Aims and objectives:
We aimed to introduce robotic dispensing to the pharmacy department of our hospital. Our objectives were to make better use of our staff and their skills to enhance patient care, to improve the efficiency of the dispensing process with consequent reductions in waiting times for patients, and to improve patient safety by reducing the number of dispensing errors. These objectives conform with the aims of National initiatives relating to medicines such as the department of Health's Strategy for Pharmacy and with the wider modernisation agenda that is set out in the NHS Plan, in particular the use of technology to support improvements in staff utilisation and to reduce clinical risks.
Support for the change:
The benefits of automation were explained to the Trust board by way of a briefing on Medicines Management. The success of this presentation generated a high degree of ownership for the initiative in the Trust, and helped significantly in attracting the funding required. Other briefings took place at a Senior level once funding had been allocated, with regular updates being provided on progress. In the pharmacy department, the staff had been briefed 12 months previously of the potential for automation affecting their working lives, and they therefore had a high level of understanding of the implications well in advance of the robot being installed. A project team including representatives from all levels of the pharmacy, estates department, health informatics and others oversaw the implementation of the system. The pharmacy element of this group has continued to meet after implementation to ensure full realisation of the intended benefits.
Patient and public influence:
From existing patient satisfaction data obtained via annual survey, we know that our patients regard accuracy in dispensing, information about their medicines and waiting times as the key criteria in assessing the quality of the pharmacy service they receive. These criteria also feature in assessments of the service by nursing staff. In light of this we believe that the objectives of the automation project are directly aligned with the needs of our patients and staff. We believe that the data we have collected since installing automation demonstrate that the safety and quality of the service have significantly improved.
Impact on the workforce:
Automation has paved the way for us achieving significant changes in the mix of skills required to operate the dispensary. We have developed new and expanded roles for unqualified staff in dispensing, and expanded the role of qualified technicians in checking dispensed medicines and providing medicines information to patients. We have also been able to expand our team of ward based pharmacy technicians as a direct result of staff being released from the dispensary because of improved efficiency. Automation is now seen as significant driver in developing a pharmacy workforce that is better suited to meeting the needs of patients in relation to their medicines.
Measuring the results:
We have measured the benefits of automation in the following areas. Dispensing error rates, dispensing process times, and staff and patient satisfaction. In light of the relatively small numbers of Trusts using this technology it has not been possible to directly benchmark our experiences with comparable sites. However, our data largely reflect those in the published literature on pharmacy automation, in so far as dispensing error rates have fallen significantly, process (and waiting times) have reduced, and staff and patient satisfaction have improved. In-direct benefits have also accrued in respect of improved stock utilisation and reduced wastage.
Improved performance:
Our data shows that as a direct result of adopting new working processes enabled by automation, patient safety has been improved. Dispensing errors have reduced, and we have adopted a skill mix more suited to the modern dispensary environment. We have achieved significant improvements in the efficiency of the dispensing process, and enhanced our ability to manage medicines effectively on the wards by releasing staff from the dispensary. Furthermore, we have created an attractive and modern working environment that better suits the needs of our staff and is expected to pay significant dividends in future staff recruitment and retention.
Reflecting diversity:
The installation of automation has allowed us to adopt innovative changes to the diverse range of staff groups working in the pharmacy department and to create roles, which are more suited to their skill levels. This has been based on the development of staff at assistant level, and the improved utilisation of qualified pharmacists and technicians with clinical and technical skills. We believe that we have a good understanding of the needs of our patients in respect of their medicines, and have demonstrated that automation in the pharmacy can better help us to meet these.
Sharing the learning:
Throughout the duration of the project we have shared our ambitions widely within the Trust. When robotic dispensing commenced, we communicated the impact of this via the Trust's internal newspaper and via the local media in the form of local newspaper and radio reports. We have demonstrated the robot to a wide variety of staff in the hospital including the Trust Board and the project has featured heavily in a number of Trust reports. We have shared our experiences with colleagues via professional networks across the Trent region, and have received visits from staff in many other hospitals throughout the country.
Outstanding features:
We have successfully demonstrated the benefits of implementing innovative, cutting edge robotic technology to an area not traditionally associated with automation. To achieve this we have had to challenge and re-organise traditional working practices and the design of the working environment. Furthermore, we have had to engage our staff in adapting to novel ways of working, some of which may be been seen as potentially threatening. We believe this project has substantially raised the profile of the pharmacy service in the Trust and the wider health economy, has changed people’s perceptions of the dispensary environment, and has provided the basis for profound and lasting change in the way that medicines are provided to patients.
