A $1.6 million robotic pill picker, affectionately nicknamed Picksy, has launched Sudbury Regional Hospital into the forefront of pharmacy automation. The massive, glass enclosed robotic device picks a 24-hour supply of pills for each patient and puts them on a ring in sequential order along with a label identifying the patient and the drugs prescribed.
The robotic pill picker eliminates the labour-intensive manual picking of pills for hundreds of patients every day, but the real payoff is a decrease in medication errors, said Miriam McDonald, director of Sudbury Regional's pharmacy.
Picksy is integrated with patient profiles stored in the hospital's Meditech software system and picks each patient's daily supply of medication from an inventory of 400 different drugs and 54,000 individually packaged doses suspended in so-called nests. The pill picker keeps track of the lot number and expiry dates of the medication and maintains a perpetual inventory. It can pick and discard expired medication, tells pharmacy staff when supplies need to be replenished and allocates costs by department.
The move to robotic pill picking represents a major step toward "the new frontier" of computerized physician order entry and bedside medication verification, said McDonald.
When the complete system is up and running in the next 12 to 18 months, barcodes on the medication, the patient's wristband and the nurse's ID will all be scanned as the medication is administered, cutting down on errors and ensuring patient safety.
The consolidation of pharmacy services at the one-site hospital brings Sudbury Regional into compliance with Accreditation Canada's adoption of the unit dose standard, which requires pharmacies to provide a 24-hour supply of medication for each patient.
Prior to consolidation, the Memorial and St. Joseph's sites adhered to the traditional system of delivering a seven-day supply of medication for storage in the individual hospital departments. The Laurentian site had made the move to unit dosing prior to the completion of the one-site hospital, but performed the picking manually.
Once again, it's patient safety that is driving the change.
"The traditional system of dispensing medication results in an error rate of 10 to 15 per cent," said McDonald. "Unit dosing brings the medication error rate down to five per cent."
Daily dispensing of medication will also help the hospital's bottom line by reducing risk and liability exposure, and cutting waste. Discharge from hospital prior to the exhaustion of the seven-day supply and changes in medication orders during a patient's stay resulted in a lot of drugs being returned and thrown out. According to McDonald, wasted medication cost Sudbury Regional approximately $250,000 every year.
The sequencing of medication by the robotic pill picker contributes to accuracy and streamlines the dispensing of medication by bedside nurses. Picksy collects each patient's pills for the day and attaches the plastic pouches to a ring in the same order that the medication is meant to be administered.
Prior to the deployment of the robotic pill picker and the introduction of sequencing, there were more opportunities for missing medication and making errors, said Frances Brisebois, the pharmacy department's clinical supervisor. "Now, the nurses don't have to rifle through a bin looking for medication. It's a lot easier and more organized."
The rings produced by Picksy are distributed to hospital units and stored in locked cabinets called patient/nurse servers at the patient's bedside. Additional stock and controlled drugs are stored in automated medication dispensing units, or AMDUs, located in nursing stations and accessible through fingerprint identification.
Also new to Sudbury Regional's pharmacy is the introduction of centralized IV admixture. Until now, nurses in the individual units were responsible for adding drugs such as antibiotics to IV bags. This process will now be performed by pharmacy staff in a centralized, sterile facility, minimizing waste and infection.
The deployment of automated medication management technology will free up Sudbury Regional's pharmacists to spend more time consulting with physicians, nurses, patients and families.
"A machine is only as good as the information that you give it," said Brisebois. "When a patient is admitted to hospital, the doctor takes the list of medications the patient brings with him and assumes that what you tell him you're taking is actually what you're taking.
"We can get every part of the process right, but if you tell the doctor that you're taking a prescription for your blood pressure and you tell him the wrong one, it can create a problem."
Pharmacists also know that the medication a patient picks up in a drug store may not be what he's taking, said Brisebois.
"If they don't like the way it makes them feel, they may only take half of what they're supposed to take. That may be the reason they're admitted to hospital because what they're doing may actually be harmful to them."
Picksy has been well received by pharmacy staff, but medication reconciliation remains the responsibility of flesh and blood pharmacists.
According to McDonald, freeing up staff to focus more on clinical pharmacy has a payback of 5:1.
"For every dollar you spend on clinical pharmacy, you get five back in risk avoidance, a reduction in morbidity and mortality and fewer medical errors."
