Dispensing robot in place at one branch of Grays Pharmacy |
But it is not suitable for all
Delegates at another BPC session were informed
by Steve Churton, assistant pharmacy superintendent at Boots
The Chemists, that
a small scale trial of automation in two of its larger stores (in
Oldham and Newcastle) “had not brought the benefits that
we imagined it might”. |
Introducing automated dispensing brings significant benefits
to patient care and to staff in both hospital and community pharmacies,
according to Pippa Roberts, chief pharmacist and acting director of
governance and corporate affairs, Chelsea and Westminster Hospitals NHS
Trust, and Andrew Gray, superintendent pharmacist at Grays Pharmacy,
with branches at
Berwick-upon-Tweed and Tweedmouth, Northumberland. Experiences from hospital pharmacy
As a busy department in a large London teaching hospital, it is easy
to see why the pharmacy at Chelsea and Westminster is the sort of place
where automation would be expected to make the dispensing process more
efficient, Ms Roberts said.
What was more of a challenge, however, was convincing trust managers
to release the necessary funds, she said. To do this, she built up a
business case, identifying the main stakeholders and assessing what the
key drivers were for them. For example, trust chief executives are concerned
with meeting national targets, she said. At Chelsea and Westminster,
there were issues with outpatient waiting time targets, not least because
people were waiting two hours for their medicines to be dispensed. “But
there was just not enough room to get any more pharmacy staff or stock
into the small outpatient dispensary,” she
explained.
In addition, pharmacy staff were becoming increasingly involved in ward-based
roles, she added, but finding the time to do these was difficult. This
was particularly the case on a Friday afternoon, when even the most senior
pharmacists were being called back to the dispensary to help with the
workload.
Once the funds had been secured, the implementation process went fairly
smoothly, she said. “The robot was put up in five days and we were
able to preserve the service and work around it.” More problematic
were issues such as the costs of software interfaces, which are needed
for the existing pharmacy computer system as well as the robot itself,
she explained. Training and testing the system were key to successful
implementation. “You can’t do enough of either of these,” she
stressed. Also it is important to view the robot as just a part of a
wider system change, she added.
Now it is up and running, the robot picks approximately 100,000 packs
per month. A large portion of these are items for ward boxes, which are
now selected overnight, Ms Roberts explained. “About 80 per cent
of stock is now stored in the robot, including refridgerated items,” she
added. Real time stock
control is another benefit, especially where there are satellite pharmacy
departments housing expensive drugs such as those used for patients with
HIV. The robot makes it easier to know where all the stock is located
and enables overall stock levels to be reduced, she said.
For staff, one of the main benefits of having automated dispensing is
that they now go home on time. There has also been a positive effect
on recruitment. Even though there has been an overall increase in dispensary
activity, 34 per cent fewer pharmacists and 52 per cent fewer technicians
now work there, Ms Roberts continued. “This has refocused the way
we can deliver services,” she said. “These staff have been
redeployed in pharmaceutical care.” Outpatient waiting times for
medicines are now down to 20 to 30 minutes, she added.
Using automation “as a platform for service improvement” brings
significant benefits, Ms Roberts concluded. A community pharmacist’s viewpoint
Relocating to a small, awkward-shaped site in a busy health centre
was the main impetus for introducing automation into one of his company’s
two community pharmacies in Scotland, according to Andrew Gray, superintendent
pharmacist for Grays Pharmacy. As well as the space issue, there was
a need to free staff time, in order to introduce new patient services
such as carrying out medication reviews.
Cost was clearly an issue, Mr Gray continued. A wholesaler would fund
the software, but not the robot itself, and it was too difficult to share
the equipment with other local pharmacies. Some limited funding was available
from the local primary care trust, he added. In the end, a simple “hire
purchase” deal was agreed with Mr Gray’s bank. “The
bank was used to setting up these for
financing tractors and combine harvesters,” he said, “but
this was its first dispensing robot.”
Installing the robot took about two weeks, he said, with filling it and
training staff taking another week. His tips for installation include
designing the pharmacy around the robot and giving it as much capacity
as possible.
One of the main benefits of installing automation is that technicians
now work individually at a computer terminal. It is no longer the case
that one technician produces the label with another technician finding
the stock. This will make it easier to introduce technician checking,
he pointed out. The dispensing service now provided seems to be faster
and more efficient, he added, although this is difficult to measure,
given the move to a new site. Staff time has been freed too, particularly
at the branch where the robot is not located, since some dispensing has
been centralised to the automated branch.
On the downside, Mr Gray mentioned that the conveyors of the system are
noisier than expected. Establishing a drug database for the robot was
difficult, he said, but they did a lot of this work from scratch, which
would not necessarily be the case for those installing automated dispensing
systems now. Labelling interfaces are also an issue, with Grays Pharmacy
being on its third labelling system and second wholesaler since the robot
was installed five years ago. The full potential of centralising dispensing
has also not yet been realised because of issues with patient medication
records, he said.
Mr Gray pointed out that there was no simple formula along the lines
of the number of prescriptions that need to be dispensed per month before
the costs of automation can be justified. Issues such as the moves towards
linking payment with service developments and the costs of, for example,
building extensions to pharmacies need to be considered as well. “But
if I were a medium sized-pharmacy with a few branches in a local area,
I’d be thinking about automation,” he said. |
The
Pharmaceutical Journal