No hands, no mistakes

Last month the HMYC pharmacy was equipped with a sophisticated, robotic system that dispenses medications to the various departments, while crosschecking the patient’s medical information against the prescription given by the attending physician. Hillel Yaffe Medical Center is proud to be the first, and to date the only, pharmacy in Israel to be equipped with this type of robot. The most decisive advantage is that the system almost entirely eliminates one of the most common problems in the medical field – errors when prescribing and dispensing medications to patients. The system, which was integrated with assistance and coaching from SAREL, positions the hospital and pharmacy at the cutting-edge of technology, among first-rate institutions around the world and enables the nursing staff to use the time saved to provide better care to patients.

Why do we need it and how does it work?
Dr. Eyal Schwartzberg, Director of Pharmacy Services and Laboratories said, “Most hospitals in Israel have been using the same system to dispense medication for years. Each department receives a stock from the pharmacy based on its requests and needs, and then the nursing staff, based on the handwritten or computerized prescriptions written by the physicians in patient charts, gathers the right medications, prepares them and dispenses them to patients. All of this takes up a great deal of the nursing staff’s time and can lead to mistakes in the dispensing of medications at various junctures – misreading the physician’s handwriting, selecting the wrong medication, dispensing the wrong dosage or not noticing contradictory medications. Furthermore, when physicians record the medication there is also room for various problems, most of which relate to selection of a dosage that is not right for the patient and undesired interactions between the selected medications.  

The pharmacist enters the instructions for the robot

Schwartzberg explained, “The tremendous advantage of the robot is that it catches and prevents problems with medications before they occur. Moreover, gathering and dispensing medications becomes the responsibility of the pharmacy, and the robot enables quality control at several points in the process:

1. When receiving the prescription from the departments – After the nursing staff transfers the prescription to the pharmacy, the certified pharmacist enters it into the computer (a clinical prescription control system), checks dosages and other problems with the prescription and medication (if any). The software crosschecks drug information against the data on hospitalization of the patient to ensure that the best possible drug has been prescribed, without redundancies, contraindications or sensitivities between the medications the patient receives.
2. Medications gathered without human involvement – After the prescription is entered, the robot receives an instruction and gathers the medications with the exact dosage, while checking the expiration dates and ensuring that packaging is intact. It then prints the instructions for the patient, including the date and time the medications are to be taken, and puts this into a sealed bag marked with the patient’s details and identifying barcode.
3. Checking the bags and transferring them to the department – The personal bags are transferred to the department and dispensed by the nursing staff in special carts with the patient’s name. If a patient has left, the bag is returned intact to the pharmacy, returned to the robot which checks that it is intact and verifies the expiration date. It is then returned to the inventory for reuse.

This creates a situation in which there are several important controls en route – in terms of the prescription, expiration date, dosage, type of medication, and ensuring that no unused medications are disposed of or lost. 

Furthermore, the nursing staff gains time (hundreds of hours each month) that was previously invested in preparing and gathering the medications so they can be dispensed to the patient. This time can now be spent providing more care for patients. 

Left: array of medications in the cabinet, as arranged by the robot
Right: the end of the process – the personal bag with the medications
each patient receives

First when it comes to quality too
The robotic system, which as previously stated is the first of its kind in Israel , now serves all of the internal medicine departments and, in the near future, will also serve the orthopedic, surgery and neurology departments as well. The integration and operation of the system is currently running smoothly and efficiently thanks to the cooperation of the departments and the excellent interface with the hospital’s existing information and computer systems, allowing the information to maximized and efficiently used. 

The integration of the robot is part of the hospital administration’s strategy to promote patient safety by improving the quality of medicinal care. It is the direct continuation of the unit dose method of dispensing that has been used quite successfully for several years now in the internal medicine departments and prevents errors and problems in medicinal care. When this method is adopted, the medications are dispensed by the pharmacists in the pharmacy into the drawers of a dedicated dispensing cart, according to the dosage determined by the physicians and checked by the pharmacy staff, and are transferred directly to the department at set times. This method earned the pharmacy the Quality and Excellence Prize from the Civil Service Commission in 2009.   

An item that aired on the Channel 2 news: “The robot that knows how to dispense medication,” April 9, 2012      

 Item broadcast on Hot 3 news in central Israel : “Robot at Hillel Yaffe Medical Center ,” April 12, 2012