Automation

My complements to Mr. Manjoo for writing an editorial on the impact of robotics in pharmacy.  The message is clear:  pharmacists could be replaced by robots.  Like many other pharmacy informatics professionals, I share some of the article’s viewpoints on the overall state of our practice.  Automation has a lasting impact on repetitive, assembly-driven tasks in many industries around the world.  Add to this a retail pharmacy practice being molded into an insurance driven, turnaround-time model of product delivery and it is not difficult  to conclude the slow demise pharmacy practice. 

As a second generation pharmacist, I have seen the industry transform over the past few decades.  As an active member of the Section of Pharmacy Informatics and Technology, I am also aware of how automation has changed our profession.    It is sad but expected to see the public’s view of our profession.  They are bound by their observations and interactions with the pharmacist in a retail setting.  Many of us know the boundaries of our practice stretch far beyond the walls of the typical drug store, and our future is with patients. 

Hospitals make a lot of intravenous (IV) preparations. That makes sense when you consider that most people admitted to the hospital are there because their acute illness requires more care than can be administered at home; not always, but in most cases. This is especially true for patients in the intensive care unit, i.e. the ICU.

A fair number of the medications used in the ICU are prepared on demand for a host of reasons including stability, differences in concentration, difficulty in scheduling secondary to rate variability, etc. Any pharmacist or nurse reading this will understand what I'm talking about. Example medications that fall into this category include drips like norepinephrine, epinephrine, phenylephrine, amiodarone and nitroprusside.

Last year I mused about using devices on the nursing stations designed to package oral solids on demand at the point of care. I still like the idea for several reasons, all of which can be found in the original post.  Based on currently available technology the same concept could be applied to preparation of IV products at the bedside. Robotic IV preparation has come a long way and these devices could be used at the point of care to make a nurses, and patient's, life a whole lot easier. The use of robotic IV preparation at the bedside could reduce wait times for nurses and lesson the workload on pharmacy.

In a previous post I mused about using an automated packaging system like InSite from Talyst as a type of automated dispensing cabinet for acute care patients. InSite was designed for long-term care and would simply be too large for the needs of an acute care nursing unit, but the technology is ideal.

However, the ATP-71 (PDF) from Swisslog is a bulk packager that can hold up to 71 canisters in a relatively small footprint: 31.5 inches wide x 29.6 inches deep x 30.6 inches high. For comparison, a Pyxis MedStation 4000 2-drawer main unit is 22.8 inches wide x 26.7 inches deep x 27.7 inches high. I would say that makes the two units comparable in terms of size, and I can tell you from personal experience that a 2-drawer main isn’t very big up close.

According to Swisslog: “Swisslog’s high-speed packaging and barcoding solutions are not only fast and efcient, they provide many levels of patient safety. Color coded fll-to-light trays, locking canisters, and accurate labeling with barcode capabilities enable pharmacies in any size hospital to make patient safety the highest priority. Many additional accessories and interfacing capabilities complement the packager and provide gains in workfow effciency.”

This week's Cool Technology for Pharmacy is the OnDemand 400 for RxMap from MTS, a company that specializes in adherence packaging systems.

According to the MTS website:

OnDemand ® 400 for RxMap ® is the first pharmacy automation equipment system designed specifically for multi-med adherence packaging.

This efficient system uses OnDemand technology to dispense multiple medications for a single patient quickly and accurately and in a fraction of the time it would take to do it manually. This pharmacy automation equipment system utilizes a custom interface to work with your existing information systems, enabling automated workflow management in the pharmacy. This single data input process reduces input time and the possibility of data entry errors. OnDemand ® 400 for RxMap ® uses bar-code technology to accurately dispense multiple medications into one compartment - as many or as few as needed. RxMap ® Adherence Packs vary in size and shape to meet the needs of the customers you serve. The finished product is a patient - specific adherence package filled “just-in-time” for your customer.

PROmanager-Rx is an automated system from McKesson designed for dispensing unit-dosed oral solids. PROmanager-Rx has a 12,000-dose capacity and uses a conveyor system and bar-code scanner to fill orders generated through the pharmacy information system.

The system automates storage, dispensing, restocking, and various inventory management functions via the McKesson Connect-Rx software platform. And of course the system interfaces with McKesson’s pharmaceutical distribution system.

According to the McKesson product brochure:

The PROmanager-Rx™ system helps hospital pharmacies get the most out of manufacturer packaged oral solid medications. And relieves the burden of medication packaging.

It’s the only fully automated system that directly stores and dispenses pre-packaged oral solids. PROmanager-Rx is ideal for patient-centric filling. Bar-code-driven robotics scan every dose for the greatest possible safety and accuracy.

Pharmacists are freed from packaging and dispensing activities so they can play more integral roles on the clinical care team. Bar-code scanning also simplifies tasks such as managing returns, expired meds, and overall inventory.