Automation in Pharmacy
Lobna Al Juffali,Msc
Introduction
Automation
any technology , machine or device linked
to or controlled by a computer and used to
do work
Automation is designed to streamline and
improve the accuracy and efficiencey of
the medication use process
Introduction
As the profession has accepted increased responsibility for
improving patient outcomes through implementation of
pharmacists patient care services , automation has been
relied upon to free the pharmacist from technical tasks
Introduction
Use of these automated medication management systems
have been shown to reduce medication errors by
between 26% and 81% depending on the setting in
which the machines are used.
(These high rates of error reduction are achieved when
medication orders are reviewed and profiled by
pharmacists prior to administration).
Goals for the use of automation
Reducing costs
Improving operating efficiencies
Growing revenues
Enhancing safety and quality
Integrating and managing data
Providing outstanding customer service
Factors that led to Automation
Shortages of qualified pharmacists and
technicians
Shrinking operating budgets
Automation
Advantages:
Improve efficiency( Reduce pharmacy staff and work load)
Improve accuracy, reduce errors
Improve documentation
Authorized access only, enhance security
Reduce job stress and staff turnover
Shorten med pass time for nurses/ caregivers
Disadvantages:
Additional training and technical help
Downtime, system failure and inflexibility
Cost and space issues
Medication use process
Consists of five domains:
1. Purchasing/ inventory management
2. Prescribing/medication determination
3. Medication preperation, dispensing, and
counseling
4. Medication administration
5. Patient monitoring /assessment
Technologies And Automated
Devices Applied Throughout The
Medication –Use Process
Prescribing
Clinical descion support soft ware
Computerized prescriber order entry
Dispensing
Centrilized robotic dispensing technology
Centralized narcotic dispensing and inventory tracking devices
Decentrilized automated dispensing devices
Unit dose medication repacking systems
Administration
Bar code medication administration technology
Monitoring
Electronic clinical documentation systems
Unit Dose System
First used in hospitals in 1960’s
Used to decrease medication
administration errors by nursing staff, and
reduce medication waste
Standard of practice in hospital setting
today
Used in some skilled nursing facilities
Unit dose
Medication that is dispensed in a package that is
ready to administer, directly, to the
patient.Medication/Products currently being unit
dose packaged and bar coded:
1.Solid dose pouches
2.Power fill pouches
3.Strip packs
4.Oral dose syringe fill
5.Sterile Injectable syringe fill
6.Liquid unit dose
Unit Dose Systems
Unit Dose examples:
Manufacturer’s unit dose packs/cards
Medication cassettes
Unit Dose Systems
Advantages:
Improve accuracy, less errors
Easy to track usage
Less nursing time at dispensing
Less wastage, savings to facility and patient
Disadvantage:
More pharmacy processing time and equipment cost
Requires more storage space and cassette cost
No cost savings to pharmacy
Limit nursing processing and checking ability
Decentralized Automated
Dispensing Devices
unit base dispensing cabnits, are secure
storage cabinets capable of handling most
unit dose and some bulk (multiple –dose)
medications.
Automated dispensing systems
are drug storage devices or cabinets that electronically
dispense medications in a controlled fashion and track
medication use.
Their principal advantage lies in permitting nurses to
obtain medications for inpatients at the point of use.
Automated dispensing systems
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.
Do we centralize or decentralize
centralized storing and packaging and
decentralized distribution.
Automated Medication Dispensing
Devices
Small systems:
Pyxis medstation
Baxter ATC
Script-pro 200
Larger systems:
Baker cells
Baxter international
The Baxter ATC-212 dispensing
system
uses a microcomputer to pack unit- dose
tablets and capsules for oral
administration.
It is usually installed at the pharmacy.
The Baxter ATC-212 dispensing
system
Medications are stored in calibrated canisters that are
designed specifically for each medication.
Canisters are assigned a numbered location, which is
thought to reduce mix-up errors upon dispensing. When
an order is sent to the microcomputer, a tablet is
dispensed from a particular canister.
The drug is ejected into a strip-packing device
where it is labeled and hermetically sealed.
The Pyxis Medstation, Medstation
Rx, and Medstation Rx 1000
are automated dispensing devices kept on
the nursing unit.
These machines are often compared to
automatic teller machines (ATMs).
The Pyxis Medstation, Medstation
Rx, and Medstation Rx 1000
The Medstation interfaces with the pharmacy computer.
Physicians’ orders are entered into the pharmacy computer and
then transferred to the Medstation where patient profiles are
displayed to the nurse who accesses the medications for verified
orders.
Each nurse is provided with a password that must be used to
access the Medstation.
Currently ,nurses select the patient required and then select the
drug required from a list of all drugs available in the unit. The units
can also be run in ‘profile mode’ where the pharmacist reviews
medication orders and profiles a list of medications currently
prescribed for the patient and nurses then select from that list.
The Pyxis Medstation, Medstation
Rx, and Medstation Rx 1000
Pharmacists or technicians keep these
units loaded with medication. Charges are
made automatically for drugs dispensed
by the unit.
Earlier models had sufficient memory to
contain data for about one week, and
newer models can store data for longer
periods.
Advantages of the Pyxis®
System
1. Nursing staff are guided to the correct drawer and
pocket to access required medicine. Medicines which
sound similar or have multiple strengths are loaded
indifferent drawers of the machine. Access is restricted
to only one drawer/door at a time.
2.
