1. Automation in Pharmacy
Lobna Al Juffali,Msc

2. Introduction Automation
any technology , machine or device linked to or controlled by a computer and used to do work
Automation is designed to streamline and improve the accuracy and efficiencey of the medication use process

3. Introduction
As the profession has accepted increased responsibility for improving patient outcomes through implementation of pharmacists patient care services , automation has been relied upon to free the pharmacist from technical tasks

4. Introduction
Use of these automated medication management systems have been shown to reduce medication errors by between 26% and 81% depending on the setting in which the machines are used.
(These high rates of error reduction are achieved when medication orders are reviewed and profiled by pharmacists prior to administration).

5. Goals for the use of automation
Reducing costs
Improving operating efficiencies
Growing revenues
Enhancing safety and quality
Integrating and managing data
Providing outstanding customer service

6. Factors that led to Automation
Shortages of qualified pharmacists and technicians
Shrinking operating budgets

7. Automation Advantages:
Improve efficiency( Reduce pharmacy staff and work load)
Improve accuracy, reduce errors
Improve documentation
Authorized access only, enhance security
Reduce job stress and staff turnover
Shorten med pass time for nurses/ caregivers
Disadvantages:
Additional training and technical help
Downtime, system failure and inflexibility
Cost and space issues

8. Medication use process
Consists of five domains:
Purchasing/ inventory management
Prescribing/medication determination
Medication preperation, dispensing, and counseling
Medication administration
Patient monitoring /assessment

9. Technologies And Automated Devices Applied Throughout The Medication –Use Process
Prescribing
Clinical descion support soft ware
Computerized prescriber order entry
Dispensing
Centrilized robotic dispensing technology
Centralized narcotic dispensing and inventory tracking devices
Decentrilized automated dispensing devices
Unit dose medication repacking systems
Administration
Bar code medication administration technology
Monitoring
Electronic clinical documentation systems

10. Unit Dose System First used in hospitals in 1960’s
Used to decrease medication administration errors by nursing staff, and reduce medication waste
Standard of practice in hospital setting today
Used in some skilled nursing facilities

11. Unit dose
Medication that is dispensed in a package that is ready to administer, directly, to the patient.Medication/Products currently being unit dose packaged and bar coded:
1.Solid dose pouches
2.Power fill pouches
3.Strip packs
4.Oral dose syringe fill
5.Sterile Injectable syringe fill
6.Liquid unit dose

12. Unit Dose Systems Unit Dose examples:
Manufacturer’s unit dose packs/cards
Medication cassettes

13. Unit Dose Systems Advantages: Improve accuracy, less errors
Easy to track usage
Less nursing time at dispensing
Less wastage, savings to facility and patient
Disadvantage:
More pharmacy processing time and equipment cost
Requires more storage space and cassette cost
No cost savings to pharmacy
Limit nursing processing and checking ability

14. Decentralized Automated Dispensing Devices
unit base dispensing cabnits, are secure storage cabinets capable of handling most unit dose and some bulk (multiple –dose) medications.

15. Automated dispensing systems
are drug storage devices or cabinets that electronically dispense medications in a controlled fashion and track medication use.
Their principal advantage lies in permitting nurses to obtain medications for inpatients at the point of use.

16. Automated dispensing systems
These automated dispensing systems can be stocked by centralized or decentralized pharmacies.
Centralized pharmacies prepare and distribute medications from a central location within the hospital.
Decentralized pharmacies reside on nursing units or wards, with a single decentralized pharmacy often serving several units or wards.
These decentralized pharmacies usually receive their medication stock and supplies from the hospital’ s central pharmacy.

17. Do we centralize or decentralize
centralized storing and packaging and decentralized distribution.

18. Automated Medication Dispensing Devices
Small systems:
Pyxis medstation
Baxter ATC
Script-pro 200
Larger systems:
Baker cells
Baxter international

19. The McLaughlin dispensing system
includes a bedside dispenser, a programmable magnetic card, and a pharmacy computer.
It is a locked system that is loaded with the medications prescribed for a patient.
At the appropriate dosing time, the bedside dispenser drawer unlocks automatically to allow a dose to be removed and administered.
A light above the patient’ s door illuminates at the appropriate dosing time.
Only certain medications fit in the compartmentalized cabinet (such as tablets, capsules, small pre-filled syringes, and ophthalmic drops).

20. The Baxter ATC-212 dispensing system
uses a microcomputer to pack unit- dose tablets and capsules for oral administration.
It is usually installed at the pharmacy.

21. The Baxter ATC-212 dispensing system
Medications are stored in calibrated canisters that are designed specifically for each medication.
Canisters are assigned a numbered location, which is thought to reduce mix-up errors upon dispensing. When an order is sent to the microcomputer, a tablet is dispensed from a particular canister.
The drug is ejected into a strip-packing device
where it is labeled and hermetically sealed.

22. The Pyxis Medstation, Medstation Rx, and Medstation Rx 1000
are automated dispensing devices kept on the nursing unit.
These machines are often compared to automatic teller machines (ATMs).

23. The Pyxis Medstation, Medstation Rx, and Medstation Rx 1000
The Medstation interfaces with the pharmacy computer.
Physicians’ orders are entered into the pharmacy computer and then transferred to the Medstation where patient profiles are displayed to the nurse who accesses the medications for verified orders.
Each nurse is provided with a password that must be used to access the Medstation.
Currently ,nurses select the patient required and then select the drug required from a list of all drugs available in the unit. The units can also be run in ‘profile mode’ where the pharmacist reviews medication orders and profiles a list of medications currently prescribed for the patient and nurses then select from that list.

