Automated compounding of 5-fluorouracil elastomeric infusion pump: Impact on the prevention and reduction of musculoskeletal disorders through an ergonomic study

Introduction
The preparation of 5-fluorouracil elastomeric infusion pumps exposes hospital pharmacy technicians (HPTs) to a high risk of musculoskeletal disorders (MSDs). A dual-channel compounding system (peristaltic pump and syringe pump) was implemented to reduce this risk. An intervention conducted by two master’s students in ergonomics evaluated the contribution of the automated system to MSD reduction in our anticancer drug compounding unit by comparing manual filling (combined with per-process gravimetric control) and automated filling of elastomeric infusion pumps.

Materials and Methods
The ergonomic study was conducted among HPTs from the unit who had been trained to use the automated system. A self-assessment questionnaire completed by HPTs before and one year after implementation of the automated system was used to identify the location and intensity of pain. Systematic observations of both preparation methods were performed to assess postures adopted during compounding: joint ranges of motion, movements performed, grasping areas used (distance calculations between HPTs and equipments), interactions, and time allocation.

Results
Six questionnaires were analyzed. Before automation, pain was mainly reported in the forearms (5/6 HPTs; high intensity in 50% of cases and moderate intensity in 33%), arms and neck (4/6 HPTs; no cases of high intensity and 50% moderate intensity for each location). After automation, pain was mainly reported in the forearms (3/6 HPTs; moderate intensity in 50%) and neck (3/6 HPTs; moderate intensity in 33%), with no high-intensity pain reported. Two activity chronologies comparing manual and automated compounding were performed. Manual preparation lasted 8 min 30 s, during which HPTs performed manual handling for 90% of the time, carried out an average of 13 actions/minute, and used 76% of the equipment located within the close reach zone. HPTs interacted with products for 62% of the time and with the computer system guiding the gravimetric preparation steps for 26% of the time. Automation reduced preparation time to 5 min 30 s, handling time to 48%, and the number of actions to 8 actions/minute. 57% of the equipment used was located within the close reach zone. 18% of the time was dedicated to data entry on the automated system’s touchscreen. The time dedicated to visual checks increased substantially (73%) to ensure correct filling of the 5-FU syringe.

Discussion/Conclusion
Automation reduced preparation time and the physical constraints associated with manual handling, particularly in the upper limbs. It transformed HPT activities from predominantly manual tasks to activities involving data entry, monitoring, process control, and validation of the automated compounding process.

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