Automation in Pharmacy

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 McLaughlin dispensing system

▶ includes a bedside dispenser, a programmable magnetic card,

and a pharmacy computer.
▶ It is a locked system that is loaded with the medications
prescribed for a patient.
▶ At the appropriate dosing time, the bedside dispenser drawer
unlocks automatically to allow a dose to be removed and
administered.
▶ A light above the patient’ s door illuminates at the
appropriate dosing time.
▶ Only certain medications fit in the compartmentalized
cabinet (such as tablets, capsules, small pre-filled syringes,
and ophthalmic drops).
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 Baxter ATC-212 dispensing system
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

Pharmacist
Order Fulfillment Final scan
Review &
& Verification
Verification
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