ASHP National Survey of Pharmacy Practice in Hospital Settings: Operations and Technology - 2023.

PURPOSE: Results of the 2023 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. METHODS: Pharmacy directors at 1,497 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online using Qualtrics. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA's hospital database. RESULTS: The response rate was 21.6%. Inpatient pharmacists independently prescribe medications in 26.7% of hospitals. Advanced analytics are used in 5.7% of hospitals. Basic analytics are used in 87.3% of hospitals. Pharmacists work in ambulatory or primary care clinics in 54.2% of hospitals operating outpatient clinics. Most hospitals (86.1%) use automated dispensing cabinets as the primary method of maintenance dose distribution. Machine-readable coding is used in 73.6% of hospitals to verify doses during dispensing in the pharmacy. Autoverification functionality in the electronic health record system is used in 73.4% of hospitals. Most hospitals report some integration of pharmacy services to optimize patient care transitions (60.0%), while 24.9% report no integration. Traditional technician activities still predominate, but more advanced roles are emerging. Technologies to assist sterile product preparation are used in 62.8% of hospitals. CONCLUSION: Drug distribution continues to trend toward decentralized models with medications available closer to patients. Technologies are enabling this transition to occur without a significant negative impact on patient safety. The pharmacy workforce is stable, and more advanced responsibilities are being assigned to pharmacy technicians, enabling pharmacists to increase their clinical role.

Pysanky to Microfluidics: An Innovative Wax-Based Approach to Low Cost, Rapid Prototyping of Microfluidic Devices.

A wax-based contact printing method to create microfluidic devices is demonstrated. This printing technology demonstrates a new pathway to rapid, cost-effective device prototyping, eliminating the use of expensive micromachining equipment and chemicals. Derived from the traditional Ukrainian Easter egg painting technique called "pysanky" a series of microfluidic devices were created. Pysanky is the use of a heated wax stylus, known as a "kistka", to create micro-sized, intricate designs on the surface of an egg. The proposed technique involves the modification of an x-y-z actuation translation system with a wax extruder tip in junction with Polydimethysiloxane (PDMS) device fabrication techniques. Initial system optimization was performed considering design parameters such as extruder tip size, contact angle, write speed, substrate temperature, and wax temperature. Channels created ranged from 160 to 900 µm wide and 10 to 150 µm high based upon system operating parameters set by the user. To prove the capabilities of this technology, a series of microfluidic mixers were created via the wax technique as well as through traditional photolithography: a spiral mixer, a rainbow mixer, and a linear serial dilutor. A thermo-fluidic computational fluid dynamic (CFD) model was generated as a means of enabling rational tuning, critical to the optimization of systems in both normal and extreme conditions. A comparison between the computational and experimental models yielded a wax height of 57.98 µm and 57.30 µm, respectively, and cross-sectional areas of 11,568 µm2 and 12,951 µm2, respectively, resulting in an error of 1.18% between the heights and 10.76% between the cross-sectional areas. The device's performance was then compared using both qualitative and quantitative measures, considering factors such as device performance, channel uniformity, repeatability, and resolution.

Modelling and experimentation of a continuous nutrient recovery reactor - an assessment of mixing on reactor operation.

Phosphorus recovery from human waste will help assure global food security, reduce environmental impact, and ensure effective stewardship of this limited and valuable resource. This can be accomplished by the precipitation of struvite (MgNH4PO4·6H2O) in a two-zone reactor, continuously fed with nutrient-rich hydrolysed urine and a magnesium solution. The solid struvite crystals are periodically "harvested", removing accumulated crystal mass - and therefore recovered nutrients - from the process, and the operating campaign can, in principle, be continuously operated in a batch-continuous operating mode. A previously developed process model is augmented, incorporating two well-mixed volumes (upper zone and lower zone) that are coupled by intermixing forward and back flows. The intermixing back flow is parametrised and, therefore, adjusted for analysis. Crystal linear growth rate is modelled by a simple power-law kinetic, driven by the nutrient solution's saturation index (SI) of struvite. The instantaneous mass transfer rate of struvite constituents from liquid to solid phase is predicted, using the total interfacial area of the crystal population exposed to the well-mixed solution. This model describes a 12-L, laboratory reactor operated in the hybrid batch-continuous mode, although larger reactors could easily be accommodated, subject to their mixing behaviours. Experiments were performed at a 10-hour hydraulic residence time (HRT), which, importantly, is based on the volume of the well-mixed lower zone, since this is the volume of liquid that actively interacts with the suspended struvite crystals. The Mg/P feed molar ratio was varied (0.34, 0.64 and 1.29) to assess Mg feed rate-limiting behaviour. The concentration profiles of elemental P and Mg agree with experimentation, while P and Mg composition in the solid and X-ray diffraction support the production of struvite.

