Automate to accumulate

Pharmacy technicians are facing growing pressure to dispense medication more quickly and in greater volumes. Increasingly, hospital pharmacists are turning to automation to make life easier and to help the pharmacy become more efficient.

WITHIN the hospital pharmacy, large numbers of medication doses are produced on a daily basis, both for the hospital itself and in some instances, to supply to other local facilities too. Typically, the work of the hospital pharmacist or technician requires precision, yet certain tasks can be repetitive and time consuming, involving repeated filling of syringes and bags with liquid medication. Syringe work often involves forceful, repetitive movements of the thumb, hands and wrist, particularly when transferring large fluid volumes or filtering solutions. 

In a survey looking specifically at repetitive strain injury in the hospital pharmacy sector¹, a large number of pharmacy staff reported problems affecting the thumbs, hands or wrists. In addition, staff may adopt a poor posture when performing aseptic work, stooping from the waist with arms outstretched, often unsupported, and making awkward twisting movements. This can lead to further strain on the back, shoulders and neck and, after a prolonged period of time, many man-hours can be lost due to ill-health.

"Pressure is on to implement changes to make the production of medicine safer and more accountable"

With working conditions like this, it is perhaps unsurprising that a report by the Audit Commission acknowledges that pharmacy is facing a major recruitment crisis, noting that 15% of pharmacy posts are vacant. The problem is made worse by the demand for new services and the need to extend operating hours.
For many, using devices to automate syringe filling can take the physical strain out of batch filling, producing more in a shorter space of time, as well as providing a high degree of accuracy and accountability from ingredient source to patient. Many automated devices are now capable of producing and labelling 200 10mL syringes in fifteen minutes, a feat that would task even the most practiced of technicians.

The Royal Free Hospital has seen a real benefit from implementing automation, now critical for the safe and efficient production of intravenous medicines. The Royal Free Hospital is one of the largest licensed Central Intravenous Additive Service (CIVAS) facilities in the country and is currently number one in the UK for supplying filled infusers. To assist with a demanding workload, the Royal Free Hospital has installed nine Baxa repeater pumps for automated fluid transfer and filling of syringes. The pumps are being used for the reconstitution of antibiotics, preparation of methadone, production of oral solutions such as sodium chloride, sodium bicarbonate and potassium chloride, batch filling of bottles of eye drops, and for batch filling 15mL and 20mL epidural syringes with other medications. Up to 200 other vials and syringes per day are filled, ranging from 3mL to 40mL.

By reducing filling times and the number of manual manipulations, production times have been significantly improved. As a result, larger batches are being produced and staff can take on other tasks to help improve efficiency levels. By using a repeater pump to carry out many thousands of repetitive movements, it is also possible that the risk of repetitive strain injury may be reduced.

Increasingly, there is pressure on pharmacies to manage the entire process of dose production, involving them more at ward level and in the training of ward staff. This is to be encouraged as, according to research2, by far the greatest number of medication errors is at ward level. However, less time in the pharmacy and more time on the wards means the demand on technicians and pharmacy resources are increasing. They need to find new, more efficient methods of working if they are to avoid an escalation of personnel issues such as stress, repetitive strain injury and recruitment.

External pressure is also on the hospital pharmacy to implement changes to make the production of medicine safer and more accountable. According to 2004 data from the Dr Foster Healthcare Research Group, medical accidents and errors contribute to the deaths of 72,000 people a year. Estimates suggest this costs the NHS £2 billion in increased hospital stays . There is increasing pressure too from organisations such as the National Patient Safety Agency to reduce these figures and provide better procedures and differentiation in the dispensing of medication on the ward.

The UK is one of the first European countries to publicly acknowledge medication errors are a problem, and while there are no figures that can be directly attributed, hospital pharmacies are expected to demonstrate more accountability than ever.

The Audit Commission Report - A Spoonful of Sugar: Medicines Management in NHS Hospitals - aims to raise the profile of medicines management and states that the pharmacist has a central role to play in redesigning services around patients’ needs and in ensuring optimal use of medicines. It is the technician’s responsibility to ensure that medication is produced in aseptic conditions and that potential cross-contamination during the production process is minimised. This is particularly relevant for batch-filling and if the medicine has a shelf-life, before being administered to the patient. Automation that manages production from source to labelling prevents manual handling of the medicine and the equipment dispensing the medicine, resulting in a cleaner process, with less potential for cross-contamination.

One hospital which has embraced the benefits of automation is the Universitaire Ziekenhuizen Leuven in Belgium. This is a highly specialised academic hospital offering integrated and permanently available care for disease prevention, diagnosis, treatment and revalidation. It was one of the first hospitals to install the latest automated total parenteral nutrition (TPN) compounder technology from Baxa. There are now in excess of 350 in operation worldwide.

It is clear is that hospital pharmacists that introduce automation into their pharmacies are gaining significant benefits from this technology. Automation is assisting technicians in the production process and is taking the strain out of repetitive activities and poor posture. It is allowing staff to concentrate on more challenging work, and is offering greater peace of mind that the medication being administered to patients is highly accurate and sterile. Should a problem occur, an automated system enables the pharmacist to see exactly when and where any error may have taken place. This level of detail and accountability is essential, if hospitals are to address and reduce incidents related to errors in the administration of medicine and increase patient safety.

References
1. Minimising pain resulting from the repetitive nature of aseptic dispensing – Linda Abbott & Trevor N Johnson, PhD, MRParmS, Hospital Pharmacy Europe, Vol 9, March 2002.

2. Dr Foster Healthcare Study Group 2004:http://www.timesonline.co.uk/article/0,,2-1214427,00.html


By Terry Aston. Terry is managing director of Baxa UK.