Automation doesn’t mean end to errors
Automation doesn’t mean end to errors
Current advances are tools, not solutions
Advances in pharmacy automation often are promoted for their safety features. It’s hard to go through an automation company’s literature or hear a sales pitch without several references to how the automation will decrease medication errors. But while the makers of automated systems may make claims, industry watchers say the technological pitfalls are many, primarily because the money or willingness to invest in a fully integrated system is not always there. Meanwhile, physicians still resist even the simplest order entry systems.
Help may be on the way with the publication within a few months of an anticipated white paper, "Automation in Pharmacy." It was commissioned by the Automation in Pharmacy Initiative, a collaboration of the industry’s national pharmacy associations.
Of the newer technologies available, several have features pharmacists could use to improve medication safety. Bar coding, for example, is available throughout integrated systems, providing tracking from robot retrieval and packaging, to a dispensing cabinet, and onto the patient via wristbands.
Automated restocking is more commonplace, as are cart system features such as drawers that light up when the right medication is typed into the terminal; also, only the correct drawer compartment will automatically unlock. Safe-like boxes directly adjacent to cart systems for the PPNs and narcotics not included in unit dosing are available, popping open only after terminal password entry and a card swipe.
Infusion pumps have increased automatic loading and multi-dose calculation (complete with warning flashes for misloading levels), all while a patient’s volume history is coordinated.
Computer software increasingly can alert clinicians to potentially adverse interactions and background such as known allergy reactions. On a per patient basis, the generic and brand names, expiration dates, and lot numbers can be accessed at the dispensing point.
These safety features are available in a completely integrated and bar coded robot retrieval, packaging, dispensing, and administration system for several hundred thousand to $1.5 million dollars. With the continuing cutbacks and consolidation among providers, finding this kind of money for pharmacy automation isn’t easy.
"Our experience in contract research with those developing automated dispensing machines has given us the insight that these machines have the potential to make major system changes that will reduce errors," says Ken Barker, PhD, head of the department of pharmacy care systems at Auburn (AL) University and a lead author of the "Automation in Pharmacy" white paper.
"But unfortunately," he adds, "the options that affect error reductions too often get cut off at the time of purchase. I’d say the most important thing one can seek in an automated dispensing system is comprehensiveness. What we see is that if it only automates a small part of the overall system, then the errors caused by the interfaces may exceed those prevented by the system itself. In other words, if you purchase a robot, be sure to purchase the bar code reading system that’s optional with it."
Mark Neuenschwander, a pharmacy automation consultant in Bellevue, WA, agrees. "The most important aspect of automation is point of administration scanning. There is a gap between the box and the bedside. That gap between the decentralized cabinet and the bedside is the most important thing to emphasize to the industry right now. Until the industry eliminates that gap, medication errors will continue."
Another problem with bar coding systems is the lack of prepackaged drugs to feed the dispensing machines. If hospital officials want to invest in a completely integrated scanning system, from robot to bedside, covering all kinds of medications, it first must repackage most of its drugs in-house, opening the door to human error.
Conversely, too heavy a reliance on automation creates other problems."We see a lot of medication errors as drugs are sent to the equipment, and the wrong item gets picked up all the time without the screening process requiring an independent check by a second individual," says Michael Cohen, president of the Institute for Safe Medication Practices in Warminster, PA.
Says Charles Myers, MS, MBA, assistant vice president for professional affairs at the American Society of Health-System Pharmacists in Bethesda, MD, "In the hospital, the prescription is recorded, the device does its thing, and the nurse gets the drugs and dispenses. But we think the pharmacist should be involved to make sense of interactions, dosages, etc., and I’m afraid that automation is being installed without that oversight. That information can be linked to pharmacist computers, but too often that step is missed."
What’s more troubling
The industry could take a major step to significantly reduce medication errors that wouldn’t involve expensive dispensing automation: a basic, low-cost computerized prescriber order-entry system that includes standard drug names and dosages.
Can’t read a physician’s handwriting? No problem. Unsure of dosage levels or frequencies? Quickly match it to your system’s protocols or alert orders. Sounds simple, but as Barker notes, "Physician order entry is an idea that’s been around for about 20 years, and the advantages have been known for about that long. Everyone agrees that it would reduce errors and significantly reduce cost, but hardly anyone has figured out how to persuade the physicians to use it."
Why? "The systems are not as user-friendly as they need to be to minimize the effects on physicians,"he says. "Secondly, an equally important aspect is the cost’ in terms of physicians’ time and that the benefits from this don’t accrue to the physician. That’s the crux of the problem."
[For more information, contact: Ken Barker, PhD, Department of Pharmacy Care Systems, 128 Miller Hall, Auburn University, Auburn, AL 36849. (334) 844-5152. Michael Cohen, president, Institute for Safe Medication Practices, 300 West Street Road, Warminster, PA 18974. (215) 956-9181. Mark Neuenschwander, The Neuenschwander Company Inc., 15225 NE 20th St., Bellevue, WA 98007. (425) 644-6797. Charles Myers, MS, MBA, Assistant Vice President, Professional Affairs, American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. (301) 657-3000.]
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