In November 2019, Stanford Healthcare, an educational medical center, consistently ranked among the best in the United States, was moved to a new hospital building. With seven floors and 824,000 square feet, the hospital would require more than two billion dollars a decade to plan and build. Most hospital descriptions focus on ventilated private patient rooms or the newest operating rooms, but one of the building’s most sophisticated technical features is located in the basement. The hospital pharmacy is there, and there are some advanced robotic devices for storing and dispensing the drugs that are everywhere.
How Robotic Pharmacy Works
Most of the pharmacy space in the new building was taken up by three robotic devices, all from the same manufacturer (Swisslock, contrary to expectations, an Italian company). Both are for bulk storage and retrieval of drugs. These large rectangular boxes, called BoxPickers, stock drawers containing medicine boxes. A mechanical picker moves further down the aisles and removes the necessary boxes. Many of the drugs in these boxes are designed to assign boxes to patient sites. The most commonly prescribed drug for many patients. Often prescribed and over-the-counter medications are on the boxer. It is like a pharmacy cabinet, which takes the medicine to the technician and records the inventory information in real time.
Another machine is a PillPick robot, made by Swisslock, that wraps the value of a particular patient’s prescription in a small bag. Each vacuum-sealed bag contains one tablet; This is achieved by suction from an entire bottle. If the patient requires multiple pills, the bag is attached to a plastic ring that delivers all the medicines a patient needs in a day. Before Philip could pack 1000 doses per hour, a pharmacologist would have to manually pack 4-5 hours a day.
All three robotic machines automatically monitor their inventory and automatically generate orders for the hospital drug wholesaler each day. All these are linked to the Electronic Medical Record (EMR) EPIC of the hospital. Stanford was the first hospital to combine EPIC and Swisslock for complete management of the drug supply chain. EPIC manages the medicine inventory and is the source of all medicine orders for patients. When a physician orders a medicine for a patient at EPIC, it is automatically sent to the Swisslock system and the orders are automatically routed to BoxPicker or PilPick, which is then compiled by a technician or automaton. is done. If prompt delivery is required, pharmacy technicians place the patient into the hospital’s pneumatic tube delivery system for quick delivery.
New roles for pharmacists and human technologists
The hospital employs 70 pharmacists and over 100 pharmacologists. Their jobs have changed drastically with new buildings and systems. Deepak Sisodia, director of Stanford Healthcare Pharmacy, explained:
In the old building and prior to the installation of the new pharmacy management system, pharmacists and technicians spent a great deal of time selecting medicines for patients and delivering them to the bed. This gave quality control and in particular less time for pharmacists – doctors and patients – to consult about their medicines.
And the time taken on quality control under the old process is very demanding. There is a bar code system to ensure that patients receive the medicine they want, but human involvement in the selection and packaging of medicines leads to many mistakes. Pharmacists reviewed each order—they still do—but many more errors were found, and they took longer to find.
Pharmacist Johnny Wayne at the hospital describes the quality paper:
If Pillpax has the right medicine then we don’t have a problem anymore. This is true at all times; We haven’t received tablet selection errors yet. Problems only occur when the pill gets stuck in the bag or when some of the pills break. We still review every order, but it’s a very quick process.
Techniques still need to be prepared, assembled, and labeled in negative pressure “clean rooms”. These include intravenous drugs, cancer chemotherapy drugs, and non-verbal nutrition. All of these drugs required a sterile environment, and were made in a manner similar to the old hospital.
Inventory management has changed significantly with new tools and systems. It was previously manual and “based on prediction;” A buyer will walk the shelf for 4-5 hours a day and rearrange based on experience. Now if there are no malfunctions, all inventory management and reordering is handled by automated systems, more precisely. Vladimir Hernandez, the technician overseeing the pharmacy, said his job has changed:
We only knew our inventory count once a year when we did inventory pickup once a year, but now this data is directly available with some monthly practices. Some medicine cans are too large to fit in a Swisslock, so we have to check their size manually. But most of the time inventory is now only printing a few reports.
Wayne and Hernandez both have time for new tasks at their jobs. For Wayne, the focus is now on counseling rather than filling and verifying medications. He jokingly refers to most of his time there as a “call center”—a collection of pharmacies in the basement, where doctors call doctors. Stanford is a hospital that focuses more on research, so doctors are always looking to enter innovative dosage or drug orders into the EPIC. But the possible orders do not reflect what they are intended, so the patient must speak to a doctor to see if he or she is to improve their growth. Venu was informed if the doctor ordered that the EPIC be misdiagnosed or if it was not in the prescribed system setting.
Now that delivery has become more automated, Wayne has more time to work in a “call center” answering questions from patients or nurses. Aligning drug transactions on a daily basis to prevent diversion is a new task. They have time to participate in various screening trials, enroll patients in trials, prepare their medicines and coordinate deliveries. The hospital conducts at least ten tests daily and admits patients.
The “coded” vane for patients in an emergency sometimes takes or immediately mixes different medicines in a pack in the patient’s room. This was his only expression on the hospital’s medical platform. When he constantly distributes drugs at medical sites, he loses some contact. Most of those contacts are now done by specialist pharmacists from various hospital departments.
Both Wayne and Hernandez are more focused on technology than ever before. Hernandez’s job became a technician, so he was tasked with building all of Omnicell’s pantry units on the patient’s floor and connecting them to the EPIC and Swisslock systems. He should also know inventory management applications.
Johnny Wayne also learned that he needed to have knowledge of EPIC, Omnicell and Swisslog systems. If she gets a call from a doctor or nurse about a drug-related system problem, she tries to help solve it. He did not train here as a pharmacist, but now there is no difficulty. However, at first he said that it is very beautiful.
Moving towards a fully autonomous pharmacy
Deepak Sisodia, chief of pharmaceutical services at Stanford, is on the advisory board of Autonomous Pharmacy, an industry group that seeks to lead hospital pharmacies toward error-free autonomous operations. He thinks Stanford has taken a major step toward that goal with new systems and procedures in the new hospital building. Stanford failed Phase 3 (described by Sisodia as “half”) in the five-tier structure of the Autonomous Pharmacy, which is characterized by the following characteristics:
Most of the process is automated with extensive use of barcode tracking
The data is integrated throughout the company and is known to the majority
Pharmacists are relatively focused on drug delivery with some direct patient care.
Technicians ensure manual extraction and controlled components, and nurses rely on automated delivery.
Sisodia thinks the roles of Jonny Wayne and Vlad Hernandez are perfect for the position, and that they and their colleagues will change further in that direction over time as Stanford moves toward full autonomy. The Sarkar-19 pandemic appeared shortly after the new hospital opened, so pharmacy workers were somewhat restrained in how they performed their medical duties. However, he believes Stanford will be at the forefront of innovation and improvement in how pharmacists and technicians add quality and value to patient care.
