The Pharmaceutical Journal
Vol 269 No 7215 p370
14 September 2002

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World Congress of Pharmacy and Pharmaceutical Sciences summary

Can dispensing technicians and automation help ensure patients safety?

Pharmacists play a vital role in patient safety, but in many countries of the world, including the United Kingdom, there is a shortage of pharmacists. Pharmacists, therefore, need help to create an environment that will enhance the safety of medicines use. Speakers at a pharmacy practice symposium entitled "Pharmacists, technicians and machines" on 3 September discussed the role of dispensing technicians and automation in helping to ensure patient safety.

According to Lisa Lifshin, of the American Society of Health-System Pharmacists, Bethesda, Maryland, United States, well trained pharmacy technicians can complete tasks which do not necessarily require the knowledge and judgement of a pharmacist and by enhancing safe medication use, they can help to promote the safest productive environment, while freeing the pharmacist to provide better clinical care for patients.

To do this, however, technicians have to be well trained by means of properly accredited training programmes. In the US, the ASHP is the only organisation to accredit technician-training programmes. Accreditation is still a voluntary process, and there are, therefore, inconsistencies in the quality of training.

For a training programme to be accredited it has to reach certain standards in relation to the training site, the programme itself and the teachers, and is subject to regular review by the ASHP. The training is rigorous and has to include didactic, experiential and laboratory experience and be of at least 600 hours duration. During the past five years the number of accredited programmes has doubled to 90, but to ensure enough technicians, many more programmes will need to be accredited in the near future, said Ms Lifshin.

Registration of technicians is also an issue, she said. In the US, it is patchy, with some states requiring technicians to be registered and some not.

Dr Han de Gier, of Health Base Foundation, Houten, the Netherlands, discussed the potential influence of computerised decision support systems on pharmaceutical care, including medication safety. Most computerised systems in pharmacies enable the processing and management of information (eg, input of data from prescriptions). However, decision support is frequently lacking.

Pharmacy decision support systems can be defined as software that integrates information on the characteristics of individual patients with a computerised knowledge base for the purpose of generating patient-specific assessments or recommendations designed to help a pharmacist or patient make health and medication-related decisions. Such systems should help not only with decisions related to dispensing but also to pharmaceutical care and should allow for efficient collaboration between pharmacists and medical practitioners.

This type of system is available in the Netherlands and is in use in about one third of Dutch pharmacies, said Mr de Gier. No studies have yet been published on the effectiveness of the Dutch system in relation to pharmaceutical care. However, studies looking at systems in other countries have generally concluded that evidence of effectiveness is limited, but this can largely be due to the differences in system features and the difficulties in comparing them.

Uncertainty exists as to the features required for a computerised decision support system to optimise pharmaceutical care, and the benefits of such systems can be realised only if the knowledge base on the software is standardised and based on good quality evidence. Consensus on standards (eg, categories of drug therapy problems) is essential and a great deal of further research is needed to evaluate decision support systems, he concluded.

Professor Harold Godwin, director of pharmacy, University of Kansas, US, described various automated systems used in US pharmacies. Increased use of both automation and technicians could help to relieve the growing pressure on pharmacists and reduce medication errors.

Automated dispensing systems include compounders for intravenous fluids, packaging and dispensing carts (including machines for unit dose packaging) and robotic dispensers. The most exciting development, however, is technology that automates patient drug administration by use of a bar code on the medicine. The bar code is scanned using a portable scanner and can be used to check not only the identity of the medicine but also the identity of the patient. It charts administration and ensures that the patient receives the right drug in the right dose at the right time.

In the US, automated systems have been more eagerly embraced by hospital pharmacists than by those in the community, but robotic technology is now being used in community pharmacies, too. Automated systems improve dispensing accuracy, reduce medication errors and cost, allow for better utilisation of the workforce and provide opportunities for expanding the scope and level of pharmaceutical care, he concluded.

Developments in molecular biology

The final speaker, Daan Crommelin, of the Netherlands, discussed some of the latest developments in molecular biology which are enabling progression towards increasingly sophisticated drug delivery systems. Up until now delivery systems have been relatively simple, targeting organs and body systems, but the next step is to target cells, and possibly the cell nucleus as well. This involves what is known as nanotechnology.

Liposomes have been studied as drug delivery systems for the past 10 years, and although they have the ability to target cells, distinguishing, for example, between cancer and non-cancer cells, the technology is not yet available to use liposomes as drug delivery systems in practice. Comparing the liposome to a submarine, Mr Crommelin explained that research on liposome-entrapped diphtheria toxin A has progressed to identifying a "docking" facility (ie, a hydrophilic coating for the liposome) and a "homing device" (an antibody). What is still needed, however, is an "engine" to push the liposome into the cell. Researchers at Cornell University (US) are working on this.
— Contributed by Pamela Mason