24. The Pyxis Medstation, Medstation Rx, and Medstation Rx 1000
Pharmacists or technicians keep these units loaded with medication. Charges are made automatically for drugs dispensed by the unit.
Earlier models had sufficient memory to contain data for about one week, and newer models can store data for longer periods.

25. Advantages of the Pyxis® System
Nursing staff are guided to the correct drawer and pocket to access required medicine. Medicines which sound similar or have multiple strengths are loaded indifferent drawers of the machine. Access is restricted to only one drawer/door at a time.
Increased stock holdings close to patients
Ward stock levels are monitored by the pharmacy computer and stocks topped up before drugs run out, reducing delay to patients and staff frustration.
4. Management of controlled medication.

26. Advantages of the Pyxis® System
5. Possible to add additional safety features for individual high risk drugs for example,must be authorised by two staff, soft lock outs to prevent duplicate administrations (reduces risk of multiple administrations when staff forget to sign for medications), advice given or required information recorded at time of dose removal.

27. Advantages of the Pyxis® System
6.Use of profile mode enables constant monitoring by pharmacist of drug dosages/interactions.It also reduces the amount of interpretation required by nursing staff at time of dose removal.
7. Real time data collection for drug usage which can be advantageous for audit and other quality improvement processes.

28. Disadvantages of System
1. May be frustrating to get drugs in an emergency.
2. While there are incremental safety benefits running in non-profile mode, most of the research has been at sites where the machines have been run in profile mode.

29. Script-pro 200 Usually installed in the pharmacy
Fills vials directly from dispensing cells
Can print prescription and auxillary labels

30. Baker cells In pharmacy system Counts a 30-count vial in 3-5 seconds
Option to use software that dispenses medication after a prescription is canned

31. The medication administration record (MAR):
Monthly record of dispensed medications for each specific patient
List of medications with administration times
Medication dispensing nursing/ facility staff initials/ signatures
May include list of prn medications
Tracks missed doses and changes in medications

32. Bar Code Medication Administration (BCMA))
is a point-of-care software solution that addresses the serious issue of inpatient medication errors by electronically validating and documenting medications for inpatients.

33. Bar Code Medication Administration (BCMA)
It ensures adherence to the “5 Rights” of medication administration (Right Patient, Right Route, Right Dose, Right Time, Right Medication). and visually alerts staff when the proper parameters are not met.

34. Bar coding in the pharmacy
Order Fulfillment & Verification
Pharmacist Review & Verification
Final scan

35. Bar Code Medication Administration (BCMA
A. Patient name
B. Medication name
and strengths
C. Time of
administration
D. Bar code for
bedside scanning

36. At bed side

37. Disadvantage Bar codes mismatch with drug, dose and patient at times
Bar code sometimes function erroneously
Unable to scan bar codes properly at times
Unreadable bar codes
Time consuming

38. Computerized Physician Order Entry (CPOE)
clinical information system that enables a patient’s care provider to enter an order for a medication, clinical laboratory or radiology test, or procedure directly into the computer.
The system then transmits the order to the appropriate department, or individuals, so it can be carried out.

40. Computerized Physician Order Entry (CPOE)
The most advanced implementations of such systems also provide real-time clinical decision support such as dosage and alternative medication suggestions, duplicate therapy warnings, and drug-drug and drug-allergy interaction checking."

41. Advantages
Replaces hand-written orders (legibility, completeness, readily and quickly accessible, improved communications between physician and pharmacist; no delay or loss ...)
Supports ready access to patient data and patient assessment
Can help improve patient safety and prevent medical errors and adverse drug events by checking the dosage etc.
Supports improved recording, data trails, quality assurance and error awareness and reporting

42. Advantages
Potential to improve efficiency and resource usage by integrating different departments - laboratory, imaging, nursing and medication records
Cost-effectiveness benefits:
Can reduce additional and often avoidable costs (clinical, litigation ...) that can result from medication errors;
Can show test and medication costs - potential to reduce prescription costs;
Can reduce the number of duplicate tests;

43. disadvantages
Cost
Risk of a system generating medication errors e.g. through incorrect configuration or physician input
Systems may need medical terminologies not in local use
User resistance to introduction of computer-based technologies

44. Clinical Decision Support Systems (CDSSs)
Clinical Decision Support Systems are "active knowledge systems which use two or more items of patient data to generate case-specific advice"  [Wyatt J, Spiegelhalter D, 1991].
Clinical DSSs are typically designed to integrate a medical knowledge base, patient data and an inference engine to generate case specific advice.

45. Clinical Decision Support Systems (CDSSs)
drug doses, routes, and frequencies.
drug allergy checks
drug-laboratory value checks,
drug-drug interaction checks,
providing reminders about corollary orders (eg, prompting the user to order glucose checks after ordering insulin)
drug guidelines to the physician at the time of drug ordering

46. Functions of CDSS
Four key functions of electronic clinical decision support systems are outlined in :
"Administrative: Supporting clinical coding and documentation, authorization of procedures, and referrals.
"Managing clinical complexity and details: tracking orders, referrals follow-up, and preventive care.
"Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests.
"Decision support: Supporting clinical diagnosis and treatment plan processes

47. Role of Pharmacist
Develop policy for dispensing, delivery and storage of medication in facilities
Formulate quality assurance policy for drug distribution
Track usage and monitor medication usage and returns, including initial doses, house supply stock
Monitor the use of controlled substance: record keeping of supply, usage and disposal

48. Role of Pharmacist
Provide patient specific recommendations on drug therapy and medication needs
Ensure accuracy of Medication administration record MAR and documentation
Provide drug information to staff, residence, family and other health care providers
Ensure compliance with all applicable laws and regulations governing drug distribution