A modelling approach to prepare synthetic urine for struvite precipitation studies.

Nutrient recovery from wastewater is an effective strategy to prevent eutrophication and provide value for the treatment process. Human urine is a small but highly nutrient-rich stream in the total flux of domestic wastewater from which struvite (MgNH4PO4.6H2O) could be recovered and used as a fertiliser. Consequently, synthetic urine was used in most struvite precipitation studies, due to biohazard issues in real human urine. A modelling approach was developed to formulate synthetic urine recipes based on elemental urine composition, using matrix solving strategy to select and quantify chemical salts for synthetic urine preparation. The model also included mass balance, chemical speciation, and equilibrium dissociation expression for solution thermodynamics predictions in the formulated urine. In this study, synthetic solutions of fresh and stored urine were assessed with this model using Engineering Equation Solver (EES) software to calculate the quantity of salts, pH, ionic strength, and struvite saturation index. Simulation results in EES were successfully verified using PHREEQC simulations, while model validation comprised the examination of urine composition with their reported recipes.

ASHP National Survey of Pharmacy Practice in Hospital Settings: Workforce - 2022.

PURPOSE: Results of the 2022 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. METHODS: Pharmacy directors at 1,498 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA's hospital database. RESULTS: The response rate was 23.7%. Inpatient pharmacists independently prescribe in 27.1% of hospitals. Advanced analytics are used in 8.7% of hospitals. Pharmacists work in ambulatory or primary care clinics in 51.6% of hospitals operating outpatient clinics. Some level of pharmacy service integration is reported in 53.6% of hospitals. More advanced pharmacy technician roles are emerging. For health systems offering hospital at home services, 65.9% of pharmacy departments are involved. Shortages of pharmacists and technicians were reported but are more acute for pharmacy technicians. Aspects of burnout are being measured in 34.0% of hospitals, and 83.7% are attempting to prevent and mitigate burnout. The average number of full-time equivalents per 100 occupied beds is 16.9 for pharmacists and 16.1 for pharmacy technicians. CONCLUSION: Health-system pharmacies are experiencing workforce shortages; however, these shortages have had limited impact on budgeted positions. Workforce challenges are influencing the work of pharmacists and pharmacy technicians. Adoption of practice advancement initiatives has continued the positive trend from past years despite workforce issues.

ASHP National Survey of Pharmacy Practice in Hospital Settings: Clinical services and workforce-2021.

PURPOSE: Results of the 2021 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. METHODS: Pharmacy directors at 1,498 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA's hospital database. RESULTS: The response rate was 21.9%. Pharmacists are routinely assigned to a majority of patients at least 8 hours per day, 5 days per week in 70.4% of hospitals. This is an increase from 60.8% in 2018 and has steadily increased over the past decade. Pharmacists independently prescribe medications pursuant to a diagnosis in 30.9% of hospitals, an increase from 21.1% in 2020. Pharmacists have prescribing authority in 67% of health-system ambulatory clinics and can recommend or schedule pharmacogenomics testing for drug and dosage selection in 11.4% of hospitals, an increase from 5.4% in 2019. Pharmacists are using electronic methods in 82.5% of hospitals to collect information for monitoring medication therapy. Shortages of entry-level pharmacy technicians are acute, with 73.4% of survey respondents reporting a shortage. Technician shortages have affected pharmacy operations and have prompted new recruitment and retention strategies. CONCLUSION: Despite workforce challenges, clinical pharmacy services continue to expand to cover increasing numbers of patients with medication management services in both the inpatient and outpatient settings. The use of data analytics and pharmacy technicians has contributed to this evolution. Addressing the workforce challenges will be critical to sustain this progress.

