2. CONTENTS
License Agreement 1
Preface by Christopher Jerry 3
Foreword by Eric Kastango 5
• OBJECTIVE 6
• PERSPECTIVE 7
• OVERVIEW: PARADIGMS 18
• REVIEW: PRODUCTS 31
• SEMIAUTOMATED-MANUAL SYSTEMS 32
A. BD Cato 33
B. DoseEdge 37
C. i.v.SOFT 44
D. Pharm-Q ITH 49
E. Phocus Rx 54
F. SP Central Pharmacy for Sterile Room Medication
Preparation 59
G. Verification 64
• HIGHLY AUTOMATED ROBOTIC SYSTEMS 69
A. APOTECAchemo 70
B. INTELLIVILL I.V. 76
C. i.v.STATION 82
D. RIVA 86
Quick-Look Product Guides 92
Quick-Look Comparative Guide 103
Vendor Information 105
Authors 106
© 2014 THE NEUENSCHWANER COMPANY, INC. All rights reserved. It is illegal to share this report or reproduce this report in
any way for dissemination to anyone outside licensee’s company without the express written permission of The
Neuenschwander Company.

3. PREFACE
In February of 2006, my two-year old daughter, Emily Jerry, died
from an IV compounding error that could easily have been
prevented by using the kinds of technologies reviewed in this
report.
In the fall of 2005, doctors found an exceptionally large yolk sac
tumor (YST) in Emily’s tiny abdomen. Their diagnosis was shocking
as, outwardly, Emily appeared to be a completely healthy and
vibrant toddler—giggling pretty much every minute of every day.
Emily was the youngest of three amazing siblings and was
absolutely adored by her older brother, Nate, and sister, Katherine.
Our oncology team recommended that Emily be admitted into a
leading pediatric facility in Cleveland for three days each month to
receive their prescribed chemotherapy regimen. We were told,
because the mass was the size of a grapefruit, that five or six
months after successful chemo treatments she would most likely
require surgery to remove residual scar tissue.
By February of 2006, the oncologists were beginning to think that
Emily’s tumor might not be responding well to the etoposide being
used in her chemotherapy. She had not lost any weight, which was
rare. As a matter of fact, she had gained a pound, which they told
us was a first among their pediatric oncology patients. Emily also
had not exhibited many of the flu-like symptoms that typically
accompany chemotherapy. This prompted the ordering of an MRI
to see if a different course of treatment might be required.
By the grace of God, the MRI revealed that Emily’s tumor had
completely disappeared. They couldn’t even find residual scar
tissue, which normally follows chemotherapy treatment for tumors
of any size. Bottom line: we witnessed a miracle!
Even after this marvelous outcome, which every caregiver on the
planet dreams of experiencing (even once during the course of his
or her career), Emily’s oncology team recommended one final
three-day round of chemotherapy. They wanted to make certain
that no residual cancer cells remained that could pop up later in life
and pose a threat.
© 2014 THE NEUENSCHWANER COMPANY, INC. All rights reserved. It is illegal to share this report or reproduce this report in
any way for dissemination to anyone outside licensee’s company without the express written permission of The
Neuenschwander Company.

4. With an amazing prognosis, Emily’s mother and I decided to bring
our girl in for a final three-day round of chemotherapy, which
started February 24 on her second birthday. Everything went
extremely well on that Friday and Saturday. Then, on Sunday, for
what was supposed to the last dose before taking her home cured,
the worst imaginable IV compounding error occurred that took our
daughter’s life.
The technician preparing Emily's last IV, thinking she was doing the
right thing, took an empty compounding bag and filled it with three
vials of 23.4% sodium chloride instead of using the called for
premixed 0.9% sodium chloride. Before the day was over, our
darling girl was taken by an unintended and uncaught medication
error—an error, which could have been intercepted with the use of
simple, proven technology.
Today, with all my heart, I believe Emily’s short life was meant to
save tens of thousands of precious lives going forward. And it can, if
we all join hands and truly learn from what happened.
As Emily’s father, my life is now devoted to doing all I can to prevent
similar medical errors. I am convinced that had my daughter’s
hospital used common bar-code scanning technology to verify
containers and drugs when making sterile compound preparations
in its clean room that day, we would not have had to say goodbye.
I encourage everyone to read the insightful report that you hold in
your hands and to encourage your hospital to implement such
safety systems in its pharmacy as soon as possible.
Christopher Jerry
President and CEO
Emily Jerry Foundation
www.emilyjerryfoundation.com
© 2014 THE NEUENSCHWANER COMPANY, INC. All rights reserved. It is illegal to share this report or reproduce this report in
any way for dissemination to anyone outside licensee’s company without the express written permission of The
Neuenschwander Company.

