Going for automation Print E-mail
Written by Richard King   

In this article I will look at the reasons why community pharmacists are choosing to automate their pharmacies and the benefits they have achieved. My comments will be based on my own recent automation installation experiences.

The main automation options for pharmacists at present are automated dispensing machines (robots) and automated labelling machines. In essence robots dispense products requested by the patient medication records (PMR) labelling system and automatically deliver them by conveyors, chutes or air-tubes to the PMR workstation/s. Robotic dispensing can be done either by relatively simple and fast ‘channel’ machines that store the medicine packs in U-shaped channels, or by machines with robotic picking arms that move along and across medicines stored by the robot on shelves.

Robotic dispensing can now be followed by automated/robotic labelling, if so desired, on a separate machine available from certain manufacturers.

Reasons to automate can include any or all of those below. The reasons are not necessarily in priority order, as every pharmacy owner’s priorities are different:

  • Freeing up pharmacists and technicians to do more added value work;
  • Patient safety and pharmacy reputation;
  • Increasing productivity;
  • Making better use of pharmacy space;
  • Competitive advantage;
  • Cost control.

Freeing up staff


The selection of stock from shelves, drawers or cupboards can represent 20 per cent or more of the total time spent dispensing. The amount of time saved by automating this stage of dispensing depends primarily on:

  • The size and shape of the pharmacy;
  • What type of shelves/drawers/cupboards are used;
  • How neatly and tidily stock is held;
  • Whether there are any pre-existing fast-moving or prepacked sections.

Even in the most tidy traditional pharmacy, on a busy day, one could expect to see an hour or two of time saved by using an automated picking machine to select stock. If dispensing technicians or even pharmacists are routinely selecting stock, then automation presents a significant opportunity to free those people to do more ‘value adding’ activities such as increased patient counselling, medicines use reviews (MURs), diagnostic testing etc. These activities would gain the pharmacy additional revenue.

There is some debate about how much of the total dispensing stock should be held in the automated dispensing machine. The 80/20 law would suggest that the biggest benefit in time-saving would be achieved by just using a robot to select the fastest-moving items automatically. My experience, however, suggests that a disproportionate amount of time can be spent looking for slower-moving items. Staff tend not to know intuitively where slow-moving items are stored and indeed these are often mislocated or lost, as they are only used occasionally. Experience suggests therefore that the maximum benefit arises from putting most items into the robot, apart from very bulky items and controlled drugs. Most robotic dispensing machines are not designed to store/handle liquids, but some can handle liquids in non-glass bottles, especially if they are also packed in a protective cardboard carton.

Patients safety


There surely cannot be an experienced pharmacist who has not either made a dispensing selection or labelling mistake, or failed to pick up one made by another member of staff under their supervision. It is well known in quality improvement terms that you “cannot inspect accuracy into a process”. In other words, even if more than one person checks the work of another, not all errors will be picked up. The only successful way to avoid such errors is to stop them happening in the first place.

Using an automated machine to select stock, and possibly an automated labelling machine to label it, has already been proved to almost eliminate such errors. Only if the robot has been misloaded with stock can it make a picking error against the PMR command.

While customers seem reasonably resigned to errors occurring in many areas of their life, they seem not to readily understand or accept that mistakes can ever be made by healthcare practitioners! In these increasingly litigious times, patients who have been either psychologically or physically damaged by a dispensing error are increasingly unlikely to be satisfied just by a humble apology. In addition, the amount of time involved in resolving a dispensing error that has got all the way to the patient can be hours not minutes, even if no serious harm was done. In the process the reputation of the pharmacy can be significantly damaged. It is well know that “bad news travels faster than good” and dispensing errors are no exception to this rule, so expect dissatisfied customers to tell most of their friends and relatives, who may then stay away from your pharmacy.

In summary the following errors are virtually eliminated if you are using automation both to pick and to label:

  • Picking the wrong product, wrong strength or wrong pack size;
  • Attaching a correct label to the wrong pack;
  • Supplying the wrong number of packs;
  • Supplying correctly labelled medicines to an incorrect person;
  • Supplying unlabelled packs.

Increased productivity


Several trends have combined over recent years to increase significantly the number of drug packs and patients served by all pharmacies:

  • Original pack dispensing;
  • Multiple drug prescribing by GPs;
  • Reducing periods of treatment per prescription (to cut waste).

These trends have created queues and backlogs of work in most pharmacies at busy times. In some pharmacies – those that were perhaps poorly designed or equipped in the first place or are inadequate in size – these factors have led to a limitation both on overall and peak work capacity and thus have created many dissatisfied customers.

In my experience there is no doubt that automating a pharmacy increases both its average workrate and its peak workrate. Automation therefore increases the amount of total dispensing that can be done (in a given time) and also increases the peak work rate that can be achieved at busy times. The significantly reduced dispensing error rate further enhances staff morale and productivity and reduces unproductive time spent redoing work.

Automation can be used to adjust staffing levels over time or to change the staff skill mix. Using an automated labeller, for example, could be an alternative to employing a final checking technician.

Better use of space


In a brand-new pharmacy, automating from day one can mean that a professional pharmacy can be run in a smaller footprint space than if traditional shelving, carousels or continental drawers were used. This increased space efficiency has allowed some pharmacists to move into health centre environments that would not have been possible had they chosen to use less space-efficient drawers or shelf storage.

For existing pharmacies, automation allows the whole pharmacy design to be reconsidered. The dispensary space freed by automating can be devoted to consultation areas or increased selling space, which generate additional revenue.

Competitive advantage


Patients will not suddenly flock to a pharmacy simply because it has installed automation. But if, as a result, pharmacists and staff have more time to spend with patients and waiting times are reduced, these pharmacies can expect to see increases in business levels, usually at the expense of nearby traditional pharmacies with overcrowded and inefficient dispensaries.

Cost control


Automated pharmacies tend to achieve higher margins through lower rates of wastage. Dispensing robots work on the ‘first in, first out’ principle, whereas in many non-automated pharmacies new stock ends up being put in front of old, resulting in out-of-date stock.

Automated pharmacies also tend to hold less stock on the basis that usage patterns are monitored by the machine, which can highlight over- and under-ordering, allowing the pharmacist to tailor stock levels more accurately to local demand and identify slow or non-movers while they are still in date.

Sponsored by Robopharma UK.
 
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