ASHP national survey of pharmacy practice in hospital settings: Impact of COVID-19 pandemic on pharmacy operations-2020.

PURPOSE: Results of the 2020 ASHP national survey of pharmacy practice in hospital settings pertaining to pharmacy operational changes implemented in response to the coronavirus disease 2019 (COVID-19) pandemic are presented. METHODS: Pharmacy directors at 1,437 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. RESULTS: The response rate was 18.7%. Seventy-three percent of hospitals implemented changes to hospital units, including 46% that increased intensive care unit bed capacity; 94% made changes to pharmacy supply chain acquisition, changes to products, and/or increased inventory. Staffing changes were implemented by 69% of hospitals, with the most common being staffing reductions (55%) and salary reductions (16%). Medication-use changes were implemented by 86% of hospitals, with treatment guidelines for COVID-19 treatment (79%) and opening compassionate use or investigational drug studies (55%) being the most common. Changes in sterile compounding processes were implemented by 84% of hospitals. Personal protective equipment (PPE) shortages led to 71% of hospitals modifying PPE use standards in sterile compounding. Eighty-seven percent of hospitals changed operational activities, such as changing medication return practices (56%), medication reconciliation processes (46%), intravenous medication recycling (38%), and discharge counseling (37%). Hospitals experienced shortages of many medications, including albuterol inhalers (60%), sedatives and anesthetic agents (58%), neuromuscular blockers (43%), corticosteroids (34%), cardiovascular agents (24%), investigational agents (24%), and dialysis solutions (6%). CONCLUSION: The pharmacy profession responded to myriad threats to operations and patient care during the COVID-19 pandemic in 2020.

An Integrated Centrifugal Degassed PDMS-Based Microfluidic Device for Serial Dilution.

We propose an integrated serial dilution generator utilizing centrifugal force with a degassed polydimethylsiloxane (PDMS) microfluidic device. Using gas-soluble PDMS as a centrifugal microfluidic device material, the sample can be dragged in any arbitrary direction using vacuum-driven force, as opposed to in a single direction, without adding further actuation components. The vacuum-driven force allows the device to avoid the formation of air bubbles and exhibit high tolerance in the surface condition. The device was then used for sample metering and sample transferring. In addition, centrifugal force was used for sample loading and sample mixing. In this study, a series of ten-fold serial dilutions ranging from 100 to 10-4 with about 8 µL in each chamber was achieved, while the serial dilution ratio and chamber volume could easily be altered by changing the geometrical designs of the device. As a proof of concept of our hybrid approach with the centrifugal and vacuum-driven forces, ten-fold serial dilutions of a cDNA (complementary DNA) sample were prepared using the device. Then, the diluted samples were collected by fine needles and subject to a quantitative polymerase chain reaction (qPCR), and the results were found to be in good agreement with those for samples prepared by manual pipetting.

ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration-2020.

PURPOSE: Results of the 2020 ASHP national survey of pharmacy practice in hospital settings are presented. METHODS: Pharmacy directors at 1,437 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IQVIA hospital database. RESULTS: The response rate was 18.7%. Almost all hospitals (92.5%) have a method for pharmacists to review medication orders on demand. Most hospitals (74.5%) use automated dispensing cabinets (ADCs) as their primary method for drug distribution. A third of hospitals use barcodes to verify doses during dispensing in the pharmacy and to verify ingredients when intravenous medications are compounded. More than 80% scan barcodes when restocking ADCs. Sterile workflow management technology is used in 21.3% of hospitals. Almost three-quarters of hospitals outsource some sterile preparations. Pharmacists can independently prescribe in 21.1% of hospitals. Pharmacist practice in ambulatory clinics in 46.2% of health systems and provide telepharmacy services in 28.4% of health systems. CONCLUSION: Pharmacists continue their responsibility in their traditional role in preparation and dispensing of medications. They have successfully employed technology to improve safety and efficiency in performance of these duties and have employed emerging technologies to improve the safety, timeliness, and efficiency of the administration of drugs to patients. As pharmacists continue to expand their role to all aspects of medication use, new opportunities highlighted in ASHP's Practice Advancement Initiative 2030 have been identified.

