Automatic management of medicine becomes the irresistible trend in the pharmacy?

Date :2014/5/13 9:07:14    Number:8758

Introduction: With the development of technology and the increase of working efficiency, the traditional mode of “drug management by person” cannot accommodate the development speed and mode of modern hospital and has become a barrier; undoubtedly, the automatic management of medicine will be the good trend in the future.

According to the statistic data, there are 6.5 incidents caused by the drug averagely in every 100 inpatients in which 28% may be prevented; in the adverse events of drug that can be prevented, approx. half of them may be caused by the errors in transcription of medical order, drug dispensing and administration. The idea of modern pharmacy construction from developed countries in Europe and North America has been used to try the automatic management of drugs for many years. However, the pharmacy automation has been carried out in less than 200 of 30,000 pharmacies in China. As the informationization construction in China’s hospitals is improved gradually, the automation of medicine management has become the inevitable direction in the large hospitals.

For the medicine management is related to the safety of life, we should change the process from the prescription issued by doctor to the drug being delivered correctly to the patient if we want to renovate the concept “drug management by person” which is not limited to subscribe and get the medicines.

A drug should be handed over from the hospital and doctor to the patient after it is delivered from the pharmaceutical factory and sold to the hospital by the supplier. In the medicine management process (drug storage, receiving and assignment of department, drug dispensing and doctor’s prescription…), the fundamental purpose of each step is to safeguard the basic medication safety of the patients.

A set of automated drug management system was established by XYDY Medical Technology (Beijing) Co. Ltd for Peking Union Medical College Hospital. He Yuan, the general manager of the company, introduced in the interview that the large hospital in the concept of European and American countries is not the large scale in China; it referred to instead the high efficiency in handling the patients which was related to the high automation in the European and American hospitals. “The hospital with 300 beds or above is considered as the large hospital in US, and in the US large hospitals with 300 beds or above 99% of them have employed the automatic management system. In China, the management is far from the automation even in the large hospital with 2,000-3,000 beds.”

The Pharmacy Administration Regulations issued by the Ministry of Public Health in 2011 indicates clearly that the unit dose dispensing should be carried out for the oral drug. For the efficiency and error, the manual dispensing and delivery is far worse than the automatic dispensing. Although “Four Checks and Ten Verifications” may be achieved by the pharmacist, the problems occur inevitably in the practical operation due to the excessive patients in hospital and the limited staffing of pharmacist. For the nurse, the “Quality nursing project” promoted by Ministry of Public Health in 2010 required that “Return the time to nurse and nurse to patient”; however, the nurses have to do many works that in fact are not undertaken by them in day-to-day work such as drug receiving, dispensing and assignment.

When XYDY Medical Technology win the bid of automatic project of Peking Union Medical College Hospital, the company found in the investigation of 57 wards in the hospital that a nurse should be assigned in each of department to collect the medicines for the inpatients in her department and the collected medicines may be lost inevitably as a result. Moreover, it should cost hours to get the medicines when there is emergency drug borrowing and withdrawal or the temporary prescription issued by the doctor, and the multiple trips are also required in each day.

“In a vasculocardiology department, a special nurse should be go and come between the ward and pharmacy for 17 times every day!” said He Ruan. “It is not only low efficiency for the medical professionals, but also for the patients because of the errors in the drug management by person, drug dispensing and getting without the automation. The pharmacies in many hospitals are crowded with the patients and the procedure may be more labored if the drug error or withdrawal occurs.”

For the management of some special drugs, the lack of automation may not only lead to the problems in management, but also be harmful to the health of medical staffs. For example, the fog generated by the drugs of chemotherapy may be inhaled by the operator if there is no strict protection in the preparation procedure due to its toxicity. Therefore, the strict requirement should be applied for the management and preparation, the health professional, however, cannot avoid such contact for the lack of appropriate automatic equipments in the past resulting in the occurrence of cancer suffered from time to time.

