Hospital Pharmacist
Vol 11 No 8 p306
September 2004

Automated dispensing — should we be putting on the brakes?

By George Gannon

Which is faster — a Ferrari racing car being driven around Monza by Michael Schumacher or the rate at which automated dispensing systems are being introduced into UK hospital dispensaries? Statisticians (and indeed pharmacist colleagues) will no doubt remind me that, because one is measured in kilometres (or miles) per hour and the other in, say, hospitals per month, these two examples cannot be compared. Even so, the rate at which automated dispensing systems are being tendered for and installed into hospital pharmacies in the UK seems to be fast — it will not be long before the majority of hospital dispensaries in the country contain such technology.

Is such wide-scale implementation entirely a positive thing? Or are there potential pitfalls, and if so, is there anything that can be done to avoid them? For my own part, while I can see that automation brings various benefits,^1,2 I have concerns about how its introduction is being managed at a strategic level.

Many of my reservations stem from my experiences with hospital pharmacy computer systems. There is no doubt that these perform a useful function and are clearly preferable to hand-writing labels and manually ordering stock using a cardex system. However, I know of few, if any, hospital pharmacists who are entirely happy with how their computer system works. Each system has been developed independently from another to different specifications, making it difficult for pharmacists changing jobs to move between different systems. Although enhancements and upgrades have been introduced over the years, these seem to have been dictated more by suppliers’ preferences than by customers’ needs. The reality seems to be that each system now requires dispensary staff to “work around” it in some way, before they can deliver the service they wish to in a modern and changing NHS.

So will the same issues apply to automated dispensing systems in future years? How flexible will they be? Will the technology dictate how pharmacy services develop, rather than the other way around?

At the moment there is growing competition in the market and suppliers seem to be genuinely interested in meeting customers needs. But will this always be the case, once most hospitals have systems that they are effectively “stuck with” for quite a period of time. Will we get the developments we want in order to deliver the services of the future. What will be the cost to trusts and the incentive to suppliers to deliver these? In other words, will only some trusts benefit from enhancements such as:

· Receipt of requisitions from a central NHS store or external supplier
· Automatic checking of deliveries with exception reports
· Vendor-managed relationships with suppliers or NHS central stores
· Advanced stock management systems
· Faster loading, especially for ward assembly
· Interfaces so that automated dispensing systems can interact with electronic prescribing systems
· Automatic labelling

As end-users, there is clearly a limit to what pharmacists can do to prevent systems from “stagnating”. There are, however, strategies that I believe might help, including:

· Lobbying for national specifications for automated dispensing equipment (equivalent to those that exist for many medical devices)
· Forming strong user groups with the aim of, among other things, letting suppliers know our main concerns and how we would like systems to develop
· Building long-term upgrade pathways with robotic suppliers
· Taking a more co-ordinated approach to purchasing automated dispensing systems both in terms of how such technology fits into local IT strategy and at a more regional or national level

As far as the latter point is concerned, we in England might be able to learn from those in Wales, where a more centralised approach to procurement has been adopted. This enables services to be planned on a more strategic basis. It also means that better value for money can be obtained when purchasing systems as well as enabling a large-scale evaluation of the effects of automated dispensing to be carried out.³

As well as the potential for system fragmentation and stagnation, there are other strategic concerns. For example, how does it fit in with moves towards delivering a more ward-based service and the development of satellite pharmacies? How will automated dispensing link up with some of the ward-based electronic prescribing and administration systems now available?⁴ Electronic prescribing will itself have a dramatic effect on how and where a dispensing service needs to be located and could even lead to larger off-site centralised dispensaries serving large geographical areas.

How do we know that the right technology has been purchased? The truth is – we do not. Most trusts purchase technology shortly after they manage to secure funds because of the pressure to spend the budget allocation in a specific financial year.

In general, to continue with the motoring analogy, I cannot help thinking that we should be putting on the brakes regarding pharmacy-based automated dispensing. This is not to say that we should not put our foot down on the accelerator at some time in the future, just that we should stop at the cross-roads first and look around us in all directions before moving on.

References

1. Fitzpatrick R. Automated dispensing — developing a business case to support investment. Hospital Pharmacist 2004; 11:109–11 (PDF 120K)
2. Savage J. Robotic dispensing — why it’s inspiration not perspiration. Hospital Pharmacist 2004; 11:122 (PDF 50K)
3. Whittlesea C, Phillips C, Roberts D, Burfield R, Savage J, Way C. Automated dispensing — how to evaluate its impact. Hospital Pharmacist 2004;11:283–5 (PDF 110K)
4. New computerised medicines system is installed at Charing Cross Hospital. Pharmaceutical Journal 2003;271:570