Procurement, Distribution and Systems Manager, Harrogate and District NHS Foundation Trust, UK
The Harrogate and District NHS Foundation Trust is a small District General Hospital consisting of around 450 beds and provides a health service to approximately 200,000 people in Harrogate and the Rural District, and North East Leeds. In 2009/2010 250,000 people passed through the Hospital doors, but generally there are no long term patients, apart from an on-site mental health ward which is run by the Hospital on behalf of the local PCT.
The Pharmacy Department provides a full range of services including Aseptic production, dispensing to 44,000 in-patients via the Main Dispensary, dispensing to 206,000 out-patients via the Outpatient Dispensary, a ward top-up service consisting of approximately 150 ward boxes per week, ward technician services, including the use of patients’ own drugs, and a full range of clinical pharmacy services. The team consists of 24 Pharmacists, 39 Technicians and Support Workers and five administration and clerical staff.
In July 2009, the business case to install an automated dispensing system was passed, headed by Kevan Bradley, Procurement, Distribution and Systems Manager, and in February 2010, the Pharmacy Department at Harrogate District General completed the implementation of an ARX automation solution (Figure 1).
This included the Vmax automated dispensing system with the ProLog fully automatic loading system. This is now situated in Stores, where automatic ward box picking occurs, and delivers medication to the Dispensary via conveyors.
The DoH has been highlighting automation as a strategic goal for Pharmacy since the early 2000’s which has been vastly publicised in numerous articles in the Pharmaceutical Journal, Chemist and Druggist and Hospital Pharmacy Europe. Accompanied with numerous Trusts throughout the country promoting their successful robotic installations and reporting positive benefits ever since, automation seemed the natural way to progress the Pharmacy Department and Harrogate District General.
Furthermore, after attending several seminars at the annual Robotics Conference in Birmingham, the measurable benefits in staff-time, stock reductions, lower error rates and faster turnaround times became apparent. All this enabled Kevan Bradley and his colleagues to outline an agreement at board level to write a business case.
To guarantee a positive result from the business case the Pharmacy had to ensure they performed in depth research into the automation providers that supplied to the UK, all the different options that were available and also those that would best suit the working environment of the department, listen to the experiences of other trusts and understand all the benefits that could be achieved.
The Pharmacy had a clear understanding of the main objectives they wanted to accomplish as a department and knew that to reach the goal of a ‘patient-centred service’ with a high visibility of technicians at ward level, combined with the move to ‘one stop dispensing’, a more automated approach to dispensing and distribution was required. Adhering to the Pharmacy Department’s own mission statement and the overall business objectives of the Trust, the key reasons to automate were as follows:
- Automation will improve the accuracy of the dispensing process and thus will eliminate selection errors, reduce dispensing errors and improve patient safety
- Automation will improve dispensing service levels leading to a more rapid supply of medicines to patients
- Automation will improve stock control within the Pharmacy and will reduce wastage
- Staff time will be released which can be re-invested into clinical or other duties
- Automation will reduce the space required to store medications and provide a better working environment
- This was just the first stage of a full modernisation programme to further enhance the use of technology to improve efficiency and to enhance patient safety. Along with installing automated dispensing systems, the plan was to upgrade the pharmacy Ascribe system and develop electronic prescribing and discharge systems.
Once the business case for the automated dispensing system was approved in July 2009, the Harrogate and District NHS Foundation Trust entered the OJEU tender process which resulted in one clear winner in terms of evaluation criteria – ARX Limited.
Implementing an automated dispensing system
One of the most important aspects to ensure the implementation was a success was to heavily involve staff from the beginning. It’s a known fact that people do not like change it was essential not to exclude them from a project that would affect the way they work. By providing them with regular updates on the project and also by ensuring the abilities of the robot were not oversold, eliminated apprehension and produced a speedy adaptation to the new automated dispensing and distribution process.
Installing an automated dispensing system into an operational pharmacy department is a big project that needs full co-operation between Trust and Supplier. As all the planning was done ‘up front’, and an implementation plan and detailed checklists were provided to Kevan and the team, which outlined everyone’s responsibilities, the agreed time schedules were achieved and almost no disruption was caused to the Pharmacy. ‘ARX were exceedingly helpful throughout the whole project, all the way through from the contract award, to the service we are receiving today’, Kevan comments.
As part of the contract, the Pharmacy Department were provided with full training on the equipment, ranging from basic day to day use, to more in depth functionalities such as reporting. Kevan adds, ‘The training was well thought out and covered everything we needed to know. The engineer’s enthusiasm for his product was infectious and he was happy to pass on as much of his knowledge you wanted.’
What has been achieved so far?
Since the installation of their ARX automated dispensing system in February 2010, the Pharmacy Department at Harrogate District General has experienced both financial and qualitative benefits allowing them to surpass the expectations set out in their business case.
- By automating their dispensing process, they have been able to enhance patient safety
- Due to the high picking speeds of the Vmax system and also because the Vmax can pick multiple packs in one movement, a quicker turnaround time of discharge and outpatient prescriptions has been achieved
- Dispensed items have significantly reduced error rates as all packs are recognised by their barcodes and corresponding dimensions. As packs are safety checked by the system on input, it is almost impossible to input a medicine under the incorrect barcode. Therefore, by keeping a record of the location of every pack inside the system by its barcode, the picking head will always pick the correct pack
- Error rates at the point of final check have been reduced and noticed by the Pharmacists themselves.
