Mercy Medical Center, a 476-bed health care facility in Canton, Ohio, is part of the Sisters of Charity Health System. We use a hybrid medication distribution model, with a 24-hour cart fill from the central pharmacy and 39 automated dispensing cabinets deployed on the nursing units for first doses and PRN medications. In 2008, we installed McKesson’s 

ROBOT-Rx as part of a facility-wide automation project to implement bar code scanning from the point of medication receipt through administration.

Prior to 2008, Mercy used a manual filling process for all medications and performed a cart fill three times a week. This practice was labor-intensive, inefficient, and resulted in missed doses, as well as higher inventory costs and an increased risk of medication errors. Thus, a multidisciplinary team was assembled to investigate options for improving medication dispensing and delivery. We determined that automation was required for our distribution model to maximize patient safety and permit the redeployment of resources into roles that directly enhance patient care. 

In presenting our case for purchasing the robot to the capital budget committee, our justification centered on three major points: improved patient safety, increased operational efficiency, and expansion of clinical pharmacy programs. After evaluating several vendors and dispensing models that responded to our invitation to participate in an on-site vendor fair, pharmacy chose the ROBOT-Rx as it would easily integrate with our existing repackaging equipment and automated dispensing cabinets (ADCs). Additionally, once the robot was certified at our facility, the Ohio State Board of Pharmacy would grant a waiver requiring our pharmacists to check only 10% of dispensed doses, significantly improving workflow. 

Installation and Use
The implementation required some renovation to the pharmacy department, including the installation of a 220-volt power supply on the emergency power circuit, pneumatic air lines to supply air pressure to the robot, and an industrial air compressor in close proximity to the pharmacy. 

Once the robot was successfully installed, McKesson provided one week of on-site training to ensure proper usage. The entire staff was trained during that week, and we have new staff members trained as part of their orientation process. Our workflow was adjusted such that now, pharmacy staff enter medications into the pharmacy information system, and then the robot scans the bar code and uses pneumatic and electrical power to pick each medication dose. This process is supported by the Connect-Rx software, which provides the interface between the PIS and the robot. Our pharmacy technicians are responsible for loading the restock rack into the robot, as well as keeping the labels and envelopes for packaging stocked. Beyond these steps, little human interaction is required, as restocking, return processing, expiration date checking, and dispensing are all automated via the software. 

The robot houses multiple dosage forms, including oral solids, unit dose liquids, vials, and syringes. The robot contains 600 rods that store these medications prior to picking. Large, bulky items—such as IV solutions, inhalers, creams, and ointments—are dispensed manually or placed in ADCs. Controlled substances are not stored in the robot, as they require additional security measures. 

Benefits of Robot Implementation
By leveraging bar code verification we have significantly reduced the risk of human error. Moreover, bar codes now drive the procurement, dispensing, administration, and crediting processes for each medication in our facility. We also moved to 24-hour cart fill without the need to add additional resources to pharmacy staff; in essence, we doubled the cart fill frequency with a cost avoidance of 2.5 FTEs. Furthermore, by streamlining the dispensing and crediting processes, we have reduced our inventory costs. As a result of this implementation, we were able to expand our anticoagulation clinic from 24 hours per week to 40 hours through the redeployment of one pharmacist FTE.

Mercy has experienced few problems and a high return on investment since implementation. We have seen an annual reduction in inventory of roughly $60,000, and the expansion of our anticoagulation services has increased revenues by roughly $150,000 each year. First dose turnaround time has improved by 43%, which has increased both nursing and patient satisfaction. Moreover, each year since the installation of the robot, the number of pharmacy doses dispensed has increased; in 2011, the pharmacy department dispensed 2.9 million doses, with 1.8 million of those picked by ROBOT-Rx. This equates to roughly 2,900 doses dispensed by the robot daily, with 99.9% accuracy. 

To build on the positive results realized through the use of robot driven, bar code distribution, Mercy is looking into expanding the scope of the robot to include ADC replenishment. We see any reduction in human interaction with drug distribution activities as a positive step toward eliminating medication errors in our facility.

John L. Feucht II, MBA, RPh, is the director of pharmacy services at Mercy Medical Center in Canton, Ohio. He received his BS in pharmacy from Butler University and his MBA from Walsh University. John also is a clinical assistant professor of pharmacy practice at the Northeastern Ohio Medical University.