On the 18 November 2014, PharmConsult conducted a Forum titled Applying proved technologies for medicines safety and distribution efficiency.
The aim of the Forum was to provide a mechanism to discuss more fully the benefits that technology (such as bar coding and automation), which has proved its value in other industries, can provide in healthcare and particularly with medicines.
The Forum featured:
- a keynote address from Mark Neuenschwander from Seattle, USA, a recognised expert and consultant in promoting and facilitating wise development and sound deployment of medication-use automation focusing on barcode-enabled medication dispensing, preparation, and administration. Mark was awarded the Institute for Safe Medication Practices’ Lifetime Achievement Award in 2010 in recognition of his two decades in working to increase safety in medication use;
- presentations from four pharmacists who provided insights into their experiences in hospital pharmacy dispending automation / robotics and technology integration; and
- discussion among participants in relation to experiences and issues which need to be addressed with automation, robotics, electronic medication management systems and bar coding at the bedside.
During his compelling presentation, Mark Neuenschwander made many salient points while summarizing the history of the medicines-related safety technology in North America, noting the shifting medicine distribution paradigm and things that have worked and haven’t (offering reasons for each). Below is a summary of some of a few of his points:
- The drug distribution paradigm in the US has changed over the last 20 years from centralised pharmacy-based processes to decentralised ward-based automated dispensing cabinets and eventually to hybrid systems to facilitate unit dose drug dispensing.
- Today nearly two-thirds of US hospitals are scanning patients and most medications just prior to administration and the results in error prevention are impressive.
- The tipping point for the widespread adoption of scanning of barcodes on medicines at the point-of-care in the US was the US Food and Drug Administration (FDA) issuing a rule requiring drug manufacturers to include barcodes on all immediate packages (i.e. the package from which the dose is taken to be administered).
- While most medications can move from the loading dock through the pharmacy to the point of care intact with manufacturer bar-coded labels, some medications require preparation and compounding. These include the higher-risk drugs like chemotherapy, often involving high-risk patients (e.g. paediatrics, oncology, etc.).
- Neuenschwander has recently completed a report on Bar-Code Medication Preparation (BCMP) technologies available in the US that reviews more than 12 products from semi-automated manual systems to highly robotic systems. All these systems use bar-code scanning to verify containers and ingredients and to produce final order-specific bar-code labels for scanning prior to administration to a patient. In addition, many semi-automated manual systems utilise a combination of imaging (where cameras capture images of drug vials and drawn-up syringes used during compounding), and gravimetrics (which require compounding technicians to weigh vials, syringes, and bags before and after drawing up and adding to bags).
- One leading BCMP provider has compiled data from several million IV preparations, revealing consistent product selection error rates of nearly 5.5% distributed across 14 different error types. The most repeated error involved wrong selection of products.
- Bar-coding at the bedside protects nurses. Experience shows that in virtually every hospital that moves to bedside barcoding, within the first week, nurses are prevented from giving medications that would have caused harm to a patient.
The Australian experience
The presentations from the Australian pharmacists who had implemented pharmacy dispensing robotics and experienced the challenges of integrating these with existing systems, reported the following in regard in-pharmacy dispensing automation:
Outcomes / benefits or robotics:
- faster dispensing processes where one hospital reported decreases of 64% in time to collect stock, 29% in total process time, and 100% in time refilling dispensary shelves);
- improved stock rotation and a reduction in expired stock (including a decrease of 75% in write offs);
- less chaotic staff movement within dispensary and store leading to greater efficiency;
- improved space utilisation;
- increased security of stock holdings;
- instant stocktake for the majority of stock;
- reduced stock selection and dispensing errors;
- redeployment of staff from store and dispensary to support direct patient care (where one hospital reported increases of 8% in production of discharge medication records and 32% in pharmacist interventions);
- reduced out of hours recall activity via on-call remote access;
- removal of repetitive stocking and unstocking tasks.
The advice the pharmacists offered to those considering pharmacy automation included:
- Consider carefully the interfacing with pharmacy software (including financial reporting).
- Appoint a dedicated project officer / champion and an implementation team with key targets and accountability.
- Think about from where support from the vendor will be provided.
- Limit the number of people involved in negotiations.
- Ensure there are written assurances of timely delivery of products, with penalties for non-delivery.
- Collect data before installation, even if it slows down implementation.
In regard to the critical issue of interfaces, the Forum heard that there are many key actions which must be completed to achieve successful integration of systems. These included: planning interfaces carefully; building the costs of interfaces into the business case; ensuring there are key deliverables associated with the interfaces; engaging with vendors early to assess willingness to interface/integrate, to agree on scope and on capability, to determine if the interfaces will scale up to multi-site, if emulators available, and if a test environment will be available after go-live; and above all, not underestimating the amount of effort required to test (and retest) properly.
A point made by Mark Neuenschwander probably sums up much of the discussion when he said that ‘automation should not be done just because you can. Automation must serve you, not the reverse’.
PharmConsult Pty Ltd