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Published on 2 March 2009

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Implementing pharmacy automation

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A Mach4 pharmacy automation system is being introduced at Southend University Hospital in a bid to improve patient safety and medicines management, tackle space constraints and improve efficiency

Joanne Middleton
Service Development
Pharmacist
Southend University
Hospital NHS Foundation
Trust
Essex, UK

There are many reported benefits from using automated dispensing systems in hospitals. These include a significant reduction in dispensing errors, reduced stock holding and improved
stock control, reduced waiting times for outpatient and discharge prescriptions, reduced staff time needed in the dispensary – meaning that dispensary staff can be released to support direct patient care – reduced expenditure on agency staff and reduced expired drug expenditure.[1]

As medication-related errors are the second most commonly reported adverse incidents,[2] safety is an important driver for introducing automated dispensing, but improvements in quality of patient care and reduced costs are also valuable  considerations. Medicine packaging is such that it is sometimes hard to distinguish between different products, and this can
lead to picking errors, where the wrong medication is
mistakenly chosen.[3]

These factors led Southend University Hospital NHS Foundation Trust to decide to introduce an automated system into its pharmacy. The department put together a business case for the robot which was formally approved in June 2007. The tender was awarded to Mach4, and the robot is now being installed and will go live in November 2008.

Reasons for introducing automation
Southend University Hospital is a busy district general hospital with a very busy outpatients department. Many prescriptions are written at the hospital, rather than at the GP, as in some other hospitals, and there is a large cancer unit nearby, so chemotherapy drugs are regularly dispensed via the pharmacy department. There are about 80 pharmacy staff in total.

There are a number of reasons for introducing pharmacy  automation at Southend:

  • To improve patient safety by reducing dispensing errors, particularly picking errors, which will be eliminated with automation.
  • To increase efficiency on site, which will bring a reduction in outpatient waiting times. Prior to introducing the robot our outpatient wait has been unacceptably long. Pharmacists’ time was invariably wasted looking for missing stock, which will be freed up with the introduction of the Mach4 system.
  • To tackle space constraints and improve the efficiency of storage in the pharmacy: automation typically reduces the pharmacy storage footprint by 50%.
  • To improve stock control, reduce the time pharmacy staff spend identifying and resolving stock discrepancies, improve stock rotation and reduce stock wastage. Automated Pharmacy systems improve stock rotation by employing a strict “first in, first out” system. The system will be further improved with the development of bar codes that contain information on the batch number and expiry date of a product as well as the basic product details.
  • To release pharmacy staff from the dispensary to fulfil clinical duties on the ward. At Southend, not all wards use the “one-stop” or “dispensing for discharge” system, and even fewer have dedicated medicines management technicians. The aim in the future is for all eligible wards to have one-stop dispensing and dedicated medicines management technicians in order to manage the dispensing system safely and effectively, check the patients’ prescriptions before discharge and to take on extended roles, eg, taking drug histories.
  • To implement one-stop dispensing, so that when patients are admitted to hospital, the medicines they require for discharge can be dispensed. Medicines management technicians who will no longer be needed in the pharmacy will then have time to check the patients’ prescriptions before discharge and will also be able to take proper drug histories to reduce medication-related errors.
  • To reduce staff costs. Staff who are no longer needed in the pharmacy will be able to work on the ward, meaning that additional funding for these new roles will not be required as staff time will be reinvested where it is really needed.
  • To reduce stock holding costs. Other sites that have introduced robots have reduced their stock holding considerably because of improved stock rotation and we estimate that we will reduce ours by about £250,000 as a one-off saving.

The system

Storage and distribution
The Mach4 system is a storage and distribution system. It can store and distribute any medicines which are contained in a box, have a barcode and fit within certain weight parameters, encompassing the vast majority of medicines dispensed at Southend. It interacts with the pharmacy computer system, so when a prescription is to be dispensed the patient’s details and the medicine required are entered into the pharmacy system which communicates with the robot’s computer. The robot then picks the medicine and delivers it by means of conveyor belts within the pharmacy department to the point of request. It is also possible to have external chutes feeding a secure out-ofhours emergency cupboard, for example, so, in theory,
the pharmacist would be able to dispense the medicine from a remote location via the robot to a secure location that nurses are able to access.

Each “robot” consists of a Medimat or main storage area and a fast-moving unit, or Speedbox, which stores and dispenses fast-moving lines independently of the main picking and loading head.

Automatic loading
The system being installed at Southend features an automatic loading option so that medicines can be tipped into an automatic loader which picks up the packs, reads the barcode, measures the size of the boxes and stores them on a suitable shelf. This cuts down dramatically on the time needed to put medicines
away. The automatic loading hopper can be filled and allowed to load overnight. when demand for dispensing is low.

Refrigeration
The system being installed will contain a fridge in each robot. At Southend we have decided to use the automated firdges to store medicines with known picking errors, such as insulins and vaccines, which have similar packaging and are relatively low use. We are avoiding storing items that are dispensed in multiples as the fridge shutter opens and shuts as each individual box is picked, and there is a risk that the temperature
of the fridge could be compromised.

Reasons for choosing Mach4
The Mach4 system came out best for us both in terms of value for money and suitability of design. One of the main reasons for choosing Mach4 was that the robot was able to fit into the existing pharmacy department – the space is restrictive as it includes several structural pillars and the ceiling height is low at only 2.5 m. The system chosen for Southend consists of two
L–shaped robots, in which the picking head is able to move round at 90 degrees. Each machine has a Speedbox and a fridge, and can dispense to any of our 11 output points around the department. This design effectively gives us four picking heads, which will mean that we will still be able to use the system whilst it is being serviced or repaired.

Dealing with potential problems
While the benefits of introducing automation are numerous, will inevitably be problems to be overcome during the implementation process – it is hoped that they will be short lived.

The pharmacy department has had to continue to work while the system has been installed, meaning working around building work. While the redistribution of pharmacy staff and improvements in skill mix should be regarded as positive, and will hopefully improve employee job satisfaction in the long run, there are always some people who will be resistant to change
at any level, and some people may understandably worry about the change in their roles. We have tried to address this problem by involving the whole department throughout the process process and through good communication.

Site visits to other hospitals, such as Morriston Hospital in Swansea in Wales, where automation has already been introduced, showed us that pharmacies that have re-engineered their department and workflow have found automation particularly beneficial and we have reviewed all our processes as part of the project.

Future
We have carried out baseline measurements, including a time and motion study within the pharmacy department, and have looked at dispensing errors, outpatient waiting times and urgent going-home prescriptions. These will be measured again after the system has been running for several months in order to analyse any improvements resulting from the robot.

Resource
W: www.pasa.nhs.uk

References
1. Brinklow N. A report assessing the impact of an automated dispensing system (ADS) at King’s College Hospital NHS Trust. Reading: NHS PASA; 2006 May.
2. Fitzpatrick R. Automating the hospital medicines supply chain. Hospital Pharmacy Europe 2008;39:77-9.
3. Green C, Hughes D. Ward automation with Medi365 at the Countess of Chester Hospital NHS Foundation Trust. Hospital Pharmacy Europe 2008;40:69-71.



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