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Practice development - Introducing the future

Automated dispensing units may change dispensing in larger dispensaries, writes Dr Jeremy Phipps.

Dispensing practices are keen to embrace new technologies to reduce error rates and improve workload efficiency. The newest innovation is the automated dispensing units (ADU), a form of robotic dispenser.

These units are incredible to see in action, seeming to verge on science fiction. In the not too distant future, a dispensing doctor might generate a prescription during a consultation and issue the medicine to the patient simply by making a couple of keystrokes on a terminal.

Automated prescribing dates back to the 1970s and the introduction of electronic pill counters. However, the 1990s saw huge improvements, with the introduction of ADUs.

Initially, these were developed for use in hospital pharmacies but over the past five years they have spread to community pharmacies and are starting to be considered by dispensing doctors.

ADUs may change dispensing in medium to large dispen-saries, releasing staff from the tasks of pill counting and shelf-stocking to develop new working patterns and roles such as monitored dosage systems.

The range of actions these robots perform varies according to their size, manufacturer and cost. The simplest models are based on automated storage of medicine in their original packs, simplifying medicine selection by dispensers and improving stock turnover.

Additions to basic models are available, depending on the manufacturer, including automatic medicine selection and transport to the dispenser; automatic labelling of the pack; and even automatic storage of the medicine pack within the machine. Here the delivered medicine packs are simply poured into a hopper which stores them automatically within the ADU.

How ADUs work
Models vary, but ADUs could be likened to large cabinets. Medicines are stored within them, usually in what appears (superficially) to be a random manner.

Medicine requests are made by the dispenser via one or more computer terminals and one of two selection methods are used in the ADU: a picking arm may be used, or medicines are dropped into a channel in a manner akin to a vending machine.

Both methods convey the chosen medicine to a collection chute and onwards via conveyer belts, if required, even directly to the front counter.

At six to 15 cubic metres in size, ADUs may sound too large for many dispensaries, but since they store most of the drug stock, they can use the space currently occupied by the practice's drugs.

Currently, community pharmacists with these machines either use staff to input the prescription request or scan the bar code now present on most scrips. Dispensing doctors could potentially simplify this through direct information exchange between the practice's computing system and the ADU.

Although most ADUs use the bar codes on the medicines to facilitate their internal storage systems, the mechanisms vary considerably between models. The simpler ones involve a member of staff scanning the bar codes and being instructed, by a system of lights, where the pack should be placed.

More advanced models either involve the staff member scanning the pack and the machine using a robotic arm to place this, or the automatic hopper system.

Pros and cons
Reasons to invest in an ADU include a possible reduction in human error.

Many pharmacies have been able to reduce their staffing, especially at peak times, following the introduction of an ADU and have noticed an increase in the numbers of patients attending, possibly attracted by the increased efficiency or novelty. This increase is likely to be less marked for dispensing doctors, with their relatively fixed potential market.

With a machine controlling stock and automatically selecting the medicines added earliest, there is a lower risk of medicines on the shelf going out-of-date. It is also possible to gauge more accurate stock levels, enabling a better financial audit and an overall reduction in stock levels.

The increased speed of dispensing with an ADU leads to shorter waiting times, potentially creating a calmer working environment.

The biggest drawback is cost, both the initial price of ADUs (£50,000-£200,000) and the ongoing maintenance (up to £20,000). Significant savings in staff expenditure would need to be made to make the most complex machines worthwhile.

Most units are not refrigerated and so are unable to store fridge items. Some units are, however, licensed for use as a controlled drug cabinet.

There can also be problems related to the storage of heavy or bulky items, particularly foodstuffs and liquids over 500ml, although some newer machines are able to cope with these.

ADUs produce some noise, especially the conveyer belts, but most owners do not seem to find this a particular problem. They rely on the electrical supply, although there is usually an option of battery back up for 30 minutes.

The picking arm system has the more complex mechanism, reflected in its higher maintenance costs.

The selection process works on bar codes and this causes problems with parallel import packs, although this is hardly a problem at today's euro to sterling exchange rate.

Similarly, there are difficulties with splitting an original pack of medicine stored in the unit, such as a five-day course of antibiotics rather than the more standard seven days. It is possible to use part of a pack and return the remainder to the ADU for later use, but most leave the remainder for manual dispensing.

Despite these shortcomings, most purchasers are able to use these robots for more than 90 per cent of dispensing. Whether it makes economic sense will be a decision for individual practices, but if you have the chance to see one in action, prepared to be amazed.

  • Dr Jeremy Phipps is a dispensing GP in Lincolnshire

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