ASHP national survey of pharmacy practice in hospital settings: Prescribing and transcribing-2019.

PURPOSE: Results of the 2019 ASHP national survey of pharmacy practice in hospital settings are presented. METHODS: Pharmacy directors at 4,863 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online, using an online survey application. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IMS Health hospital database. RESULTS: The response rate was 10.8%. Pharmacists are increasingly managing medication use in the areas of vancomycin therapy, antibiotic selection and dosing, and anticoagulation. Electronic health record (EHR) decision support is guiding prescribing, and nearly 50% of hospitals are customizing drug warnings. Adoption of compounding technology continues, with 43.6% of hospitals using technology in their sterile compounding processes. Nearly half of hospitals have active opioid stewardship programs, and pharmacists are leading these efforts. Specialty pharmacy operations are growing in health systems. Human resource commitments to support new services are increasing; however, vacancy rates for technicians are challenging. Staff credentialing continues to expand for pharmacist and technicians. CONCLUSION: Pharmacists continue to assume greater responsibility for writing medication orders, dosing, ordering laboratory tests, and monitoring outcomes. Health-system pharmacists are taking a leading role in addressing the opioid crisis, advancing safety in compounded sterile preparations through adoption of intravenous workflow technologies, and optimizing EHR applications to leverage clinical decision support tools to improve the safe prescribing and use of medications.

Filled Carbon Nanotubes as Anode Materials for Lithium-Ion Batteries.

Downsizing well-established materials to the nanoscale is a key route to novel functionalities, in particular if different functionalities are merged in hybrid nanomaterials. Hybrid carbon-based hierarchical nanostructures are particularly promising for electrochemical energy storage since they combine benefits of nanosize effects, enhanced electrical conductivity and integrity of bulk materials. We show that endohedral multiwalled carbon nanotubes (CNT) encapsulating high-capacity (here: conversion and alloying) electrode materials have a high potential for use in anode materials for lithium-ion batteries (LIB). There are two essential characteristics of filled CNT relevant for application in electrochemical energy storage: (1) rigid hollow cavities of the CNT provide upper limits for nanoparticles in their inner cavities which are both separated from the fillings of other CNT and protected against degradation. In particular, the CNT shells resist strong volume changes of encapsulates in response to electrochemical cycling, which in conventional conversion and alloying materials hinders application in energy storage devices. (2) Carbon mantles ensure electrical contact to the active material as they are unaffected by potential cracks of the encapsulate and form a stable conductive network in the electrode compound. Our studies confirm that encapsulates are electrochemically active and can achieve full theoretical reversible capacity. The results imply that encapsulating nanostructures inside CNT can provide a route to new high-performance nanocomposite anode materials for LIB.

A Compact, Syringe-Assisted, Vacuum-Driven Micropumping Device.

In this paper, a simple syringe­assisted pumping method is introduced. The proposed fluidic micropumping system can be used instead of a conventional pumping system which tends to be large, bulky, and expensive. The micropump was designed separately from the microfluidic channels and directly bonded to the outlet of the microfluidic device. The pump components were composed of a dead­end channel which was surrounded by a microchamber. A syringe was then connected to the pump structure by a short tube, and the syringe plunger was manually pulled out to generate low pressure inside the microchamber. Once the sample was loaded in the inlet, air inside the channel diffused into the microchamber through the PDMS (polydimethylsiloxane) wall, acting as a dragging force and pulling the sample toward the outlet. A constant flow with a rate that ranged from 0.8 nl · s - 1 to 7.5 nl · s - 1 was achieved as a function of the geometry of the pump, i.e., the PDMS wall thickness and the diffusion area. As a proof-of-concept, microfluidic mixing was demonstrated without backflow. This method enables pumping for point-of-care testing (POCT) with greater flexibility in hand-held PDMS microfluidic devices.

