Chapter 5 Automation Systems Steve Rough and Joel Melroy

Chapter Outline Key Definitions Introduction Adverse Event—an injury resulting from a medica- tion or lack of intended . Key Definitions Automated Dispensing Cabinets—secure storage Current Trends cabinets typically located decentrally on patient care units Medication Errors Versus capable of handling most unit-dose and some bulk (multi- Adverse Drug Events ple-dose) due to storage limitations. The Medication Use Process Automation—any , machine, or device linked to or controlled by a computer and used to do work. Automa- Strategies for Automation tion is designed to streamline and improve the accuracy and Drug Purchasing and Supply efficiency of the medication use process. Chain Management Systems Carousel Automation—a medication storage cabinet Drug Distribution and with rotating shelves used to automate dispensing. Dispensing Systems Centralized Robotic Dispensing System—centrally Safety Issues Surrounding the located devices designed to automate the entire process of Use of Automation medication dispensing including medication storage, distri- bution, restocking, and crediting of unit dose medications. Strategic Plan for Selecting Automation Within a Health Medication Error—any preventable event that may cause System or lead to inappropriate medication use or patient harm while the medication is in the control of the health care Cost Justification of professional, patient or consumer. Automated Systems Supply Chain Management—the management of the Automation Impact on pharmaceutical order-to-pay process including management Pharmacy Manpower of inventory and distribution of supplies throughout the Informatics Pearls medication use process. Conclusion Technology—anything that is used to replace routine or References repetitive tasks previously performed by people, or which extends the capability of people.

the Pharmacy informatics primer n 77 Introduction through reducing medication delivery time In today’s health care marketplace, payers and improving patient safety and clinical and patients demand high quality, efficient, programs. All of these important initiatives and cost-effective service. Through successful can be accomplished through appropriate implementation of technological advance- use of automation. As the profession accepts ments, pharmacy departments can play a vi- increasing responsibility for improving tal role in providing high quality and efficient patient outcomes through implementation service to patients. Efficient use of technol- of patient care services, automa- ogy and automation is a prerequisite to the tion continues to be relied upon to free the survival of the profession and the advance- pharmacist from technical tasks. Shortages ment of pharmacist patient care services.1 of qualified and technicians The purpose of this chapter is threefold: coupled with shrinking operating budgets (1) to provide background on the use of are leading managers to explore technolo- automation in inpatient pharmacy practice, gies that can complete less cognitive dis- (2) to describe several pharmacy automated tributive tasks traditionally performed by dispensing as well as their pharmacists and technicians. advantages and disadvantages and intended Strategic partnerships between health roles within the medication use process, systems and pharmaceutical wholesalers are (3) to identify best practices for maximizing increasing the rate of availability and de- the safe and efficient use of automation, and ployment of new automation and technolo- (4) to provide a predictive model for the gies. Wholesalers serve as intermediary busi- impact automation will have on the future nesses that purchase pharmaceuticals from of pharmacy practice. On completion of this drug manufacturers for resale to pharmacy chapter, the reader should have an under- customers. Rising complexities and costs of standing of the role of pharmacy-based day-to-day pharmacy operations, shrinking automation in an integrated health system personnel resources, and limited technol- as well as practical tools for implementing ogy expertise have led pharmacy directors such automation. to seek partnerships with vendors possess- ing a broad line of automated products. Current Trends Coupled with traditionally strong pharmacy/ The application of automated dispensing wholesaler business relationships and declin- systems within the practice of pharmacy ing wholesaling drug distribution business began in the early 1960s. However, changes margins, this trend has created incentives for in the health care system and the profes- wholesalers to develop more profitable (auto- sion’s transition to pharmaceutical care mation-related) business ventures. Thus, have dramatically increased the demand for since the mid-1990s wholesalers have ac- incorporation of automation into pharmacy quired pharmacy technology and automation practice over the past 15 years. Corporate companies at a rapid rate. Mergers between and organizational goals of reducing costs, drug wholesalers and medication dispens- improving operating efficiencies, grow- ing automation companies has been a key ing revenues, enhancing safety and quality, component to drug wholesaler growth and integrating and managing data, and pro- survival. Traditional automated distribution viding outstanding customer service are and information system technologies used by primary drivers of this trend. Pharmacy wholesalers to provide services to their phar- managers are often expected to improve macy customers are now being sought after efficiency by reducing pharmacy staff and by these same customers to improve phar- nursing workload while increasing quality macy purchasing and inventory management

78 n chapter 5: Pharmacy Automation Systems