5.02.2008

Does a Hospital Really Need a Pharmacy Robot?

Can a big, expensive machine prevent medication errors at a hospital? Maybe, but I’m skeptical.

The machine in question is a $1.5 million “pharmacy robot” that recently began operating at Loyola University Hospital in Maywood, Illinois. The hospital says the robot is “designed to eliminate the type of life-threatening human medication errors that injured actor Dennis Quaid's newborn twins.”

According to a
hospital news release,

The robot places single doses of medication in small plastic bags. Each bag has a bar code that identifies the drug. When the system is fully implemented, the nurse will scan the bar code on the medication bag, along with the bar code on the patient's wrist band. If the computer detects it's the wrong drug or wrong dose, a pop-up warning will appear and the computer will sound an alert…

The system is 28 feet long and 13 feet wide. At the front end, a robot arm packages medications in single-dose bags. At the back end, a patient's medication bags are arranged in order of administration and attached to a plastic ring. A card attached to the ring specifies each drug, along with important patient information.
The robot packages 3,200 medications, including tablets, capsules, vials, ampules and suppositories. It works around the clock.


Sounds impressive. So why am I skeptical?

First of all, it sounds like a lot of diligent work is required by human beings to make sure the robot does its job properly. People have to place the medication in the robot so that medication can be dispensed, right?

More importantly, I wonder whether the hospital really examined the issue of WHY medication errors occur. Installing a machine like this seems to imply that hospital officials believe problems are caused by human errors that a machine won’t make.

And while that may be true to some extent, it is also true that a lot of factors contribute to human errors. When I
wrote previously about the incident involving the Quaid twins, I noted the two medications that were mixed up came in identical vials with near-identical labels. When that is the case, isn’t it just as likely a pharmacy technician could put the wrong medication into the robot as it is a nurse could administer the wrong medication?

Further, the pharmacy is only one part of the process by which medications ultimately get to a patient’s room. Has Loyola looked at all the other steps in that process? The bar code system that is part of the new installation may help, but I’m inclined to believe there are other opportunities for mistakes.

I would be more impressed by Loyola’s announcement if, rather than focusing on the robot, they were describing it as part of a broader attempt at process improvement. And I suspect that any reduction in medication errors at Loyola will not be as great as officials there hope.

3 comments:

Richard Ricker said...

Mr. Bernstein,
I apologize for the delay in responding to your posting in May 2008 regarding the installation of the SwissLog Robotic System at Loyola University Medical Center;however, I was just recently made aware of the article.

In response to your comments, I agree that the installation of automation without a comprehensive review of the medication distribution system with an analysis of potential failures would be short-sighted.

The news release focused on the intial step in the implementation of a long term strategic plan to enhance the medication distribution system at Loyola and enhance patient safety by reducing (not eliminating) medication errors.

The introduction of human error will always be present in any system; however, with the automation plan being implemented at Loyola, we hope to minimize these errors.

The SwissLog Robotic System will provide the Pharmacy Service with a process to repackage all medication with a 2-dimensional bar code, which will provide the foundation for the integration of Cardinal Health System's Pyxis 3500Medstation. By integration, I mean that the replenishment of all the Pyxis units will be provided by the SwissLog Robotic System utilizing an enhanced ParX process. This process is enhanced by embedding the specific Pyxis cabinet information into a barcode on the medication ring , allowing a pharmacy technician to scan the ring and the specific drawer in the Pyxis unit prior to replenishment(this will be a first in the nation utilizing this process). It is hoped that this process will eliminate the type of errors that occurred in Methodist Hospital in Indianapolis,IN and at Cedars-Sinai in Los Angeles.

With the successful implementation of the SwissLog Robotic System and the installation of Pyxis 3500 Medstation in all patient care and procedure units by late fall,2008our next phase involves the implementation of the EPIC Bedside Point of Care (BPOC)system. This system will allow for the use of multiple bar code systems (i.e. medication, patient ID band, and nurse ID Badge) to ensure that the right medication in the right dosage form is administered to the right patient at the right time.

Ongoing evaluation and enhancements to the implementation of automation at Loyola will be required to ensure that the investment in capital and additonal expense will result in documented reduction in medication errors and enhanced patient safety.
I hope this helps provide additional background information regarding the implementation of automation at Loyola University Medical Center in Maywood, IL.
If you should have any additonal questions, please contact me.

Thank you.

Richard H. Ricker
Administrative Director of Pharmacy Services
Loyola University Medical Center
Maywood, IL 60153

It is hoped that by the r

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