When we think of a pharmacy, many of us picture a shelf-lined room laden with drugs of every description—and white-jacketed pharmacists who pluck those drugs off the shelves, filling prescriptions one by one. While that would be an accurate picture in many venues, the pharmacy environment is quite different at Sentara RMH Medical Center in Harrisonburg and Sentara Martha Jefferson Hospital in Charlottesville.
For these two hospitals, filling prescriptions is a highly automated process that employs the latest in robotic technology to ensure safety, accuracy and efficiency. Thanks to these automated pharmacies, several thousand prescriptions can be filled daily, around the clock, with 100 percent accuracy.
Sentara RMH actually has been using robotics for quite some time, investing in the technology nearly two decades ago, and in 2001 installing a $1 million robotized pharmacy system that could hold 12,000 units of medication.
The system proved so successful that in May 2018, the hospital extended its use of the technology by implementing the Omnicell XR2 Automated Central Pharmacy System. A beta partner with Omnicell, Sentara RMH is only the second hospital in the world to install the XR2 (the other is St. Luke’s University Hospital in Bethlehem, Pa.). The new system is capable of holding 60,000 units of medication, according to Jamin Engel, PharmD, manager of the Sentara RMH Pharmacy.
The XR2, which occupies a secure, enclosed space within the Sentara RMH Pharmacy, consists of a series of trays filled with individual, bar-coded doses of medications, as well as a large, rotating robotic arm that moves back and forth along a motorized track. When a medication request is entered into the system, the appropriate trays automatically slide out so that the robotic arm can pluck out the meds and place them, with 100 percent accuracy, into bins that are then accessed by pharmacy personnel.
While filling these prescriptions, the robot scans each bar code on the dispensed drugs. If, by chance, an incorrect drug is picked up, the bar-code scan enables the system to recognize the error, interrupt the process and alert the pharmacy staff.
Under normal circumstances, once a prescription is filled, the system’s trays slide back into place to await the next order.
After leaving the pharmacy, robotically filled prescriptions are stored in patients’ rooms in secure cabinets, which can be opened only by authorized personnel with electronically coded badges. The drugs are scanned for accuracy one final time at the patient’s bedside before they are administered.
Engel notes that to help ensure accuracy, pharmacy technicians randomly check 5 percent of everything the robot picks on a daily basis.
“We work hard to eliminate any chance for dispensing errors,” he says. “I’ve been here 10 years, and I’ve never seen the robot make a mistake in picking a medication.”
Pharmacy team coordinator Bill Thomas, who led the XR2 project, says Sentara RMH hopes to grow and expand operations with the addition of refrigerated meds, as well as a packaging system inside the robot itself.
“The XR2 is a game changer, and a lot of other sites are interested in this technology,” says Thomas. “They’re lining up just to come look at it.”
In June, groups from Europe, Australia and other locales worldwide visited Sentara RMH to see the XR2 and evaluate it for use in their home countries.
“They’re coming to Harrisonburg to see this robot in action and to see how they can market it,” adds Thomas.
Engel and Thomas point out that utilizing robotic technology brings other advantages as well, giving Sentara RMH the ability to downsize equipment needs; increasing pharmacy staff productivity; saving thousands of work hours; supporting efficiency in the patient units; and, thanks to computerized inventories, allowing for better planning to help prevent drug shortages.
“Now there’s no need to stockpile drugs,” says Engel. “We know several days out whether or not we will need certain meds, so the system reduces our costs considerably.”
He adds that Sentara RMH and Sentara Martha Jefferson are “two of the most automated hospital pharmacies you can find anywhere.”
Another Early Investor
Sentara Martha Jefferson Hospital was also an early adopter of robotic technology, acquiring its own system in 2000.
“What motivated us to move in this direction was a 1999 medication-error study called ‘To Err is Human,’ conducted by the U.S. Institute of Medicine,” says Wayne Nye, pharmacy manager at Sentara Martha Jefferson. “The results of that study were a bombshell for the healthcare industry in terms of identifying the morbidity and mortality associated with medication errors. The study got a lot of attention, particularly in the pharmacy business, and we realized the time was right to invest in new technology—if for no other reason than to avoid medication errors.”
Like its counterpart at Sentara RMH, Sentara Martha Jefferson’s pharmacy builds numerous checkpoints into its processes to ensure safety for its patients.
“When we get medications in our pharmacy, the first thing we do is use bar-code technology to make sure that they scan and identify themselves properly,” says Nye. “The second step may include having to repackage these drugs in a way that is friendly to the robot. Those robot packages must properly scan as well. We examine these drugs from a safety and identification standpoint before we even get them into the robot, as a way to make our process safer and more efficient.”
Nye also points out that storing drugs in secure cabinets in patients’ rooms allows nurses to administer medications more efficiently on-site, instead of having to make a separate trip to the pharmacy.
Much like at Sentara RMH, the staff at Sentara Martha Jefferson checks the accuracy of its pharmacy robot on a daily basis, ensuring its accuracy when filling new patient medication orders and the big-batch jobs that supply all patients with medications for the next 24 hours.
For Douglas Paige, pharmacy operations manager, Sentara Martha Jefferson is the third facility with a highly automated hospital pharmacy that he has worked with in a management capacity.
“One of the biggest advantages of the emergence of time- and labor-saving robotic technology is that it has freed up pharmacists to work on the floors with nurses and physicians, making sure patients’ medication needs are met,” says Paige.
“The new system enables us to transfer a lot of the labor associated with dispensing the hard product—the medications—over into the much more important clinical support services, helping physicians and interacting with nurses and patients. We can serve a mission that is much more central to patient safety and good patient outcomes by making sure our patients get the right medication at the right time.”
Paige and Nye stress that, in spite of the revolutionary leap taken with the robotic system, it hasn’t been just the programmers, database managers and system architects that have enabled the technology to work so well in a pharmaceutical setting.
“It was a special type of pharmacist who got involved to make sure the patients’ interests—as well as our professional goals for safety and accuracy—are served in a way that is not only positive and safe, but also legal and compliant,” says Nye. “Engineers build a lot of good things into technology to make things go right, and the pharmacy team members help make that happen, day after day.”