Robot works for patient safety at Nebraska Medical

The newest employee in the remodeled inpatient pharmacy at the Nebraska Medical Center in Omaha is eight feet tall and 36 feet wide and is capable of storing 44,000 medication unit doses. The center has installed a Swisslog PillPick system in hopes of ensuring greater patient safety, reducing medication errors, and increasing productivity by giving pharmacists more time to spend consulting with physicians and nurses about patient care and medication safety.

The system packages, stores, and dispenses medications in bar-coded, unit-dose form, and can dispense more than 6,000 unit doses daily.

"Fewer than 1% of acute care hospitals in North America have this technology," said Nebraska Medical Center executive director of pharmacy and pathology services, Mike Powell. "The Nebraska Medical Center is fortunate to have such state-of-the-art technology. This system will definitely help eliminate possible medication errors."

Powell said bar-coding has the potential to dramatically reduce medication errors during dispensing and administration. "Accurate dispensing is key to patient safety and automatic packaging based on bar code recognition assures us of that," he said. "The robot also offers compact and efficient storage.

Additionally, bar-codes will help our hospital make sure that the doctors and nurses are administering the right drugs at the appropriate dosages. The reduction of medication errors has an obvious patient impact and has a financial benefit, too. As a general rule, each adverse drug event due to medication errors can add more than $5,800 to the hospital bill of a single patient." He said the added costs come from factors such as longer hospital stays, drugs used to counteract incorrect dosages, and extra nursing and physician costs.

A critical component to bar code implementation happens at a patient's bedside, center officials said. In a typical administration cycle using bedside verification, a nurse will scan the bar code on the unit dose and scan the patient's wristband to ensure that the "five rights" are met: right patient, right drug, right dose, right route, and right time. The nurse also scans the bar code on his or her hospital identification badge to record who administered the drug.

Pharmacy and nursing must work together

It is vitally important that pharmacy and nursing work closely together, said Nebraska Medical Center director of nursing resources and development Dawn Straub, RN. "Nurses are at the sharp end of patient care delivery, that point where all preceding work and actions of others culminate into actual intervention to the patient," she said. "Bar coding will help provide patient safety at this point of interaction and give the nurse a safety net."

The PillPick also promotes safety because it is fully automated. After it is filled and verified by a pharmacist, the doses dispensed are not touched by human hands until they are given to a patient. It contains up to a three-month supply of commonly dispensed drugs.

"Simply put, the more human intervention, the greater probability for error," Powell said. "This automated system minimizes handling by pharmacy staff, reducing the potential for human error.

After just one month of operation, Center staff were seeing "amazing results," according to director of pharmaceutical and nutrition care Chris Shaffer. "One big difference is the phones aren't constantly ringing in the pharmacy any more because nurses aren't calling about missing medication doses," Shaffer said. "We estimate the PillPick system will eliminate about 17,000 phone calls a year." Shaffer also said the system eliminates the tedious and time-consuming tasks of handling and packaging unit-dose medications, freeing pharmacists to spend more time consulting with physicians and nurses on patient care.

"Research shows that when pharmacists round with physicians, medication errors are reduced by up to two-thirds," Shaffer said.