Thus, the old mode “Drug management by person” cannot accommodate the development requirements in the new era for many hospitals and the automatic management of medicine has become extremely urgent.

The nurse and pharmacist of hospital are responsible for the automatic management of medicine to ensure the storage-preparation-distribution in the medication cycle, as well as the safe and effective management in the individual parts of safe medication for the patients. To achieve the above goals, one of the methods is to develop the drug management technology. In the recent 50 years, such technology has evolved to the complex system allowing the decrease of cost, improvement of patient safety and the medication safety. For the better trace of the medicine, University of Tennessee Medical Center (UTMC) used the “patient specific” medication software for the management of auto-distributing cabinet in Knoxville. The execution of this software may reduce the time that the nurses in ward spend in the management of medicines so as to increase the efficiency of staff and improve the nursing operations. The medication management of all patients has now covered by the clinic and profile test (including the drugs not be stored in the cabinet previously) to decrease the error of medications. What is result when the efficiency increases? The increase of nursing time for the patients and the good compliance of drug treatment improve the nursing satisfaction. According to a recent report from the medical institute, the additional cost related to the drug hazard during the treatment in hospital is estimated conservatively as high as USD 3.5 billion every year as the salary and productivity loss, as well as the additional medical expenditure are not included yet. The news about the drug confusion comes top with the evidences which can be seen everywhere.

Although there is some progresses in the standardized drug management system with the significant advantages in every aspect, as a practical study case, the experience from the kidney unit in University of Tennessee Medical Center showed that the “patient specific” medication management system may increase the patient safety ensured by the ward nursing and pharmacist.

As the pharmacy becomes the inevitable trend, the duty of pharmacist should be to help the physician to prepare the medication plan, direct the medicine administration for the patients and verify the reasonability of drug combination in the doctor’s prescription. Because of the relative fewer medical resources in China, the construction and management level of the hospital pharmacy in China remained mostly on the level in 1950s of developed countries while the pharmacists miss their own duties due to the excessive prescription dispensing and drug delivery which they have to copy with every day. The high-intensity of physical labor may lead easily to the error in delivering the drug which can result in the tensions between doctors and patients if the error is mild or the medical malpractice if the error is severe. With the improvement of modern level of the hospital as a whole, the backward pharmacy management has been a big obstacle for the improvement of medical level and modernization degree of the hospital, and the more economic loss may be brought to the hospital as well.

The hospital pharmacy plays an irreplaceable role in the drug treatment. The inpatient pharmacy is the basic guarantee for all the medical departments to carry out correctly the drug treatment. As a functional department with highest visit rate in the patients, the outpatient pharmacy is the last section where the outpatients may acquire the medical services from the hospital and is the important location where the medical quality, service level and management ability may be presented.

The total solution for pharmacy should be implemented with the space plan and design as the basis, the automatic technology of pharmacy as the core and the supplies and appliances of the pharmacy as the replenishment to create a excellent environment for the pharmacy personnel and drug buyers in combination with the personalized decorations, as the pharmacists are released from the strenuous physical labor with the low added value, they will have the energy to perform their own duties and offer the patients with better and more professional pharmaceutical services, and create more values for the society with the professional knowledge. At the same time, the solution may decrease the management cost of the hospital and bring more social benefits and economic values for the hospital.

As the critical part in the modernization construction of pharmacy, the pharmacy automation will realize the auto-control for the management and delivery of medicine by means of advanced automatic technology and HIS system, resulting in zero-error in medicine distribution, increase of space/time efficiency and staff productivity, saving of energy and lowering of the management cost.

Auto-pharmacy is the automatic management system of medicine designed especially for the pharmacy which may provide a good solution for the pharmacy with the various layouts. The intensive storage system of auto-pharmacy may save significantly the storage space for the pharmacy; the intelligent mechanical arm may reduce significantly the drug-obtained time due to the manual operation; and help increase the level of drug management of the hospital; at the same time, the auto-pharmacy may boost the correctness of drug dispensing of pharmacist to increase the safety of medication.