From a legislative perspective, the medicine control done by the pharmacist is invaluable. However, often legislation does not recognise automation designed to make medicine retrieval easier, though such automation is in daily use in many hospitals and healthcare units. After the installation of the Mega-Fixu automated dispensing system at HUS Pharmacy, all medicine packages were validated during a period of over a year until the margin of error could be proven to be less than 0.02%. After that, the validation rate was lowered.
The medicine dispensing and retrieval for the Helsinki and Uusimaa Hospital District HUS is headquartered at HUS Pharmacy in Meilahti. Medicine retrieval there is led by the NewIcon Mega-Fixu automated dispensing system (ADS), which retrieves 38 percent of all the medicines dispensed in the HUS operating area.
At the moment, Mega-Fixu stores approximately 80,000 medicine packages, covering over 1,100 products. In addition to automated retrieval, medicine packages are also retrieved manually. This is because of medicines requiring cold storage and heavy medicine packages that are stored outside of the ADS. The production manager for HUS Pharmacy, leading pharmacist Sirpa Nieminen, states that their future goal is to centralise medicine retrieval.
‘For us, the role of automation in medicine retrieval is great and significant. The efficiency and accuracy produced by the ADS is the most important thing, because the ADS is nearly always faster and more accurate than a person. When Helsinki joined HUS Pharmacy in 2016, we wouldn’t have been able to fulfil the needs of our customers without the ADS. It is our aim to grow the retrieval percent of Mega-Fixu in the future, and to use its AI for the pharmaceutical validation of medicines stored externally,’ Nieminen says.
Trust in the ADS was born as a result of validation
At HUS, every 10th dispense row is sent to validation. Product-specific validation is used for those products, for example, that have been observed to stick together. The Mega-Fixu ADS also sends to validation such crates where it itself considers the content to be inaccurate. Thus, the percentage of nearly all validated medicine in relation to all retrieved medicine rises to 12 to 16 percent.
The ADS receives between 2,500 and 4,000 medicine package per day at HUS Pharmacy, and retrieves between 250 and 350 crates. Last year, the HUS Pharmacy ADS retrieved approximately 800,000 medicine packages, of which 14% (110,000 packages) were validated.
‘The validation process at HUS is the result of long-term work. When HUS Pharmacy introduced Mega-Fixu, every medicine package was validated during the first year. When the margin of error dropped below 0.02 percent, the number of validations could be reduced. After this, we were able to rely on Mega-Fixu operating as it should. However, we do want to validate medicines by randomly sampling 10 percent of them. This allows us to ensure medical safety and the reliable functioning of Mega-Fixu,’ Nieminen explains.
The Medicines Act must be updated in collaboration
The world has changed fast during the last few decades, and automation has become a part of the daily life in health services. The Medicines Act has not been updated with regard to validation since the 1980s, and it does not recognise the role of automation in medicine retrieval. Nieminen thinks that the law should be updated in collaboration with different stakeholders.
‘At the heart of all this is patient and medical safety – that much can be agreed on by all. From a legislative perspective, a validation performed by a pharmacist is the best possible one, though automation is almost always better than a human. If the ADS is proven to function properly, it should be considered whether or not a random sampling by a pharmacist produces any additional value, or if the same task could be handled by a pharmacy technician, for example,’ Nieminen remarks.
By updating the Medicines Act and increasing the percentage of automation, the time staff spends in medicine retrieval could be allocated for tasks where a human being is invaluable.
‘It may be that in the future there won’t be enough personnel resources available for tasks relating to pharmaceutical logistics; people would be needed more in customer service and wherever the patients and other healthcare professionals are. This is the time when an ADS is necessary,’ Nieminen sums up.
HUS Helsinki University Hospital
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