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Pharmacists at the University of California San Francisco are in the process of bringing one of the world's largest and most advanced robotic pharmacies online.
The automated pharmacy is not expected to reduce pharmacy staffing needs, said Lynn Paulsen, PharmD, director of pharmaceutical services, UCSF Medical Center, but it is already creating a safer working environment for both patients and pharmacy personnel.
"We have already filled more than 400,000 oral-solid and sterile-injectable doses with zero order-fill errors," Paulsen told Drug Topics. "Technician picking would generate between 0.1% and 1% errors."
The automated pharmacy is part of an overall upgrade to UCSF's 2 hospitals that includes bedside bar-coding and electronic medical records going live in October and electronic order entry scheduled for 2012. The automated pharmacy will also serve a third hospital scheduled to open in 2014.
The new 15,000-square foot pharmacy is located in Mission Bay, a new high-tech and biotech development area in the western part of San Francisco. The automated pharmacy will eventually replace UCSF's current 5,000-square-foot facility, which is hemmed in by other operations and cannot be expanded.
"That kind of space opens a lot of opportunities," Paulsen said. "You can start thinking about automation in a big way. We're not expecting to save FTEs [full-time equivalent employees] because there is a tremendous amount of quality assurance and oversight and feeding of the machinery needed. The difference is that quality of the product and our services jumps up a couple of logarithms. We have a better career path for technicians, who will be dealing with more sophisticated systems and equipment. And we plan to redeploy pharmacists to even more direct patient-care work than they are already doing."
The Mission Bay pharmacy serves UCSF's entire inpatient population as well as approximately 180 outpatient clinics. The new facility is not licensed for outpatient services.
"We serve just over 600 beds, and our patients are almost all referrals," Paulsen said. "We're essentially a 600-bed ICU. Our patients have some pretty intensive medication needs."
Autopick and c-and-f
The automated pick system dispenses doses in a thin plastic ring that contains all medications scheduled for each patient over a 12-hour period. The med rings are bar-coded and linked to each patient's medical chart and medication order history. A bedside bar-code system that will verify patient, drug, and administration schedule is slated to go live in October.
Also coming this fall is a robotic syringe and IV compounding-and-fill (c-and-f) operation for chemotherapeutics and other sterile products. The automated system adds additional layers of safety for pharmacy staff, nurses, and patients, Paulsen said. The RIVA (robotic IV automation) system from Intelligent Hospital Systems will also allow UCSF to end its current outsourcing of sterile-fill operations, saving $2 million annually.
Sterile-product outsourcing now includes IV premixes, anesthesia, and epidurals. Paulsen said the $7 million automated system should pay for itself in just under 4 years.
The entire c-and-f operation is conducted inside a sealed environment, which curtails potential staff exposures to hazardous products. Paulsen said that UCSF is conducting before and after studies to track workplace exposures to hazardous drug products.
Compliance and accuracy
RIVA should also ease regulatory compliance. The robot automatically tracks lot numbers, expiration dates, and other details of each component required by the state Board of Pharmacy. The system also verifies the accuracy of each fill by measuring the weight and specific gravity of the final product before it is released.
The biggest challenge, Paulsen said, is that the accuracy of robotic fills exceeds the accuracy of barrel markings on syringes. That has raised questions among nurses, who must now deal with more precise fills.
"There is a whole new reality of safety standards and quality assurance routines you have to learn with an automated pharmacy," Paulsen said.