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 1960s
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:

Manufacturers 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 patients 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