My first experience of automation in hospital pharmacy was over 20 years ago when the department I worked in then installed a Pharmatriever. This was a machine developed from a card index storage and retrieval system. It stored medicines on rotating shelves, which one called up using a simple keyboard to bring the appropriate shelf to you. Initially it was a success. A vast amount of medicines were able to be stored in a relatively small area, and there was definitely a novelty value. However, enthusiasm soon waned. It was quite slow, and it was impossible for more than one person to access it at a time, both major constraints even in those less hectic days. A further problem was remembering on which shelf the desired medicine was on, or having to scroll through the machine until it arrived. My personal enthusiasm waned even further when the power failed and I had to sit on the floor and move the shelves using the manual handle.
In the UK, automation took a back seat until relatively recently. Development of clinical pharmacy and the lack of suitable technology were probably the main factors. In the 1980s and 1990s the literature described examples of automation in the USA and some parts of Europe, particularly Scandinavia. Much of the US experience was interesting but of limited use, being either for unit dose or much larger scale activity than applied in Europe. Machines have also been developed for the filling of TPN and other IV compounding, which have become widely used. The late 1990s, however, brought together the two main components of feasible automation for core functions in hospital pharmacy: sophisticated computer systems and reliable picking and distribution technology in a relatively compact unit. In association with patient packs, it enabled significant proportions of dispensing and distribution to be automated.
The question is: what do we, as hospital pharmacists, get from automation? Automation can lead to: reductions in errors; improved stock handling and control; better use of staff; and quicker turnaround of prescriptions. In countries where there is a shortage of pharmacists and/or technicians, it can help us deal with increasing workloads in the absence of extra staff. Alternatively, it can free up staff for clinical or other activities. This all sounds very rosy, but is there a downside to this Nirvana? First, considerable costs are involved; not only the cost of the machine and its maintenance, but also the non-negligible investment to install it, link it to existing computer systems and train staff to use it. Robust business cases are needed to convince hospital management that the investment is worthwhile and necessary. Automation does not eliminate all types of errors altogether, only those associated with the picking of medicines. It is still possible to label the wrong pack or hand the medicines out to the wrong patient. Automation may also introduce new errors due to new ways of working, so it is important to remain ever vigilant in our medicines safety role. Most systems available in Europe are limited to patient packs or original packs, and so some forms are not suitable for automation, including many IV infusions. Finally, the wide range of systems now available means that it is a major challenge to decide which is the best system for one’s department. Investing in an automated system is a major decision, and it is vital to get the solution that meets the needs of an individual pharmacy department.Thus, automation can help us address some of our problems, but its introduction does have to be carefully managed to get maximum benefit.
Chris Cairns, Consultant Editor