AUTOMATED DISPENSING SYSTEMS IN THE INPATIENT PHARMACY

AUTOMATED DISPENSING SYSTEMS IN THE INPATIENT PHARMACY

Chinnu P.B and Mary Raju Mathew

5 th Year Pharm.D, Dept of Pharmacy Practice, Alshifa College of Pharmacy

INTRODUCTION

Around the world, there are robots performing surgeries, doing mechanical works, solving mathematical problems, driving cars, helping humans with household chores, and even accompanying humans to the outer space. Advancement in robotic technology over the years has been drastic.  Automation has been credited with precision and easier work flow. Robots have always captured the storylines of sci-fi movies and now they have begun to be seen as a long term investment in the healthcare scenario too. Pharmacy is no exception to this robotic revolution. With the introduction of automated dispensing systems (ADS) in the 1980s, health information technology (HIT) has brought hopes of reduced rates of medication errors, increased efficiency for pharmacy and nursing staff, ready availability of medications where they are most often used, reduced cost that is associated with adverse events and medication errors, increased medication administration safety with bar-coding verification, improved pharmacy inventory and billing functions. The capacity of such systems to contribute to patient safety appears big.

Automated dispensing systems (ADS) are drug storage devices or cabinets that electronically dispense medications and track medication use. Their principal advantage lies in permitting nurses to obtain medications for inpatients at the point of use. Most systems require user identifiers and passwords, and their software can track the physician who placed the medication orders, the pharmacist who reviewed/entered the orders into the electronic medical record, nurses accessing the medicines, the patients for whom medications are administered, and provide usage data to the hospital's financial office for the patients' bills. ⁽¹⁾These automated dispensing systems can be stocked by centralized or decentralized pharmacies. Centralized pharmacies prepare and distribute medications from a central location within the hospital. Decentralized pharmacies reside on nursing units or wards, with a single decentralized pharmacy often serving several units or wards. These decentralized pharmacies usually receive their medication stock and supplies from the hospital's central pharmacy. ⁽²⁾

Automated Dispensing Systems can be installed at the pharmacy or on the ward. The Centre for Health Systems and Safety Research (Australian Commission on safety and quality in healthcare) assorts Automated Dispensing System (ADS) for inpatient services as pharmacy based ADS, wards based ADS and automated unit dose dispensing.⁽¹⁾ The pharmacy based ADS (PillPicker®) helps in dispensing large number of medications at a time, with greater speed, precision and accuracy. There are automated unit dose dispensing systems (Baxter ATC-212®) that can be coupled with pharmacy based ADS. These can remove medication from the manufacturers’ original pack, then repack the medication into a unit dose pack, decreasing dispensing errors and time spent by technicians. There are automated unit dose systems that reduce dispensing time in outpatient pharmacies too (Parata Max®). Ward-based ADS (Pyxis Medstation ®) are used as electronic storage cabinets for medicines on each ward. Since they are linked to the electronic medical record, it is well monitored and has innumerable benefits. They significantly reduce medication errors, increase clinical pharmacy services to wards and decrease nursing time spent on medicines-related activities. ⁽²⁾

Hospitals around the world have been investing in ADS since the last 10 years, in India super speciality hospitals like the Aster Medcity have introduced ADS in their pharmacies. Despite the huge cost in purchasing such systems, many healthcare centres have forseen the ability of health information technology in improving drug therapy related patient safety, and henceforth approve ADS to be a good choice for safer packaging, dispensing and administration. This issue features pharmacy based automated dispensing system.

PHARMACY-BASED ADS

Let’s take a look into how the pharmacy based ADS called PillPick® (consisting of the PillPicker® for packaging, DrugNest® for storage and PickRing® for dispensing) works:

Medications are stored on designated shelves in the ADS. When a dispensing order is entered into the ADS software, a robotic arm in the ADS selects the requested medication from the shelf within the device and transfers the product to the delivery station. Medication is stored and retrieved from the ADS, based on recognition of the ‘Number barcode’ on the product. The medicine is then checked against its barcode.

At the PillPick work station shown in Fig 1, the solid medications from the manufacturers’ pack are transferred by a pharmacist into a PillPick Canister (Fig2). Before the canister is loaded into the PillPick, a pharmacist checks if the right medications are in the canister. Canisters are coded with information related to each medication, written to a radio frequency tag (RFID) and output to a barcode label.

FIG 1 

Picture courtesy: PilPick® overview brochure. Available from: swisslog.com/pillpick.

 

FIG 2

Picture courtesy: PilPick® overview brochure. Available from: swisslog.com/pillpick.

 

The PillPick® picks up a unit dose from the canister and verifies and drops it into a unit dose bag, bag is sealed and bar-coded with a unique serial number, PillPick® then does a secondary check of pill size and shape by photographing each pack. Damaged, crushed or incorrect medications are discarded. Each encoded bag containing a single unit dose is stored in the cabinet until requested. PillPick® securely stores up to 51,060 unit doses.

On entering a dispensing order into the system, the robotic arm picks up the appropriate medication from the storage. Unit dose are scanned and verified, then placed onto a flexible, plastic ring called the PickRing® in order by administration time, a patient-specific bar-coded label is printed meantime, and the label is scanned to validate the contents of the ring. PickRings® that contain inaccurate medications are rejected and reprocessed. Vials, syringes, ampoules or cups can also be stored. ⁽³⁾

Two robots run simultaneously. One robot loads the unit dose bags, picks it from the storage unit and then loads onto the PickRing®. The second robot retrieves returned unit dose bags from the returns window and loads them back into the storage unit. Medicines which are to be filled in the patients’ cart are dispensed on one side, stat and first dose PickRings® are dispensed from the other. Each PickRing supplies a 12 or 24-hour supply of bar-coded, patient-specific medications Each PickRing includes a summary label listing each drug. Technician transfers PickRing to patient floor. The nurse locates the PickRing and brings it to the patient. After verifying patient bar code to make sure that patients are receiving the correct medications at the correct time, the nurse administers the medications. Unused medications are returned to the pharmacist. The returned unit dose packs are placed on pins through the return window. The bags are scanned, sorted and returned to storage on the PillPick®. Inventory is updated and patient account is automatically credited.

As PillPick® is fully automated this eliminates any packaging or dispensing error or administration error. The medication check done prior to loading pill pick canisters may eliminate the need for pharmacist to check again while dispensing. Both stat and first dose medicines are dispensed at the same time as other inpatient medicines. It also eliminates any administration errors by the nurse like missing a dose, by providing all of the patients’ medication on a single PickRing ®. ⁽³⁾

REFERENCE:

1.      Michael D. Murray. Automated Medication Dispensing Devices, AHRQ Archive Home. US Department Of Health And Human Services. Available from: www.ahrq.gov.

2.      Lehnbom EC, Oliver KV; et al. Evidence-briefings-on-interventions-to-Improve-medication-safety-Automated-dispensing-systems. Australian Commission on Safety and Quality in Healthcare 2013; 1(2):16-20.

3.      PilPick® overview brochure. Available from: swisslog.com/pillpick.