Pharmaceutical Robotics Require Careful Assessment

"The automated pharmacy streamlines medication delivery from prescription to patient," Paulsen says. "It was important to develop a system that is integrated from end to end. Each step in safe, effective medication therapy—from determining the most appropriate drug for an individual patient to administering it—is contingent on the other."

The new pharmacy currently serves UCSF hospitals at Parnassus (568 licensed beds) and Mount Zion (91 licensed beds) and has the capacity to dispense medications for the new UCSF Medical Center at Mission Bay (289 licensed beds), scheduled to open in early 2015. As the phase-in continues, additional steps in the process will be eliminated as doctors begin inputting prescriptions directly into computers this year.

Once computers at the new pharmacy electronically receive medication orders from UCSF physicians and pharmacists, the robotic system will pick, package, and dispense individual doses of pills. Machines assemble doses onto a bar-coded thin plastic ring that contains all of a patient's medications for a 12-hour period. Nurses use bar-code readers to scan the medication at the bedside, verifying it is the correct dosage for the patient.

The automated system also compounds sterile preparations of chemotherapy and nonchemotherapy doses and fills IV syringes or bags with the medications. An automated inventory management system keeps track of all the products, and one refrigerated and two nonrefrigerated automated pharmacy warehouses provide storage and retrieval of medications and supplies.

Antrum cautions that hospital leaders should assess how the robotic system affects the entire process, not just the mechanical filling of the prescription. That means gauging how the use of robotics affects the delivery of medications, accuracy, and the ultimate effect on patient care, she says. She also recommends getting the end user involved in the development process.

"The main thing we've learned is that you have to figure in the culture of your workplace," Antrum says. "You have to start looking at your processes first and determining how to change them with the addition of this robotic system, rather than introducing the system and then thinking people will adapt their processes. It is vitally important to consider the workarounds that people have built into the system in order to get things done."

Training will be necessary, and Antrum cautions that the manufacturer's training may not be sufficient. The number of people you train also will be an important decision. Some providers may elect to train only certain pharmacy technicians and authorize them to use the robotics, and others will open the training to all pharmacy staff.