- Reduced stock holding due to the rationalisation of medicines, which were held in the dispensary and stores, to a single stock location
- Reduced staff time due to automatic loading. The ProLog is a fully automatic loading system which allows staff to simply tip a delivery into the hopper, press ‘start’, and then leave the ProLog to load the robot. After the implementation of a new strategy, the Pharmacy Department at Harrogate District General set the ProLog to start loading packs in the afternoon so that it could carry on throughout the night, rather than during busy daytime dispensing periods
- As the stock is now held in one location, there is no need to waste time picking and transferring stock between different locations,
- The ARX system keeps a record of every single drug it stores and this information can be interrogated by staff, which has enabled a reduction in the time spent carrying out daily stock checks
- The Pharmacy Department has achieved a 50% reduction of expired stock resulting in reduced wastage. All drugs entering the system are automatically assigned a default expiry date so all packs inside the system are picked accordingly to ensure an accurate stock rotation. Staff can also request to see a report detailing all the stock nearing expiry or that has expired. They then have the choice to output these packs and assign them shorter expiry dates.
In addition to these essential benefits, there has been a noticeable difference in the atmosphere in the dispensary. Kevan Bradley comments, “The atmosphere is much calmer now, due to reduced movement. The drugs arrive directly to the technician or support worker rather than the other way round.”
Since the installation of their ARX system just 10 months ago, the Harrogate and District NHS Foundation Trust have already been able to measure some of the improvements made to the dispensing and distribution process, and envisage an improvement to this in future months as well as obtaining more vital statistics:
- A stock reduction of 20% was achieved by the end of the fourth month after installation, which is saving the Hospital significant amounts of money. This figure has not yet been confirmed
- A 50% reduction of wastage was achieved by the end of the ninth month after installation
- Staff reductions were achieved simply by not having to fill vacancies. Approximately 0.25 whole time equivalents of B4 Technicians and 1.65 whole time equivalents of B2 Support Workers have not been replaced since the automated dispensing system was installed.
The chosen solution
The Pharmacy Department at Harrogate District General chose a single Vmax robotic storage system with the addition of the ProLog fully automatic loader and automatic ward box picking. The whole system was tailored to the specific needs of the Trust, taking into account space available, required capacity and workflow requirements.
The Vmax chosen by the Trust is 8.38m long, 2.55m high and 1.6m wide and delivers packs to four dispensing terminals and four ward box drop points. This advanced robotic system has a V-shaped picking head, allowing multiple packs to be picked and output in one movement. Also, due to the advanced and unique picking mechanism, packs can be stored very tightly together, resulting in increased capacity within a smaller footprint.
Staff simply type their request into the Ascribe IT system as normal and a message will be sent to the Vmax indicating which drug needs to be dispensed, the quantity, the requestor’s ID and the delivery point. The Vmax will then pick the packs and output them onto a conveyor, which will deliver them directly to the requestor.
Furthermore, the Vmax picking head is able to pick a whole line of packs from a shelf which is most useful for fast moving products and can also pick a whole prescription in one output movement, which, as stated in the realised benefits of the Pharmacy Department, speeds up the dispensing process and reduces patient waiting times.
To store drugs within the Vmax, the barcode is scanned and the pack’s dimensions are measured. This ensures that those dimensions correspond with those that the system has on record for that barcode, almost eliminating inputting errors. Once the system has approved the pack, it will be picked by the picking head and placed on a shelf inside the machine. Stock levels are then maintained and can be communicated to the department on request.
The ProLog is an automated system used for loading packs into the robot with minimal human intervention. It can either be attached to the side of the Vmax, as in the Harrogate design, or integrated into the Vmax, should a department be tight for space.
When a delivery enters the department, packs are simply poured into a hopper by a member of staff and the ProLog will sort, scan and then pass the packs to the Vmax, where they are placed in the most space efficient location. Staff are then free to carry out other duties. The ProLog has been one of the main instigators for improving the ward-based medicines management at Harrogate District General.
Now that the automated dispensing system is in place, they are now undergoing the process of upgrading their Ascribe IT system and are hoping they can take advantage of Ascribe’s Goods Receipt interface, which is now available to use with the Pharmacy’s ARX system. This means, when the department receives a delivery, they can simply tip it into the ProLog automatic loader, type in the delivery number and the ProLog will check off each pack on the delivery as it supplies them to the robotic system. A confirmation or discrepancy report will be produced once all packs have been input. This further supports the Pharmacy objective of allowing staff to be released to perform clinical duties.
The Pharmacy are also evaluating an electronic prescribing system and currently have an internal electronic discharge system which is undergoing full testing at present.
One of the bigger projects that Kevan and his team are looking into for the future is automating as much of the supply chain as possible and therefore are researching the ward-based management systems, as ARX are now the sole supplier of the Pyxis® Product range. This will allow full integration with the robotic system in the Pharmacy, providing a fully automated and traceable supply chain solution.
Automation has been a huge success in the Pharmacy Department at Harrogate District General and as a result they have welcomed numerous Trusts who are also looking into automation themselves through their doors to see their new colleague.
Since automating the Stores and Dispensary departments, there has been a significant reduction in costs and a dramatic increase in productivity and efficiency. The Dispensary is now dispensing far more packs in a shorter period of time and patient care has been enhanced due to the improved management of staff time.
Kevan Bradley speaks very highly of pharmacy automation, and of ARX who installed their system. He stated, “Automating a Hospital Pharmacy whilst maintaining your existing service is not an easy thing to achieve. With ARX as our supplier and partner, the delivery, installation, implementation, and training all proceeded professionally as planned. This allowed the department to move, without interruption, into automation.”