One way to reduce medication errors in your hospital pharmacy is to put a robot in charge of stocking and dispensing medication doses. Roughly 300 U.S. hospitals have done just that and have, as a result, seen their in-pharmacy errors drop significantly. In this instance, robots simply don’t make mistakes.
Manufactured by McKesson Automation of Pittsburgh, Pa., ROBOT-Rx is the lead robot: McKesson estimates that 97% to 98% of hospital pharmacies with a medication-dispensing robot are using their product. ROBOT-Rx units installed in hospitals collectively dispense a half billion bar-coded doses, error-free, every year.
Evergreen Hospital Medical Center in Kirkland, Wash., is a 235-bed facility with an average daily census of 175. In March 2004, their pharmacy acquired a ROBOT-Rx, which dispenses up to 93% of all patient medications. Called Ernie (short for Evergreen Robot Noticeably Improving Efficiency), the robot does indeed improve pharmacy efficiency.
“Pharmacists still have to review orders, but the robot saves us time in the pharmacy,” says Bob Blanchard, pharmacy director at Evergreen. “Now they can be out on the floor more, where the orders occur, before mistakes happen.”
The biggest benefit of having the robot is an ongoing reduction in errors. “A good hospital pharmacy might have a 0.5% to 1% error rate,” says Blanchard, “but you have to look at the number of doses dispensed. In a busy hospital—like here—the pharmacy dispenses 1,200-1,300 doses a day. Translate that error rate, and you’ve got five or six errors each day.” Since Ernie took over the job of dispensing drugs, the number of medication errors has been reduced by 25%. It’s worth noting, though, that hospitalists and other doctors at Evergreen Hospital have no interaction with Ernie.
What Does It Take to Start Up a Robot?
Ordering and installing the robot and implementing a new system called for an overhaul of the pharmacy—in more ways than one. “It takes a bit of planning to start up,” admits Blanchard. “Very few med[ication]s are sent from the manufacturer with readable barcodes, except for IVs. We bought a couple of packaging machines, which went into the robot.”
The packaging machines are actually part of the robot. The robot is huge and is actually multiple machines working from a single “brain.” The machines parcel the bulk meds into single doses and barcode them as this happens.
A recent Food and Drug Administration (FDA) mandate requires pharmaceutical companies to include a bar code on packaging for medications, but that applies to bulk packages received at a pharmacy, not single doses.
Ernie takes up about 100 square feet in an octagon-shaped room in the hospital pharmacy. The room has 22 computerized drug-dispensing cabinets. In the center is an electronic arm that can rotate and use suction cups to pick up drug packets. The robot will grab a packet and laser-scan the bar code to ensure that it has picked the correct medication. If the bar code doesn’t match, the arm drops the packet on the floor or puts it in a bin for a pharmacist to check.
After verifying the correct bar code, the robot will place the dose into an envelope marked for a specific patient. The robot also restocks packaged doses that have been checked by pharmacists. Ernie receives the latest patient information automatically. “The robot directly interfaces with the pharmacy information system,” explains Rodger Fletcher, ROBOT-Rx product marketing manager at McKesson. “The robot … seamlessly integrates with nearly every other pharmacy information system.”
Take It to the Next Level
Evergreen Hospital has plans to further reduce their medication error rate. “Most errors occur after the drugs leave the pharmacy, on the hospital floor,” states Blanchard. “We see errors with wrong medications, wrong patients, and wrong times.”
The solution for reducing these errors is to implement additional technology. “We want to get bar coding at the bedside, where we scan the patient, medication, and nurse,” he explains. “This will catch any problem at that time, whether it’s the wrong medication, the wrong dose, or the wrong time.”
Getting Ernie installed was an integral part of this solution. “With the robot, we’re partway there. By the end of next year, we hope to have the bedside piece in place. We have all our medications bar-coded; we need basic technology at the bedside,” says Blanchard. “The selection and correct patient information are taken care of by the robot.”
Bar code scanning of medications at bedside is becoming more common. “We’re seeing a lot of momentum for this,” says Fletcher. “Industry statistics show that 7.5% to 10% of all hospitals have implemented [a bedside medication system], and others are universally planning one. The robot was developed with this in mind.”
For now, Evergreen Hospital is happy with the first stage in reducing medication errors: having Ernie sort and dispense patient meds. “It’s been a long time coming,” says Blanchard. TH
Jane Jerrard is a frequent contributor to The Hospitalist.