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The Whittington Hospital
Hospital pharmacy in the UK is jumping onto the robot bandwagon. This is hardly surprising considering the benefits technology brings to the world of pharmacy, which have been demonstrated both in the UK and abroad.(1–3) Few hospitals in the UK have been fortunate enough to gain these benefits so far, although national directives, including Pharmacy in the future – implementing the NHS plan,(4) have been instrumental in pharmacy departments obtaining funding for such projects.
Despite a number of companies supplying automated dispensing devices worldwide, experience of automation within the UK has so far been mainly limited to one type of robotic device. This will change as more hospital pharmacies, and hopefully community counterparts, take up such promising ventures.
Impact upon dispensary staff
At Camden and Islington Pharmaceutical Service, of which the Whittington hospital is a part, we have acquired four robots.(5) The discount benefits for obtaining any product in bulk are unquestionable. Our department obtained a Rowa Speedcase robot with two picking heads, capacity 27,000 packs, and picking rate of 20 seconds per pack. The annual loan purchase of our machine is little more than the annual salary paid to one-and-a-half locum pharmacists, which went down very well with the finance department. The robot at the Whittington was necessary due to the private finance initiative (PFI). Under the PFI, building projects that would have previously relied on public money are financed by the private sector. A private sector consortium paid for the hospital to be rebuilt; however, rebuilding led to the loss of the pharmacy store, which meant that medicines for use in the hospital needed to be stored more efficiently.
Ultimately, the staff responsible for maximising the use of this expensive and innovative technology on a daily basis are those based in the dispensary. The transition is enormous, and the impact (positive and/or negative) upon this group of staff, especially after implementation, has as yet to be fully evaluated.
The dispensary staff at the Whittington had to deal with a number of changes before, during and after installation of the robot. Once it was confirmed that we were going to obtain a robot, staff had to endure a number of changes in the location of medicines, which inevitably interrupted workflow and delayed work output. The reasons for delays in work had to be regularly reiterated to ward staff as well as patients. Whether such delays had any negative impacts on the patient discharge process was not investigated.
In readiness for automation, pack sizes stocked by the hospital were changed to patient packs for a large proportion of medicines. This was a significant undertaking and involved many staff within and external to the department. A lot of preparatory work had to be undertaken before this big change. Staff needed to alter their methods of clinically screening, dispensing and checking prescriptions to incorporate the use of patient packs. There were changes to the methods of working of the department as a whole, as a large proportion of wards changed to one-stop dispensing systems.
Our computer system was updated to interface the pharmacy system with the robot, which entailed changing dumb terminals in the department to PCs. Everyone had to learn new computing skills. Training was given to all department staff to familiarise them with changes in the dispensing process, ordering process and printing patient information leaflets (PILs) when required, among other things.
Staff also had to put up with building work being carried out in the “robot room” while carrying out their daily duties. The robot room was completely partitioned off from the dispensary, so noise from the building work was the main issue. Due to the short timescale involved, we were unable to evaluate whether such issues had a negative impact upon the work of staff, by increasing dispensing errors, and so on.
Once the robot was installed and operational, staff had to deal with minor teething problems and practical issues such as packs getting stuck on conveyer belts and having to climb up ladders to retrieve them. They have also had to learn how to deal with emergencies such as power failures and what to do in the event of the robot not functioning due to various reasons.
An accredited checking technician (ACT) scheme was introduced into the hospital, partly as a result of automation. Staff have had to get used to the idea of their dispensing errors being picked up by an ACT, while the ACT technicians have had to become accustomed to requesting changes to dispensed items from their colleagues.
Despite the biggest change to pharmacy practice at the Whittington for many years, staff have responded to challenges positively and appear to have conquered automation successfully. It is encouraging to see staff going home on time, having the extra minutes to advise patients on the use of their medications, and taking pride in showing off the robot to other colleagues.
Work for the future
A number of papers have touched on various subjects relating to automation. However, there has been no indepth analysis into various aspects of the automation process with respect to pharmacy in the UK and Europe, especially postimplementation. This includes dispensing errors, effects on staff (eg, physical, attitudes) and above all patient safety. There are many questions that need answering. Does automation de-skill pharmacy staff from the basics of pharmacy practice? Are pharmacy staff happy to undertake a re-evaluation and redefinition of roles? Will academic institutes have to alter teaching methods in the future as a result of automation? Will preregistration pharmacists still be able to calculate correct volumes of liquids to be given to children if the future means dispensing whole patient packs for chronic conditions? How will electronic prescribing combine with automation to facilitate a smooth, potentially flawless prescribing and dispensing system?
It is agreed that automation has a positive impact upon the profession as a whole, especially in freeing up pharmacist and technician time to be devoted to better patient care. However, it appears as though the vast majority of issues such as those above have been taken for granted.
What is the impact of automation on pharmacy staff? How do patients and other staff perceive an automated hospital pharmacy? Questions such as these and others need extensive evaluation to thoroughly investigate the impact that automation will have on pharmacy. This research will no doubt be of use to colleagues elsewhere in Europe.