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How clinical pharmacy services can be improved by dispensary automation

Dispensary automation in NHS Greater Glasgow and Clyde has seen clinical pharmacy services move from one of the worst to one of the best in the area, writes Leila Taheri

By Leila Taheri

Dispensary automation in NHS Greater Glasgow and Clyde has seen clinical pharmacy services move from one of the worst to one of the best in the area, writes Leila Taheri

How can we cut medicines waste, make savings to the tune of millions of pounds, speed up the dispensing process and provide a better clinical pharmacy service, while remaining cost neutral?

The answer is through automation. The world’s largest pharmacy distribution centre became fully operational in Glasgow last spring. NHS Greater Glasgow and Clyde’s state-of-the-art robotic technology has been described as having revolutionised the distribution of medicines to hospitals and clinics throughout the region, with the single distribution point in Glasgow replacing 14 existing pharmacy stores.

NHS Greater Glasgow and Clyde is the UK’s largest health authority. It covers some 1.2 million people and has a £120m medicines bill.
Although the use of automation and robotics in hospital pharmacy is nothing new, the sheer size of the project is unique. Indeed, Norman Lannigan, lead pharmacist for NHS Greater Glasgow and Clyde, who has been involved with the project since its inception, told The Journal that the redesign has attracted interest from hospitals in London and Cambridge and from abroad — including Oman. “What is groundbreaking is the scale of what we’ve achieved through automation,” Professor Lannigan said.

The impetus of the redesign was the need to release staff from supplying medicines to working directly with patients within integrated clinical teams. “I’ve always believed that pharmacy staff offer patients a better service as part of a clinical team . . . so the idea was to integrate them into ward-based teams,” he said.

The cost of the project

NHS Greater Glasgow and Clyde invested £3.1m for one-off costs, including:

• £800,000 on IT
• £1.1m on the automated distribution centre
• £960,000 on automated dispensaries and refitting dispensaries within hospitals
• £250,000 on training and up-skilling staff who would be redeployed to other areas including wards

Additional revenue costs are paid by making efficiency gains on things like staffing costs, which were cut by £2m.

IT and robotics, supplied by Ascribe and ARX, respectively, were employed to make the vision a reality.

Medicines are ordered electronically via an ordering schedule, “picked” by robotic arms in the distribution centre and sent to hospital wards and pharmacies throughout the region.

The centre holds around 12 days’ worth of stock, with a total value of some £2m. On average, around 200,000 packs of medicines are distributed to 4,500 destinations each week. The centre also manages home care services, which provide specialist medicines direct to 3,800 patients in homes and specialist clinics in Lanarkshire as well as Greater Glasgow and Clyde.

The system is considered error-free (Professor Lannigan said most errors are human ones caused, for example, through operators inadvertently entering incorrect information) and 96 per cent of items are supplied the first time — with medicines shortages and supply issues accounting for the remaining 4 per cent. ­However, the operation of the distribution centre has been far from problem-free. Complications have included blockages on conveyer belts, which were fixed by upgrading the system, and refilling the robots fast enough to allow picking, which was resolved by introducing a night shift when medicines could be replenished in time for picking in the day.

Meeting the expectations of the new design also involved redefining the way in which medicines are provided to patients. The “making the most of your medicines” scheme was conceived, under which patients can continue using medicines they have brought with them when admitted to hospital. Trolley-based medicines rounds have been replaced by bedside lockers, where a patient’s medicines can be stored after being checked by pharmacy technicians or nurses. This has reduced the need for represcribing medicines at discharge, thus producing cost savings, and has the added benefit of highlighting any non-compliance issues. “The best feedback has been from the ‘my medicine’ service, from nurses who think it’s safer and appreciate that patients can go home quicker,” according to Professor Lannigan. None of this is unique to Glasgow but its implementation is having other benefits.

When a patient is ready to go home, a discharge letter is faxed to that patient’s community pharmacist and GP. Communicating this information to community pharmacists has led to one significant episode where the quality of care has improved in one patient for every four, according to Professor Lannigan. For example, a community pharmacist who has received a discharge letter has the information to reinforce advice given at discharge or pick up on changes to medicines that were made in hospital but not implemented in the community. In the future, it is hoped that discharge pharmaceutical care plan will be sent electronically to community pharmacists, Professor Lannigan revealed, and work is already under way to develop this.

For all the benefits and successes of the redistribution centre, Professor Lannigan will not be content until perfection is achieved. “We want 100 per cent of patients to have access to clinical pharmacy services,” he said. 

Automation, before and after

Centralising and consolidating services resulted in cost savings and efficiencies:

• A report to Audit Scotland in 2007 revealed that just 60 per cent of inpatient beds, amounting to around 4,000 beds, had access to a clinical pharmacist. The figure for March 2012 stands at 90 per cent — which means NHS Greater Glasgow and Clyde went from being one of the worst performers to one of the best in this area.
• In August 2008, 36 per cent of inpatients used their own supply of medicines while in hospital compared with 90 per cent in March 2012, under the “making the most of your medicines” scheme.
• Using the “making the most of your medicines” scheme has resulted in £6.50 saved per patient admitted — equating to £1.5m per year — through avoiding the needless destruction of patients’ own medicines.
• Good stock management, such as avoiding reordering medicines, has saved £300 per bed over one year, amounting to £1.35m in total.
• Dispensing time has been cut from seven minutes per item to three minutes.
• The 14 pre-existing pharmacy stores were operated by 140 distribution staff, which was reduced to 40 staff following the operation of the single distribution centre. However, redundancies were avoided by redeploying staff, up-skilling and not filling vacant positions.

 

Citation: The Pharmaceutical Journal URI: 11097345

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Supplementary images

  • Checking the status of one of the robots in the pharmacy distribution centre

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