Hospital Pharmacist
Vol 11 No 5 p198-200
May 2004

Automated dispensing — practical tips on managing implementation

By Ashik Shah, MRPharmS

Implementing automated dispensing in a hospital pharmacy involves a large amount of work and planning before, during and after the machinery itself is installed. It is difficult to describe the exact nature of the things that need to be done, because that will depend on, for example, the current organisation of the dispensary (both physically and in terms of working practices) and the particular requirements of the system being installed.

This article sets out some of the main aspects of the implementation process and identifies the practical issues involved. It is based on the experiences of implementing devices at the Whittington, Royal Free and Middlesex hospitals in London.

The main aspects of the implementation process covered are:

· Planning a new dispensary layout and co-ordinating structural changes
· Managing changes to information technology
· Making changes to working practices
· Minimising disruption during the installation process
· “Going live”

Planniing a new layout

Before installation takes place, it is essential to plan how having an automated dispensing device in place will affect workflow and how the dispensary should be laid out to incorporate these alterations.

In particular, the relocation of dispensing work stations is likely to be needed. If drop shutes (without a conveyor system) are to be used, dispensing stations really need to be located by the side of the robot. If conveyor belts are used, work stations need to be at the end of the conveyors (or the drop shutes coming from the conveyor system). The need for dispensing stations in locations other than these will reduce, since most dispensing will be carried out using the automated system. It is also likely that less shelving will be required, because most lines will be stored in the device. When the new layout is planned, it should ideally take into account future considerations, such as plans to change to one-stop dispensing (if this has not been done already - see later).

In order to accommodate the device physically, it may well be necessary to knock down or build walls in the dispensary, raise ceiling heights and strengthen floors, all of which will need to be done (and checked and re-checked) before the system is delivered. It is also worthwhile checking that doorways are large enough to allow the device to be brought into the department. Although most automated dispensing systems are delivered “flat packed” their assembly still involves moving around heavy cases of glass and long sheets of metal. Other considerations include ensuring that the area where the device is to be sited is free of sewage and water pipes, so that the chance of leaks into the device, or it being damaged because of flooding, are reduced.

Air conditioning and additional lighting might also need to be installed, especially if windows are to be lost as the result of building work. Some devices can be linked up to air conditioning units to regulate the temperature inside them, which affects where they (or the air conditioning) should be sited. Additional cables and telephone lines are likely to be required, the latter enabling any problems with the automated dispensing system to be diagnosed remotely and dealt with by the supplier’s engineers without having to come “on site”. A fire-risk assessment should be carried out with the trust fire-safety officer, who will also be able to advise on the re-siting of fire extinguishers and other necessary equipment.

Whatever physical changes are made in the dispensary, senior members of the pharmacy staff should co-ordinate and control the communication between the trust’s facilities managers or estates departments and the device suppliers, typically through chairing a series of meetings. Having pharmacy staff take a lead role at an early stage is important, because making even small changes is difficult once the process is underway. Moreover, it is pharmacy staff who will be worse affected if inapproriate decisons are made. Having pharmacy staff take the lead in this way will also ensure that they are able to establish good working relationships with employees of the equipment suppliers –– such networking will be beneficial should there be any problems in the future.

Information technology

Aspects of computer systems (ie, text codes, short codes etc) may require updating. In addition, computers themselves may need changing from “dumb” dispensing terminals to PCs in order to allow, for example, access to networked programs and the internet and the printing of patient information leaflets. Consideration should be given to introducing thermal printers, which provide clear labels and make a dispensed box look more professional.

Existing pharmacy system software will need to be interfaced with the robot software, with the interface being written either in-house (as was done at the Whittington and Middlesex hospitals) or by an external provider (which could be expensive).¹

Minimising dispruption

Minimising disruption to daily dispensary work during building work and installation is obviously important. The extent to which the space where the device is to be installed can be cordoned off from the main dispensary clearly impacts on this. For example, if the system can be installed in an area adjacent to the dispensary (as was possible at the Whittington Hospital) the main sources of interruption to daily work is likely to be the increased noise and dust levels caused by the installation work going on near-by. These can be minimised by arranging for the workmen to start early and finish late for a few days, rather than work regular hours for a greater number of days. Similarly, if the robot is to be installed in an entirely separate area in the hospital (as was the case for the out-patient pharmacy at The Royal Free Hospital) then minimal disruption can be expected.

Where space considerations mean that installation work needs to be carried out within the dispensary environment (as happened at the Middlesex Hospital), disruption to the daily work process is unfortunately inevitable. There are, however, strategies that can help minimise disruption, and reduce its effects, some of which are set out in Panel 1.

Methods of working

Some changes to working practices are usually needed in order to get the maximum benefit from an automated dispensing system. In particular, moving to patient pack dispensing (if this is not already in place) is often seen as a prerequisite to implementing automated dispensing effectively, because the most widely-used automated dispensing systyems store and dispense whole packs of medicines only.

Using patient packs can be a big issue for hopsital pharmacists for two reasons. First, despite general moves towards patient pack dispensing throughout the pharmaceutical industry, some drugs (eg, certain antibiotics and calcium preparations) are often still supplied in bulk dispensing containers, and so new supplies will need to be sourced. Second, changing from an arrangement whereby seven or 14-days supply of medicines is given on discharge to supplying patient packs can have a big impact on the drug budget. The local primary care trust should be approached to provide funding. In addition, having one-stop dispensing in place generally alleviates some of the impact on the drug budget of moving over to patient pack dispensing. Prescribers in the hospital will also need to be made aware of the new policy.

Implementing automation also provides pharmacy managers with a good opportunity to review other related procedures and protocols. For example, at the Whittington Hospital, a new set of dispensing and labelling guidelines were introduced (with input from dispensary staff members) to tie in with the start of automated dispensing.

“Going live”

Once the system is installed, staff should be trained in its operation before “going live”. All staff should be provided with an opportunity to work with the machinery and be encourged to take ownership of the system and any new working practices. A select set of staff (ie, senior dispensary staff, IT staff, pharmacy stores staff and on-call pharmacists) will need more comprehensive training so they can run the device on a day-to-day basis. This tuition should be conducted by the suppliers’ engineers, with provision for this service being made when the system is procured.²

There should be a set time for loading the machine, testing the interface, and ensuring that all aspects are running smoothly before dispensing operations are transferred to the machine. Loading the machine in particular can take a considerable amount of time — approximately 1,000 packs per day could be loaded into the system used at the Whittington Hospital and approximately 20,000 packs needed to be in place before the machine was considered full enough to “go live”.

Perhaps the most important message at this stage in the implementation process is to curb the urgency to “go live” — it becomes difficult to resolve problems once this has happened.

Conclusion

Implementing automated dispensing involves a large amount of work and planing, much of which needs to be done before the machinery itself is delivered and installed. Pharmacy staff need to be at the forefront of decisions that are made. That way, the implementation process should run smoothly and the resulting system should contribute significantly to making day-to-day dispensary work more efficient.

References

1. Fitzpatrick R. Automated dispensing - developing a business case to secure investment. Hospital Pharmacist 2004;11:109–11 (PDF 120K)
2. Karr A. Automated dispensing - procuring an automated picking machine. Hospital Pharmacist 2004;11:152–4 (PDF 75K)