Is pharmacy automation the right answer for every hospital?

If the system isn’t broken, you may not need to fix it

Considering automation of your drug distribution system? First, ask yourself a key question: Does the right drug get to the right place at the right time? If the answer usually is yes, you may not need to automate.

Kenneth N. Barker, PhD, professor and head of Auburn (AL) University’s Department of Pharmacy Care Systems, says automation won’t fix a broken drug distribution system, no matter what a vendor tells you. And typically, vendors will regale pharmacy directors with time-saving statistics for certain tasks. Barker calls this "target processing" and says it’s similar to checking a chain link for a weakness. Does it make more sense, he asks, to check each link individually or to pull the chain taut?

His point: Always consider the overall impact of automation — ot its impact on an individual task. An example are the time-savings statistics that serve as the main selling point for many of these systems. These, Barker says, should be taken with a grain of salt. Here’s why: If a pharmacy technician normally fills carts and it takes four hours, and a machine can do it in three, what does the employee do with that extra hour of time? Is it useful to the hospital or a waste? And if, in fact, the hospital can use the technician for something else, will he be busy refilling the machine? Or on the positive side, at least from the point of view of the hospital’s bean counters, can a position be eliminated altogether with automation?

Barker says a computation and analysis of one automation manufacturer’s time-savings statistics revealed about 1,000 hours would be saved on a nursing unit each year if the machine was installed. "Then in an outcome study, wherever those time savings went, they didn’t show up in anything anyone had any use for," he said.

"Contrary to what vendors will tell you, you will not recapture all the time saved," says Elizabeth Allan Flynn, PhD, research associate in Barker’s department. "The vendor may say, ‘We’re getting away from filling carts.’ But you have to look at the time to fill the machines for each system."

"Salesmen want you to look at what’s best for them," Barker says. "Those who have had a bad experience [with automation] have told us ‘The salesman never told us about the time to restock the machines, etc.’" Barker says there are a few other topics a salesmen might avoid discussing, including:

• how returns to stock are handled;

• how much prepackaging has to be done;

• staff training;

• amount of space the system needs ("You don’t want to take up the charge nurse’s office to fit the system," Barker says.);

• duplicate processes — that is, is it necessary to enter the medication order twice?;

• the fact that machines cover dose distribution, not administration.

Blinded by technology

Barker says it’s easy to get razzle-dazzled by automation, once you start checking out the hardware. The glare from the technology can be so bright it obscures other, less costly alternatives — like a pneumatic tube delivery system. If the right drug is getting to the right place but needs to arrive faster, a tube system could be the answer.

In the rush to automate, hospitals sometimes forget that machines break down, Barker says. Find out if the vendor has a guaranteed up-time charge and whether they’ve got a 24-hour service provision. Also, get a backup battery with your system that lasts at least an hour, Barker says. Downtime procedures are another consideration. Are they easy? Remember, it can be a real headache when the system crashes. You want one that’s simple to revive.

Take into consideration the noise produced by the machine. Barker says earlier models produced 60 decibels of noise — enough to inhibit normal conversation. The same goes for the attached printer. Consider whether a dot-matrix printer’s paper-banging will drive you crazy. Also consider the cost of special wiring that might be needed in the pharmacy to power the machine.

And finally, make sure you do a site visit before purchasing an automated system — and don’t tell the vendor you’re planning to see the system in action. Also, it’s best to talk with users of the machine vs. the purchasers, so make your appointment with another pharmacy director, not the hospital’s chief financial officer (CFO). The reason is simple. If the system’s a bomb, the CFO who approved it might be unwilling to admit the mistake.

Three hospitals, three experiences

It took more than a million dollars and three years of time, but Hermann Hospital in Houston finally has an automated medication ordering system. Two big robots now take up most of the space in the central pharmacy. One handles vials, liquids, and ointments; the other, unit dose cups, syringes, and tablets. Integrated with the robots is a physician computer order-entry system on the floors. The cabinets on the floors cost $20,000 to $35,000 each, while the pharmacy workstations cost about $20,000.

Luisa Portugal, BS, pharmacy manager, says the staff is excited about having the robots on board, and thus far, glitches have been minimal. "We encounter really small problems," she says. "We solved an interface problem. So far it’s working to plan and I really don’t see any major problems or drawbacks."

That includes no cuts in staffing at Hermann, thus alleviating one major fear about automation — It doesn’t always mean a loss in pharmacy jobs. In fact, at least one hospital hopes its switch to automation will attract employees. Apparently, pharmacists don’t want to settle in Albany, GA, home of the Phoebe Putney Hospital. Randy Carver, RPh, pharmacy automation coordinator, says the department has rarely been fully staffed, and it currently has four openings for pharmacists.

The problem at Phoebe Putney was that pharmacists were looking for clinical roles that weren’t always possible in a big, understaffed hospital. By automating drug distribution, Carver says, pharmacists will be freer to visit the floors. Still, he says, pharmacists shouldn’t get "all strung out" on clinical roles. "Drugs have to get from point A to point B."

Phoebe Putney didn’t plan on fully automating the hospital. After the success of the first 12 automated medication cabinets — and the difficulty in maintaining two ordering systems — administrators decided to convert everything over. "We’re looking to have almost 30 machines before it’s over," Carver says.

Two desires initiated Phoebe Putney’s move to automate: capturing more charges and improving on medication delivery times. "We had a bad reputation for turnaround time due to our low staff," Carver says. "What do you do when you’ve got three people keying in orders for 300 patients?"

At first, the automated cabinets didn’t help in that area. The first cabinet in the emergency room frequently ran out of items. Carver says you have to expect such glitches in the beginning, as you develop a feel for what each floor uses. With charge captures, the results have been dramatic, he says. "In the emergency room alone, charge capture was minimal. At one point they had four full-time people auditing carts for charges." Now, just one person does the auditing, with the other three employees deployed elsewhere in the hospital."

He also recommends that pharmacists not expect too much from the machine vendors. "The account has to take ownership of the project or system. That’s my opinion," Carver says. "I’ve had good service and support from Baxter, but they don’t have time to come in and spend a month training the staff." It also helps to have a staffer who likes working with computers, he says.

Carver’s final words of wisdom on automation: "The machine doesn’t have inherent intelligence. If somebody had trouble reading before, they’ll still have trouble reading. It doesn’t change people." Nonetheless, Carver says, nobody wants to go back to the other system. "You mention it and they say, ‘Hush your mouth.’"

At the Great Plains Regional Medical Center in North Platte, NE, Pharmacy Director Jim Manning, RPh, plans to automate but says he’ll hold off on installing machines until the hospital has its new information system in place. "We feel like we need to do it to cut out paperwork and costs associated with controlled substance dispensing."

Obstetrics and psychiatry would be especially well-served by machines, Manning says. In both units, strict formularies prevail. Still, he has reservations about some of the machines. In some units, for instance, entire drawers pop open giving nurses access to many different medications.

"This is glorified floor stock," he says. "And if the machine isn’t interfaced with the patient profile system, then even more so." With the more restrictive machines, Manning sees another drawback: "They lose their capacity because they have the coil system. Coils take up lots of space." Plus, he says, coil systems can be confusing to fill.

As for machines replacing employees, Manning says it’s just not possible at Great Plains. "You get to the point in size where othing you do will change FTEs. You have to be open a certain number of hours."

For now, Manning plans to watch and wait. By this time next year, some machine manufacturers likely will have been absorbed into others. "You think you’re behind because the salesmen give you the pitch that ‘Even hospitals smaller than you are automating.’ But I’m comfortable."