Exploring the role of automation in medicines management
Automation is becoming much more prevalent within the UK health sector. In hospitals, in particular, it is being used for everything from electronic patient records and data security to patient communications, clinical decision making, and diagnoses. But one area where the use of technology is still in its infancy is within hospital pharmacies, where most drugs are still managed via traditional ‘lock and key’ medication cupboards supported by a paper ledger. And this approach can have far- reaching implications, with figures showing that every year in England alone there are more than 237 million medication errors, which cost the NHS upwards of £98m and lead to more than 1,700 deaths.
Human error
These errors can occur at several stages, from prescribing to dispensing and administering medications, and many are impacted by human factors such as fatigue, environmental conditions, and staffing levels. So, it is an area where automation can have a major impact. Automated dispensing cabinets for hospitals operate in a similar way to vending machines, but also have sophisticated software at the back end that handles patient orders, medication dosing documentation, inventory management, and billing transactions. This means that, not only do they store and locate the drugs, but they can highlight supply issues and reduce errors. There are several solutions on the market, but most use biometric recognition technology to provide access to authorised personnel, with each controlled drug having a unique code associated with it. Cabinets in clinical areas are then linked to pharmacy cabinets, creating a unique order process with a full paper trail. The digital system also allows for end-to-end tracking, ordering, and restocking, negating the need for a timely, arduous manual stocktake.
Right patient, right time
And they can connect to the electronic patient record and electronic prescribing and medicines administration (EPMA) systems, determining which drugs are needed for which patients on each ward. Pioneering this technology is Omnicell, which has installed a number of its robotic storage and dispensing cabinets in hospitals across the UK and overseas. Speaking to hdm, sales director, Edward Platt, explains: “Traditional lock-and-key systems are heavily dependent on manual and paper-based processes, keys, and outdated technology, leading to a lack of overall visibility of stock on hand and the ability to plan for the next dose; increasing the potential for delays to the first dose or missed doses altogether. “There is also a risk to patient safety through selection errors as medications can be similar, in terms of their packaging and names. “In contrast, automation and interoperability with electronic prescribing offers immediate benefits for healthcare providers. “They provide a full closed-loop medicines supply chain and medicines administration and they digitalise the supply chain and help ensure the right dose is available at the right time, in the right place.
Data-driven insight
“In addition, their associated analytics are able to highlight potential stockouts and avoidable missed doses. “Overall, optimised medicines administration workflows free up nursing time, as well as enabling the collection of more-accurate and timely data.” Cabinets can be installed in pharmacies and on the wards, with main distribution systems processing up to 2,000 items an hour within seconds of a request. As part of an 18-month trial, Northumbria Healthcare NHS Foundation Trust installed an Omnicell solution in two North East general hospitals. And the trust reported a £7,000 saving in nursing time, a reduction in drugs spend of 6% per patient, a drop in stockout levels from 22%-6%, a £30,000-a-year saving on drug spend, and a 0% missed dose rate. Becton Dickinson and Company (BD) is also at the forefront of the drive to automate medication management. Its Pyxis Inventory Connect solution has been installed at North Middlesex Hospital. Capable of dispending over 17,000 medicines, the £370,000 investment is alleviating the growing pressure on hospital pharmacists and reducing the likelihood of errors. A BD spokesman said: “With 68% of medication errors occurring during administration, there is a clear need for greater medication management consistency to reduce risk and enhance patient safety. “BD Pyxis medication management software and medication dispensing machines enable a consistent approach to medication management across an organisation to help keep teams aligned and focused on what matters most – patient care.
Operational efficiencies
“With comprehensive medication and supply management throughout a healthcare system, you can remove variability that impacts patient care and safety and improve operational efficiencies, freeing up staff time.” Platt adds: “I believe the move to automate key processes such as medication management is fast becoming a necessity, not a luxury. “It is the best way of enabling staff to focus on the critical task of patient care in the knowledge that administrative functions are being delivered in a reliable, transparent, and efficient way that provides necessary data for good analysis and decision making.” In a recent advisory report, Omnicell called for a new framework for the management of controlled drugs in hospital settings through more- widespread adoption of automated and digital systems – and this is expected to drive change in the coming years. Offering advice to specifiers, Platt said: “It’s key for hospitals to ensure interoperability with key systems and to work to dm+d and GS1 standards. “Investment in change management and detailed workflow design to deliver transformation is also crucial to success and trusts should measure the ‘before state’ to be able to accurately report on improvements and benefits and build on this moving forwards.”
Smaller solutions
But it’s not just in hospitals where automated medication management systems are helping. Capsa Healthcare’s NexsysADC solution has been designed specifically for non-hospital settings that do not need full interfacing with EPR systems, but still require secure access, inventory management, and user tracking functions. “There are many alternate care or extended care facilities that would benefit from the security, safeguards, and trackability of full automated dispensing, but which do not have the budget, space, patient population, or the need for the complexity of a full-blown system,” said Chris Miller, product director at Capsa Healthcare. “We studied the large, fully- interfaced systems and then examined the needs of alternate sites like ambulatory care centres, long-term care homes, veterinary hospitals, behavioural health clinics, even ambulances. “These sites store sensitive medication doses onsite, but traditionally they have been overlooked when it comes to technology providers. “And, as a result, there is a long history of alternate sites having to rely on flawed manual processes to store controlled doses, like a locked cabinet or a plastic ‘tackle box’ with a three-ring binder and handwritten notes.
Meeting needs
“These manual processes lead to inevitable diversion, theft, loss, inventory shortages, expirations, and a disservice to patients who need a specific dose at a specific time when it may not be available.” NexsysADC is offered in two scalable models: The 4T is a countertop cabinet that holds up to 125 stock keeping units (SKUs), while the main cabinet is floor standing and holds 400-plus SKUs. Both are fully customisable and have full track-and-trace features to ensure all activity in the cabinet is under electronic surveillance, and any discrepancy is flagged. “The top need in designing NexsysADC was security, but at a reasonable cost,” Miller says. “Before, low-cost medication storage solutions were all light on features, and easy to skirt around. “They were an open, free-for-all to access anything, so we developed a system that had the right levels of security, especially for narcotics, but we didn’t over engineer it. “In a word, it’s ‘practical’. We also made it easy for a nurse or clinician to interact to get the right dosage for a particular patient or procedure. “If you make a process too stringent, people will find a work-around, or they’ll hate the system and that’s no good for the facility, or the pharmacy. “So, with NexsysADC, we simplified how nurses get to the exact dose they need, instead of putting up too many barriers. It’s what pharmacies and their customers wanted in both price and features.”
