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Mr Savage is chief pharmacist and clinical director for clinical support services, Carmarthenshire NHS Trust, West Wales General Hospital, Carmarthen |
For most hospital pharmacists, there are few things that you experience
in your career that you would count as inspirational moments. For me,
in 1996, when I saw an automated dispensing system — a robot — at
work on a foreign language video with a tacky brass band sound track,
I knew I was seeing something significant. I just had to see this development
(the robot, not the musical ensemble!) for myself and immediately agreed
to go to Germany to see the technology in action.
Technology for some people is simply a matter of functionality. It is
a means to an end –– the car that gets you from A to B, without
thought for the magnificence of the twin overhead cam, supercharged engine
and the double wishbones that make driving home along the B4067 bearable.
No amount of pressure or slick patter from the used car salesman is needed
when these individuals come in to change their car. They just want the
beige one because it is two hundred quid cheaper.
For others, however, it is all about the smart sequential gearbox, ingenious
permanent four-wheel drive, and the array of shiny knobs machined to
make it look faster. When you are a fan of the output from Marenello,
it matters more than life itself to get their latest “must have” model – something
from Stuttgart simply will not do (... and, for Porsche fans, vice versa).
Automating the dispensing process will bring differing experiences to
different people. But love it or fear it, the outcome will be the same
because, based on our experiences in Wales ... it works!
The principles of using machinery to take the strain and embracing technological
developments are embedded in our everyday lives. Imagine washing clothes
manually. The only “dolly” anyone under 40 will have heard
of is a cloned sheep — and rightly so.
The time has come for hospital pharmacy to engage with technology, in
order to deliver reductions in picking errors, cope with a worsening
manpower shortage and modernise the supply chain.
Using robots, even for the sceptical among us, has been an enlightening
experience during the first phase of the Welsh automation project. The
penny has dropped that the calm atmosphere that descends upon the dispensary
when people are no longer rushing from shelf to computer and back is
a real benefit. The avoidance of the confusion between “look-alike” and “sound-alike” drugs
on burgeoning dispensary shelves will, I am sure, prove to be a significant
factor in reducing dispensing errors.
The ability to assemble ward boxes more efficiently, for example, through
the night is another potential benefit of introducing automated dispensing
technology. In addition, the extra storage capacity robots bring could
allow acute trusts to concentrate ward box assembly at one of their hospital
sites. Moreover, the thought of remotely initiating the supply of urgently-required
medicines from the comfort of your own home might seem on a par with
the aspirations of Mr Bush to put a man on Mars — but it is a reality
in Wales today.
With time, other benefits of robotic dispensing will no doubt accrue,
particularly to the procurement end of the supply chain. Interfacing
the dipensary computer systems with those of medicines suppliers or wholesalers
will enable the rapid expansion of electronic ordering and invoicing.
The enclosed nature of automated dispensing systems gives the same level
of assurance to auditors as that derived from the systems currently in
place, but without the need for a cumbersome paper trail.
Hence the evidence-base for the introduction of automated dispensing
systems is growing quickly. As a result, there are several contracts
to supply this technology to hospital pharmacy departments currently
out to tender –– a clear indication that I am not alone in
my enthusiasm for the technology.
There is, however, work still to be done. As with many other developments
in hospital pharmacy, although the logic of introducing change is clear,
delays in agreeing the associated financial framework can threaten the
pace of progress. Comfort can be obtained from the fact, for example,
that some primary care organisations and trusts have finally negotiated
the introduction of original pack dispensing in hospitals. This suggests
that a financial solution can be found where benefits are obvious. (Moreover,
patient pack dispensing is a prerequisite to derive maximum benefit from
the most widely used robots, so this development is important in itself.)
Of course, pharmacy-based original pack dispensing is not appropriate
in all circumstances. In clinical areas such as mental health, where
the use of original packs is inappropriate, unit dose machines might
be more appropriate. With time, a mixture of systems to best fit each
hospital’s client base will inevitably come about.
There is also a danger that the industry supporting the implementation
of these life-changing tools might be forced to expand too quickly to
keep pace with demand. If it arises, this situation will need to be managed
corporately to ensure long-term success.
Despite these issues, the market is undoubtedly maturing and I am sure
it will continue to do so to create a sustainable and vibrant industry
delivering the labour-saving devices that will become the norm for hospital
pharmacy services. The result will be the release of pharmacists and
technicians to deliver care directly to the patient in a safer and more
efficient environment.
Now where did I put my car keys?
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Hospital Pharmacist