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Comparing the upper limb disorder risks associated with manual and automated cytotoxic compounding: a pilot study
  1. Monsey McLeod1,
  2. Agnieszka Zochowska2,
  3. David Leonard3,
  4. Marian Crow3,
  5. Ann Jacklin3,
  6. Bryony Dean Franklin1
  1. 1Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust and UCL School of Pharmacy, London, UK
  2. 2Department of Pharmacy, Medical University of Warsaw, Warsaw, Poland
  3. 3Department of Pharmacy, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Mrs M McLeod, Pharmacy Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK; monsey.mcleod{at}


Objectives To conduct a pilot study to compare the upper limb disorder (ULD) risk associated with manual and automated cytotoxic compounding, and comment on the suitability of using the UK Health and Safety Executive Assessment of Repetitive Tasks (ART) tool for this purpose.

Methods The ART tool comprised 12 domains, each scored on an ordinal scale. An overall ULD exposure score was calculated and categorised using the tool as low, medium or high risk. 21 manual and four automated sessions were observed in a UK hospital pharmacy aseptic unit; a smaller sample of automated sessions were used as these showed little variation in exposure score. The following were compared: (1) median (IQR) overall exposure scores; (2) overall exposure level categories; and (3) median (IQR) risk scores for each of the 12 domains. Practicalities of using the ART tool were documented.

Results Manual sessions were associated with a higher median ULD exposure score (9.8 (IQR 8.8 to 12.0)) than automation (1.0 (0.9 to 1.3)). 14 manual sessions were low risk and seven were medium risk. All automated sessions were low risk. Overall, eight domains scored higher in the manual sessions than automated session; four domains scored the same. The largest difference in median exposure score was for domains regarding ‘force’, ‘arm movement’ and ‘arm posture’.

Conclusions Automated compounding was associated with a lower ULD exposure score than manual compounding in our aseptic unit. The ART tool was useful for comparing ULD risk of manual and automated cytotoxic compounding.

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