ASHP national survey of pharmacy practice in hospital settings: Workforce-2018.

PURPOSE: Results of the 2018 ASHP national survey of pharmacy practice in hospital settings pertaining to the pharmacy workforce are presented. METHODS: Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online. IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database. RESULTS: The survey response rate was 16.6%. The results indicate that inpatient staffing has increased for both pharmacists and pharmacy technicians. More than half of the respondents reported shortages of pharmacy managers, experienced technicians, and experienced pharmacy technicians with sterile compounding experience. More than half of the respondents reported an excess of entry-level frontline pharmacists. The perceived shortage of pharmacists is in decline, while the perceived shortage of pharmacy technicians, especially those with years of experience, is increasing. Pharmacists commonly chair multidisciplinary committees within health systems, and pharmacy leaders often report directly to the chief executive officer or chief operating officer; they are often responsible for reporting quality information associated with medication use to the health system's board. The use of a pharmacist credentialing and privileging process beyond licensure has increased over the past 4 years. Attention is being devoted to stress in the work place and addressing burnout among healthcare professionals, including pharmacists. CONCLUSION: The profession is fostering a workforce that is appropriate in composition, sufficient in number, and has the competence to improve the value and safety of medication use.

ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education-2018.

PURPOSE: The results of the 2018 ASHP national survey of pharmacy practice in hospital settings are presented. METHODS: Pharmacy directors at 4,897 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and email. Survey completion was online using Qualtrics. IMS Health supplied data on hospital characteristics; the survey sample was drawn from IMS's hospital database. RESULTS: The response rate was 16.6%. The percentage of hospitals that routinely have pharmacists assigned to provide drug therapy management has increased. Transitions-of-care processes have generally increased over the last 6 years. The percentage of hospitals with pharmacists in a wide variety of clinic types and clinical practice areas has increased over the last 2 years. Opioid stewardship programs are emerging in many U.S. hospitals, with pharmacists participating or taking the lead in program implementation. Outsourcing of compounded sterile product preparation is common. The proportion of hospitals not using any technology when compounding sterile preparations has declined. Pharmacy departments commonly track and monitor trends for administrative, operational, quality, and outcome metrics. CONCLUSION: Pharmacists continue to improve drug therapy monitoring for patients in U.S. hospitals. They are also responding to public health issues related to medication use. These advancements include taking an active role in opioid stewardship programs, safe compounding of sterile medications for patients, and reducing the need for hospital-based care.

Biosimilars: Considerations for Payers.

Evaluating biosimilars requires payers to go beyond cost considerations: safety and efficacy, reliability of supply and logistics, and the impact of state laws on substitution and interchangeability must all be deliberated.

The Impact of Technology on Safe Medicines Use and Pharmacy Practice in the US.

For decades it has been suggested that pharmacists are under-utilized and could better use their knowledge and experience to improve the use of medicines. The traditional roles for pharmacists have been preparing and distributing medicines, but this has limited both the location where they work and the available time to work more closely with other healthcare professionals to improve both the effectiveness and safety of medicines. Newly emerging technologies have made this possible. Examples include robotics that automate preparation and distribution of medicines, electronic health information, clinical decision support systems, and machine readable coding on medicine packaged. As a result of the use of these technologies, pharmacists in hospitals are working outside the hospital pharmacy and spending more time in medication therapy management activities compared to traditional distribution roles.

A Scoping Review of the Quality and the Design of Evaluations of Mobile Health, Telehealth, Smart Pump and Monitoring Technologies Performed in a Pharmacy-Related Setting.

