St Thomas’s hospital, London, has linked automation and pharmacy in the dispensary with the use of a robotic picking device. Zoë Gross went to see the system in action
St Thomas’s hospital, London, has installed a robotic picking device in
its dispensary. The Rowa Speedcase, imported from Germany, enables medicinal
products to be delivered directly to where pharmacy staff are working. It also
enables the computerised management of storage space.
Mr Tony West (chief pharmacist and clinical director for pharmacy and dietetics,
St Thomas’s hospital) showed The Journal around the dispensary recently.
The dispensary has been redesigned to accommodate the Rowa Speedcase —
a mini glass warehouse.
The new equipement has been funded by the special trustees for St Thomas’s
hospital.
The rowa speedcase
 |
| A pharmacy technician scanning a pack’s bar code before putting it into the Speedcase |
The Rowa Speedcase installed at St Thomas’s is made up of two identical
automated machines, side by side, working in tandem. Each machine has two sides
of 3m high floor-to-ceiling shelving. Mr West said that items could be more
densely stocked in the Speedcase as no room was required between shelves to
allow for a human hand to put in and take out items. In comparison, shelving
in the dispensary could not be more than about 1.6m high. A robotic arm inside
each of the machines enables the picking process to be automated.
The main control area to the system is located in the dispensary at the front
of the Speedcase. It has two input points for putting stock into the machines,
two output points and two main computer terminals.
Filling the machines
 |
| The product is placed on a conveyor at one of the entry points on the Speedcase. The machine then measures the dimensions of the pack |
Before putting items into the mini-warehouse, the barcode on each pack is laser
scanned. This enables the robot to identify, for example, different products,
different strengths or different pack sizes. The product is then placed on a
conveyor belt at one of the entry points on the front of the Speedcase and the
dimensions of the pack are measured electronically by the system.
The robotic arm picks up the product and a computer randomly allocates a space
for it on a shelf which has the correct dimension for the pack. The arm then
places the pack in that space and the system remembers exactly where it was
put. Several products can be placed on the coveyor at the same time.
In order to optimise the use of space and increase the speed of picking, the
robots are able to reorganise the contents of the shelves during the night and
place items most often used at the front of the machines.
Requesting and delivering an item
 |
| Items can be densely stored on the shelves inside in the Rowa Speedcase |
The Rowa Speedcase is linked to the pharmacy’s computer system. Requests
for products can be made at any of the dispensary’s computer terminals.
From the details entered at the terminals, the robot identifies the requested
product by the barcode on its pack. One of the robotic arms then selects the
pack from the shelf and sends it via a conveyer belt to the appropriate chute
in the dispensing area.
The computer terminal can determine which chute the robot selects for sending
the item to its destination. The picking process (the time from when an item
is requested until it is delivered) takes 15 seconds or less. There are three
spiral chutes in the dispensary: one for inpatient dispensing, one for outpatient
dispensing and one for discharge medication. The robotic arm also selects items
on a “first in first out” basis and picks items with the shortest
expiry dates first.
Products
 |
| Retrieving an item from the main control area of the Speedcase. If a product batch is recalled items can be retrieved in this way |
The machines currently hold 150-200 products. The maximum capacity of the Speedcase at St Thomas’s has not been calculated but will probably exceed around 20,000 packs. Most products can be picked by automated technology. However, there are limitations to the types of products that can go into the machines. Patient packs, injections, inhalers and eye drops can all be stored but products such as refrigerator items, unlicensed medicines and Controlled Drugs are not. There are also limitations with pack sizes and weights of products.
Origin of the speedcase
In Germany, an industrial robotic device had been adapted to work in a rural
community pharmacy. In this pharmacy there was a need to free space in order
to create an area for counselling patients and to expand clinical services for
the local community. Installing the robotic picking device in the basement created
the space required.
Benefits
 |
| Products are sent via a conveyor and chute to their required destination in the dispensary |
At St Thomas’s, the new technology has reduced the amount of storage space
required to store patient packs and hence increased the amount of available
work space in the dispensary.
The Rowa Speedcase eliminates errors associated both with manually putting stock
away and with picking items and reduces the need for skilled staff to be involved
with this task. About 20 per cent of the time previously spent putting stock
away and picking prepacked items is now taken over by the machines. As the number
of prepacked items stored in the machines increases, it is expected that the
machines will do up to 80 per cent of this work. However, this will depend on
the progress with dispensing complete patient packs containing 28 days’
supply. Mr West said that patients are currently being given a two-week supply
of their medication. The issue of dispensing a four-week supply is under review
by the local health authority.
The Guy’s and St Thomas’s Hospital NHS trust is piloting a “medicines
management project”. This scheme involves supplying inpatients with individual
patient packs, each containing a full course of treatment to cover the duration
of their stay and also discharge requirements. Patients store these packs in
locked medicines cabinets by their beds. The aim is to reduce the amount of
time patients have to wait for their medication on discharge and for pharmacists
to be able to concentrate on counselling patients about their medication, rather
than having to prepare discharge prescriptions as well.
The future
An evaluation of the impact of having the robots in the dispensary is being
undertaken. This will cover outpatient waiting times, staff and space utilisation
and contact time between patients or carers and pharmacists.
The aim of installing the automated picking device is to enable pharmacists
to have more time to meet patients at the outpatient counter and to discuss
their medication with them. Mr West said that at this point in the dispensing
procedure, pharmacists should be doing the initial screening of drug charts
and prescriptions, identifying any problems and discussing them with the patient
or clinician. He also hoped that the role of the technician would develop further
and that they would have more time to spend doing final checks on dispensed
medicines and counselling patients.
The robots are expected to be fully operational by end of this year and data
are to be collected and analysed early next year.
ARX, supplier of the Rowa Speedcase, told The Journal that a second Speedcase
is being installed in the UK at Arrowe Park Hospital, Wirral Hospitals NHS trust,
and is expected to be in operation by January.
The pharmacy department at St Thomas’s hospital
The pharmacy department at St Thomas’s hospital has been both redesigned
and extended.
The dispensary has been redesigned to accommodate the new robotic technology.
Two of the offices at the side of the dispensary have been removed and the Rowa
Speedcase has been installed in the space. With less shelving required for manually
storing products, the amount of available work space has increased. Restructuring
has also allowed more daylight in to the dispensary.
The front of the dispensary now has a “sound and vision” queuing system
for managing patients collecting prescriptions. The system both displays and
announces patients’ numbers in the queue when their medication is ready
for collection and also visually gives waiting instructions to patients. There
are four service points, one of which has a low level top for disabled patients
in wheelchairs. Each service point has a hearing loop for deaf patients, which
should soon be in operation. Patients can see the Speedcase from the waiting
area and watch the robots in action.
A number of medical specialties have moved from Guy’s hospital to St Thomas’s
hospital, with a corresponding increase in the number of pharmacists and technicians
transferred to the site. As well as the dispensary’s extension, the rest
of the pharmacy department at St Thomas’s has also been extended to provide
more work space. The extension to the department includes a seminar teaching
room, offices for the clinical team and a new drug information office.
Zoë Gross is on the staff of The Pharmaceutical Journal