5. FOREWORD
I am thrilled to be writing the Foreword for this body of work that
Jerry and Mark have written about the technology being deployed
in the cleanroom to improve the safety of compounded sterile
preparations (CSPs). You will be provided with some great
information from the authors. Jerry was my go to guy when I
needed help getting a handle on medication dispensing technology
while working on a project in the Middle East. His generosity was
in valuable and allowed me to be successful. But that story only
scratches the surface of his expertise. What can I say about Mark?
Although I haven’t worked directly with him, if you don’t know his
name or his work, then you haven’t been paying attention to the
evolution and importance of patient safety based-technology.
It is good to see that this technology survey has been published,
providing the reader with an objective assessment of software and
hardware being marketed as the silver bullet to getting the
pharmacist out of the cleanroom and making every dose safe. As
the expression goes, “trust but verify” and it couldn’t be more true
about the technology covered in this paper. It is important to also
keep in mind that this technology does not eliminate the need to
train employees or obviate the need for good aseptic technique. In
fact the opposite couldn’t be more true.
So, sit back and let the “Pro’s from Dover” start you on your
journey of enlightenment. The more you learn, the more you
realize you don’t know, so please don’t stop learning and become
complacent because your patient’s health and well-being depends
on you being the best and the brightest!
Eric S. Kastango, MBA, RPh, FASHP
© 2014 THE NEUENSCHWANER COMPANY, INC. All rights reserved. It is illegal to share this report or reproduce this report in
any way for dissemination to anyone outside licensee’s company without the express written permission of The
Neuenschwander Company.

6. OBJECTIVE
Our objective in this report is to provide a review of technology-assisted
sterile compounding systems (paradigms and products)
currently available in the United States.
Herein, we offer triangulation points intended to help readers
pinpoint their organization’s location in an expanding sea of
options while navigating their way toward safer IV-preparation.
En route, we will share observations and insights from our
experience intended to help readers select the right sterile-compounding
technologies for their hospitals.
We do not profess to provide everything in this report you will
need to know. We are prepared to dive deeper into the subtleties
of the various paradigms and products as they may apply to
individual institutions.
Finally, while we believe it is right to use sterile-compounding
technologies, we also believe they must be used the right way. In
future reports, we hope to go beyond selection to cover important
implementation and utilization factors as well.
Mark Neuenschwander
Jerry Fahrni, PharmD
© 2014 THE NEUENSCHWANER COMPANY, INC. All rights reserved. It is illegal to share this report or reproduce this report in
any way for dissemination to anyone outside licensee’s company without the express written permission of The
Neuenschwander Company.

7. AUTHORS
Mark Neuenschwander is the President of The Neuenschwander
Company, Cofounder of The TerraPharma Project, sponsor of The
unSUMMIT on Healthcare Barcoding. In addition to speaking and
consulting, he is the publisher/editor in chief and contributing
author for The Neuenschwander Reports. Mark is the recipient of
the ISMP’s tenth Lifetime Achievement Award for his leadership in
promoting patient-safety technologies in healthcare over the past
two decades.
mark@hospitalrx.com
hospitalrx.com
Jerry Fahrni, PharmD has a background in hospital pharmacy and
pharmacy informatics. In addition to working in hospitals, he has
worked for technology companies and provided consulting services
for technology developers and hospital users independently and in
concert with The Neuenschwander Company. Jerry is the lead
researcher on this latest Neuenschwander Report: In the Clean
Room. He is also a popular blogger on the subject of pharmacy
automation and technology at jerryfahrni.com.
jerry@hospitalrx.com
jerryfahrni.com
© 2014 THE NEUENSCHWANER COMPANY, INC. All rights reserved. It is illegal to share this report or reproduce this report in
any way for dissemination to anyone outside licensee’s company without the express written permission of The
Neuenschwander Company.