Background: There is currently a need for high quality evaluations of new mobile health, telehealth, smart pump and monitoring technologies undertaken in a pharmacy-related setting. We aim to evaluate the use of these monitoring technologies performed in this setting. Methods: A systematic searching of English articles that examined the quality and the design of technologies conducted in pharmacy-related facilities was performed using the following databases: MEDLINE and Cumulative index to Nursing and Allied Health Literature (CINAHL) to identify original studies examining the quality and the design of technologies and published in peer-reviewed journals. Extraction of articles and quality assessment of included articles were performed independently by two authors. Quality scores over 75% are classed as being acceptable using a "relatively conservative" quality benchmark. Scores over 55% are included using a "relatively liberal" cut-off point. Results: Screening resulted in the selection of 40 formal evaluations. A substantial number of studies (32, 80.00%) were performed in the United States, quantitative in approach (33, 82.50%) and retrospective cohort (24, 60.00%) in study design. The most common pharmacy-related settings were: 22 primary care (55.00%); 10 hospital pharmacy (25.00%); 7 community pharmacy (17.50%); one primary care and hospital pharmacy (2.50%). The majority of the evaluations (33, 82.50%) reported clinical outcomes, six (15.00%) measured clinical and economic outcomes, and one (2.50%) economic only. Twelve (30.00%) quantitative studies and no qualitative study met objective criteria for "relatively conservative" quality. Using a lower "relatively liberal" benchmark, 27 quantitative (81.82%) and four qualitative (57.41%) studies met the lower quality criterion. Conclusion: Worldwide, few evaluations of mobile health, telehealth, smart pump and monitoring technologies in pharmacy-related setting have been published.Their quality is often below the standard necessary for inclusion in a systematic review mainly due to inadequate study design.

ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration-2017.

PURPOSE: The results of the 2017 ASHP national survey of pharmacy practice in hospital settings are described. METHODS: Pharmacy directors at 4,828 general and children's medical-surgical hospitals in the United States were surveyed using a mixed-mode method of contact by mail and e-mail. Survey completion was online, using Qualtrics (Qualtrics, Provo, UT). IMS Health supplied data on hospital characteristics; the survey sample was drawn from the IMS hospital database (IMS Health, Yardley, PA). RESULTS: The response rate was 14.4%. Drug distribution systems have evolved from centralized unit dose programs to decentralized programs based on the use of automated dispensing cabinets (ADCs). These systems have been made safer by the use of lidded pockets, by the use of machine-readable coding during ADC stocking, and by linking access to medications to results of pharmacist order review. Health-system pharmacists continue to improve quality practices for compounding sterile preparations, including the use of safeguards in handling hazardous drugs. While some hospitals are prepared for more stringent standards, including United States Pharmacopeia chapter 800 requirements, much still needs to be done to meet these standards. Pharmacists are taking an active role in improving the responsible use of medications through antimicrobial stewardship and controlled-substance diversion prevention programs. The quality of the pharmacy workforce continues to be improved through the increased credentialing of both pharmacists and pharmacy technicians. CONCLUSION: Health-system pharmacists continue to have a positive impact on improving healthcare through programs that improve efficiency, safety, and clinical outcomes of medication use in health systems.

A robust, portable and backflow-free micromixing device based on both capillary- and vacuum-driven flows.

In capillary- or vacuum-driven microfluidics, surge backflow events are common when merging or pumping two similar or dissimilar liquids together if a pressure difference exists between them. In this work, a robust, portable micromixing device that is insensitive to backflow was designed, fabricated and characterised. A capillary-driven pressure balancing bypass connected between two inlet ports diminished the initial pressure difference caused by capillarity and gravity present in each liquid at the two inlet ports. Then, using manual syringe-assisted vacuum-driven pumping that operated based on the high gas permeability of polydimethylsiloxane, the two pre-balanced liquid streams could synchronously enter a dead-end micromixing channel without any backflow. To test the performance of this device, we first used it to mix two aqueous solutions of different coloured dyes. We varied the initial volume difference between the solutions to study the effect of gravity-induced pressure difference on mixing. Next, as a proof-of-concept application, ABO/Rh blood groups were successfully determined through detection of blood antigen-antibody agglutination. The filling time of agglutinated samples, driven by the simple syringe-assisted pumping, in the dead-end mixing channel was consistently 10% longer than that of blood samples without the agglutination reaction. Thus, the proposed device shows great potential for use in a wide variety of blood typing assays, agglutination-based assays and point-of-care or lab-on-a-chip testing applications.