New and emerging technologies

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Chapter: Hospital pharmacy : Medicines supply and automation

With increasing use of electronic prescribing, the opportunity arises for the seamless transfer of an order, generated from the electronic prescription, and in many cases, linked to the use of bar codes.

New and emerging technologies


With increasing use of electronic prescribing, the opportunity arises for the seamless transfer of an order, generated from the electronic prescription, and in many cases, linked to the use of bar codes. This means that orders can be generated and transmitted to pharmacy in real time, unlike paper that needs to be delivered, and this order does not hold the risk of transcription error. Indeed, by routing these orders directly from the electronic prescribing system to an integrated or via an interface to a separate dispensing system, any human intervention can be removed, significantly reducing the risk of error. Some hospitals will have a prescribing system separate to that of their dispensing system such that the prescribing system generates a paper order which is then transferred to the dispensing system by pharmacy staff. Although this gener-ates the opportunity for human error, there are usually issues around the functionality of the prescribing system to act as a dispensing system that make this an issue, and one that needs to be considered during procurement exercises.


Medicines management systems and processes should be chosen to min-imise the potential for medication errors wherever possible. Techniques such as failure modes and effects analysis can be used to break down processes into steps and determine the steps in the process that may result in an error, and identify opportunities to make the process safer and more efficient. In addition, security measures should minimise the risk of misappropriation of medicines by staff, to protect them and the wider community.


Pneumatic conveying (air tube) systems are being increasingly used for rapid delivery of ward stock and discharge medicines within a hospital. Until electronic prescribing is more widely available, time and effort are saved by sending prescriptions to pharmacy this way. They can help to support phar-macy staff who are working in a decentralised, clinically based system. The only problem may be if the system fails, if delivery is not then necessarily to the intended destination.


Ward automation of medicine supplies


In line with other industries, hospitals are introducing new technologies to manage stocks of supplies and medicines automatically in clinical areas. A number of manufacturers are producing purpose-built advanced vending machines suitable for storage of medicines and other consumable products.


Most share a number of common features, which offer significant advantages over existing storage facilities and processes. In principle, the systems consist of a number of frames containing a number of drawers and storage cupboards that come in a range of shapes and sizes. Access is computer-controlled and, most commonly, restricted via use of a pin number, swipe card, fingerprint scan or combination of the three. Product selection and identification are usually supported by a fixed location within the system, restrictions on how much drawers can open, directional light technology and a visual display, possibly of a photograph of the product, on the system’s computer monitor. Bar code technology is frequently used to control the stock in the system, which is intended to minimise the likelihood of selection and replenishment errors. Medicines administration can also be supported by the on-screen option to view or print guidelines and protocols while accessing the product. Most have a refrigerator attached which is controlled by a magnetic lock, and some have external storage options, that is, shelves or cupboards, and stock movement is monitored using bar code scanners. Similar facilities in hospital wards and departments in the USA have shown a number of key benefits. These include significant reductions in time spent on nurse and pharmacy medication-related activities, high user acceptability and significant reduc-tions in medication errors. It is anticipated that these types of systems will become the recommended storage facilities for medicines in UK hospitals in the next few years.


Clearly the opportunity to link electronic prescribing, ward automation and the ‘bar-coded patient’ allows the development of a closed-loop system in which patient safety is supported by the use of bar codes. This approach has the potential to be the future of medicines management at ward level.


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