Hospital tech: robots in the pharmacy and barcodes on the patients
After more than a year in the works, NYU Langone Medical Center launched last month a new, robot-assisted pharmacy. One of about two dozen in the nation, the pharmacy provides a glimpse into the hospital of the future.
I spoke recently with Dr. Thomas O’Brien, senior director of pharmacy, about the inner workings of the pharmacy — and about what further advances are in the works.
What does the robot equipment in the pharmacy look like? How does it work?
It looks like a big behemoth in the middle of the main pharmacy area. It has advantages over the earlier robots, primarily in the ability to do its own packaging. With [a previous generation robot], we had to have two technicians manually preparing these medications everyday. Here, that’s entirely eliminated. The device does it by itself. It holds about 54,000 doses, which represents about a four to five day supply here.
Is the robot’s work checked by a human?
Yes. The checks are up front. There are a series of steps the staff have to go through before the medication actually reaches the robot. It involves three major checks, the majority of which utilize bar code technology. When a bulk container comes in, it’s scanned. It then goes through a series of checks. It’s placed into a sealed container that can be opened with a special device to hopefully prevent any accidents. It then is placed on a turntable device and the robot literally goes in the canister, takes out the tablet or capsule and packages it and affixes three barcodes onto it.
When I came here, the vision that our senior leadership had was: We’re not using this to reduce workforce. We’re using this to re-deploy our staff, to get our pharmacists more intimately involved with our patients, with our physicians and with our nurses. [When you're a patient being discharged from the hospital] you’re usually in a state of confusion and someone hands you six prescriptions. We want to make sure that we actually monitor patients’ medications from the day they’re admitted to the day they’re discharged and follow up. It’s really meant to make better use of the pharmacists’ clinical abilities rather than their skills with the pill count.
Do patients notice any change?
Hopefully they’ll notice a difference when they start seeing more of a pharmacist, when they’re able to contact a pharmacist with a question regarding their medication. Probably the greatest impact occurs within the pharmacy.
What this technology really enables us to do — our next step at NYU — is to go toward barcoded bedside medication. We’re going to barcode our patients. Their wristbands at some point will have their identification and all the information relevant to that individual patient. About 85 to 90 percent of all the medication that will come out of the pharmacy [will be barcoded]. When a nurse goes to administer a drug to a patient, he or she will scan the patient wristband, then they will scan the medication. Not only will the two scans tell the nurse whether he or she has the right patient and the right drug, but it will also develop a real-time medication administration record. We’ll know exactly when that medication was administered to the patient. It’s also far safer for our patients. Even though we do use three points of identification, this will help a great deal in terms of ensuring accuracy.
In what other ways are you using robotics in the pharmacy?
We have an automated stock room. It’s a device that runs along a lengthy track and it goes to containers that are holding bulk medication. This is the largest one in the country here at NYU. It holds some 1,200 of these containers. The device is predicated on using barcode technology. It will select the correct container and bring it to one of three stations so the pharmacist can withdraw the bulk medication from the device and then scan it. We expect this will allow us to turn over our drug inventory. We’ll be able to keep less medication on hand and be able to do a better job of doing just-in-time ordering. It uses barcode technology, so once data is entered into this robotic device, a label will be generated specifically for that patient.
[That's] another project NYU is undertaking. The Board of Pharmacy about six months ago gave hospitals permission to send patients home on chronic medications they’re on during their hospital stay, like an inhaler or an insulin medication. Instead of [having to] discard these medications, which added to the pollution factor, we’re now able to tell the patient: You have six more doses of your inhaler and we’re giving it to you with instructions. You don’t have to rush out to the local pharmacy to get a prescription filled. The device assists us with that.
Image, top: Individual medication requests will be done at NYU Langone by machine / Courtesy of NYU Langone, photo by Joshua Bright
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