Increased stock holdings close to patients
3. Ward stock levels are monitored by the pharmacy
computer and stocks topped up before drugs run out,
reducing delay to patients and staff frustration.
4. Management of controlled medication.
Advantages of the Pyxis®
System
5. Possible to add additional safety features for individual
high risk drugs for example,must be authorised by two
staff, soft lock outs to prevent duplicate administrations
(reduces risk of multiple administrations when staff forget
to sign for medications), advice given or required
information recorded at time of dose removal.
Advantages of the Pyxis®
System
6.Use of profile mode enables constant monitoring by
pharmacist of drug dosages/interactions.It also reduces
the amount of interpretation required by nursing staff at
time of dose removal.
7. Real time data collection for drug usage which can be
advantageous for audit and other quality improvement
processes.
Disadvantages of System
1. May be frustrating to get drugs in an
emergency.
2. While there are incremental safety
benefits running in non-profile mode, most
of the research has been at sites where
the machines have been run in profile
mode.
Script-pro 200
Usually installed in the pharmacy
Fills vials directly from dispensing cells
Can print prescription and auxillary labels
Baker cells
In pharmacy system
Counts a 30-count vial in 3-5 seconds
Option to use software that dispenses
medication after a prescription is canned
The medication administration
record (MAR):
Monthly record of dispensed medications for
each specific patient
List of medications with administration times
Medication dispensing nursing/ facility staff
initials/ signatures
May include list of prn medications
Tracks missed doses and changes in
medications
Bar Code Medication
)Administration (BCMA)
is a point-of-care software solution that
addresses the serious issue of inpatient
medication errors by electronically
validating and documenting medications
for inpatients.
Bar Code Medication
)Administration (BCMA
It ensures adherence to the “5 Rights” of
medication administration (Right Patient,
Right Route, Right Dose, Right Time,
Right Medication). and visually alerts staff
when the proper parameters are not met.
Bar coding in the pharmacy
Order
Fulfillment &
Verification
Pharmacist
Review &
Verification
Final scan
Bar Code Medication
Administration (BCMA
A. Patient name
B. Medication name
and strengths
C. Time of
administration
D. Bar code for
bedside scanning
At bed side
Disadvantage
Bar codes mismatch with drug, dose and
patient at times
Bar code sometimes function erroneously
Unable to scan bar codes properly at
times
Unreadable bar codes
Time consuming
Computerized Physician Order
Entry (CPOE)
clinical information system that enables a patient’s care
provider to enter an order for a medication, clinical
laboratory or radiology test, or procedure directly into the
computer.
The system then transmits the order to the appropriate
department, or individuals, so it can be carried out.
Computerized Physician Order
Entry (CPOE)
The most advanced implementations of
such systems also provide real-time
clinical decision support such as dosage
and alternative medication suggestions,
duplicate therapy warnings, and drug-drug
and drug-allergy interaction checking."
Advantages
Replaces hand-written orders (legibility, completeness,
readily and quickly accessible, improved
communications between physician and pharmacist; no
delay or loss ...)
Supports ready access to patient data and patient
assessment
Can help improve patient safety and prevent medical
errors and adverse drug events by checking the dosage
etc.
Supports improved recording, data trails, quality
assurance and error awareness and reporting
Advantages
Potential to improve efficiency and resource usage by
integrating different departments - laboratory, imaging,
nursing and medication records
Cost-effectiveness benefits:



Can reduce additional and often avoidable costs (clinical,
litigation ...) that can result from medication errors;
Can show test and medication costs - potential to reduce
prescription costs;
Can reduce the number of duplicate tests;
disadvantages
Cost
Risk of a system generating medication errors
e.g. through incorrect configuration or physician
input
Systems may need medical terminologies not in
local use
User resistance to introduction of computerbased technologies
Clinical Decision Support Systems
(CDSSs)
Clinical Decision Support Systems are "active
knowledge systems which use two or more items of
patient data to generate case-specific advice" [Wyatt J,
Spiegelhalter D, 1991].
Clinical DSSs are typically designed to integrate a
medical knowledge base, patient data and an inference
engine to generate case specific advice.
Clinical Decision Support Systems
(CDSSs)
drug doses, routes, and frequencies.
drug allergy checks
drug-laboratory value checks,
drug-drug interaction checks,
providing reminders about corollary
orders (eg, prompting the user to order
glucose checks after ordering insulin)
drug guidelines to the physician at the
time of drug ordering
Functions of CDSS
Four key functions of electronic clinical decision support systems are
outlined in :
1. "Administrative: Supporting clinical coding and documentation,
authorization of procedures, and referrals.
2. "Managing clinical complexity and details: tracking orders, referrals
follow-up, and preventive care.
3. "Cost control: Monitoring medication orders; avoiding duplicate or
unnecessary tests.
4. "Decision support: Supporting clinical diagnosis and treatment plan
processes
Role of Pharmacist
Develop policy for dispensing, delivery and storage of
medication in facilities
Formulate quality assurance policy for drug distribution
Track usage and monitor medication usage and returns,
including initial doses, house supply stock
Monitor the use of controlled substance: record keeping
of supply, usage and disposal
Role of Pharmacist
Provide patient specific recommendations on drug
therapy and medication needs
Ensure accuracy of Medication administration record
MAR and documentation
Provide drug information to staff, residence, family and
other health care providers
Ensure compliance with all applicable laws and
regulations governing drug distribution