Saturday, May 14, 2011

Effortlessly error free?

Aah, technology... able to automate manual tasks/drudgery, and also eliminate errors! Something that should be, and is being, applied to healthcare processes to save lives... For an example, see 'Robots Take Over Hospital Pharmacy as Human Pill-Counting Talents Go To Waste' UCSF has automated its inpatient drug dispensing process and "... to date, they have prepared and processed more than 350,000 dosages without error..."

Another example, 'Improves patient safety and process efficiency with robotic medication dispensing' highlights McKesson's ROBOT-Rx... "... More than one third of medium and large U.S. hospital pharmacies use the ROBOT-Rx system to collectively dispense more than a half billion medications error free every year..." Wow, no errors at all, ever!

So, what exactly are they measuring to determine these sterling error rates? Well, generally when the order is received the robotic arm picks the appropriate item and dispenses it... using the item bar code to confirm it has the appropriate item. When the picking arm scans and reads an item bar code either it has the correct item, whereupon it picks and dispenses it, or, if it finds a bar code that it can not read, it pulls the item and discards it (e.g. via a 'problem' chute).

Pretty simple - robot, scanner, barcodes... no room for error... Well not quite! While some medications do come from the manufacturer "robot ready" i.e. each single dose (tablet, capsule, vial, etc.) packaged individually, e.g. see below, many/most do not, and these have to be "over-packaged" before being added to the automated systems for storage and dispensing.

This can be done by a third party, or by the pharmacy department's own staff. Bulk bottles (in the case of tablets and capsules), vials, etc. have to be 'over-packaged' into the individual bar coded plastic baggies. This is a significantly more human/manual process, and while it can be made rigorous e.g. by checking the bulk bottle's bar code, having a Pharmacist check step, etc., it is a potential source for errors.

So, in reality the actual zero error rates cited for the stupendously large numbers of doses dispensed (e.g. "half a billion" a year) really just mean that the picking arm has never made a bar code 'read and match' error and not that no wrong medication has ever been dispensed! After all, if a packaging error occurred in which drug X was put in a baggie bar coded as drug Y, the automated picking system would have no way of knowing... it would pick/dispense the item and chalk it up as an error-free dispense...

Granted, the error rate will be much, much lower than a manual picking system, but just because the process has been automated via a multi-million dollar whiz bang system it does not guarantee an error-free process. Claims that no dispensing errors have been made by these systems while dispensing millions of doses over a period of years need to be placed in context!

Note: yes, automation is a good thing, it just shouldn't be regarded as a "silver bullet" that will 'automagically' solve the problem of dispensing errors....

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