.

Pharmacolog AB was founded in about 2007 with the goal of improving medication safety. The founders came from a background in radiation oncology where they had seen tremendous developments in the accurate delivery of radiation therapy. They did not see the same level of quality control in the field of medical oncology so they set out to develop easy-to-use tools that could verify the accuracy of chemotherapy compounding to ensure that patients received the right drug at the right concentration.

“Right now we have three products. It started first of all with DrugLog, which is basically a device where you can take a small sample of the medication that you have prepared and the device will confirm that the medication is made of the right drug in the right concentration –  and it only takes a few seconds to give you that certainty”, explains Mr Högberg.

DrugLog uses light absorption spectroscopy to provide very quick verification of a prepared injctable drug. During the preparation of the dose, a small sample – 0.3-0.5 ml of the solution is withdrawn. It is put into a cuvette that is placed in the device and in two-five seconds the device will confirm that the prepared medication is correct. It will also show if the correct drug is present but in the wrong concentration. “It’s very quick [and] very robust. We have done several scientific studies on this to ensure that it’s accurate and provides reliable measurements”, says Mr Högberg.

There is no other easy-to-use system or device for checking the accuracy of the final product when patient-specific injections are prepared. When injectable drugs are prepared in hospital pharmacies there are quality assurance measures for in-process checks. What DrugLog provides is a quick and easy way to ensure that the end product is correct, explains Mr Högberg.

There are three main areas where DrugLog is in use today – manual injection preparation, robotic injection preparation and batch preparation.  “When [we] talk about compounding we differentiate between ‘toxic’ and ‘non-toxic’. ‘Toxic’ is typically performed at the hospital pharmacy where you have specific rules and you have the process. ‘Non-toxic’ is prepared at the ward and we can help both those processes”, says Mr Högberg.  The second area of application is in robot verification – “We have customers who have acquired a DrugLog device and are using it to confirm that their compounding robot is behaving consistently. So, every morning when they start up the robot they check that actually it knows that 10 ml is still 10 ml and so on by having the robot prepare paracetamol or something else and then they verify the concentration with DrugLog”, he says. The third area is batch production. When, for example, a hospital pharmacy produces batches of insulin infusion bags, DrugLog can be used for quality control. It is being used today in several places in Europe for this particular type of verification, notes Mr Högberg.

Toxic drugs are typically anti-cancer (chemotherapy) agents.  “Most of our customers in Europe are using our products to verify chemo compounding and the good thing is you can do it in the same process as you prepare so …..  you can check the bag before you ship it off to the hospital ward. And the good thing is also that you do not open the bag after it has been sealed ….. so basically you take your sample while preparing the bag – meaning that once it has been sealed it won’t be opened until it comes to the patient” explains Mr Högberg.  In addition to ensuring the integrity of the product this means that the risk of spillage and environmental contamination is minimised.

Visit the Pharmacolog website here.

Read and watch the full series on our website or on YouTube.