Automated unit-dose packagers for acute care pharmacy

by
State of Pharmacy Automation. Pharm Purch Prod. 2010; 8

I was doing a little Sunday morning reading and came across an interesting set of slides at the Pharmacy Purchasing & Products (PPP) website  (registration required to access the slides). I haven’t spent much time reading PPP Magazine, but I should because they always seem to have something good about pharmacy automation and technology in just about every issue.

Anyway, I’ve been looking at various automated packaging machines lately and thought the information at the PPP website was rather timely. According to information found at the site “After a slight dip in the number of facilities packaging medications in bar coded unit dose in 2009, this process realized a significant rebound in 2010. Nearly three quarters of all facilities now have such an operation in place. Hospitals taking advantage of the increased data capacity offered by two-dimensional bar codes also bounced back this year. In conjunction with these improving adoption rates, pharmacy directors are also reporting rising satisfaction rates with their operations. Despite a staunch minority that sees no need for a unit dose packaging operation, the vast majority of those without such a system plan to implement one shortly.” The graph in this post is from the PPP slide deck and shows the percentage of facilities using bar-code unit dosed packaging for medications over the past several years. This comes as no surprise when you consider the relative inexpensive nature of this technology when compared to other pharmacy automation, the ease of which it can be implemented and the push for BPOC in healthcare. Call it a perfect storm.

Among the methods for unit dosing medications 36% of respondents in the PPP presentation were using high-volume unit dose packaging machines. A cursory internet search revealed the following key players in the high-volume unit dose packaging race:

PACMED by McKesson

“The PACMEDâ„¢ high-speed packager automates bar-code packaging of oral solid medications, improves packaging accuracy and pharmacy workflow efficiencies, and facilitates the transition to scanning bar-coded medications at the patient’s bedside.
Key Benefits

  • Shrinks cabinet fill time by 70%(1).
  • Reduces oral solids packaging labor by 65%(1).
  • Reduces medication costs through bulk buying.
  • The ROBOT-Readyâ„¢ model:
    • Increases ROBOT-Rx® system packaging productivity by 300%.
    • Optimizes ROBOT-Rx inventory by reducing offline inventory.
    • Facilitates the pharmacist check via the Drug Image Library.

Automated packaging uses significantly less labor, optimizes inventory levels, and enables bulk medication buying. The intelligent PACMED packager works virtually unattended to fulfill orders electronically, replenishing for carts, cabinets, pharmacy stock and multiple sites.

The PACMED packager automatically tracks medications by lot numbers and expiration dates, ensures refilling and perpetual inventory through bar-code verification, and standardizes bar-code formats to facilitate bedside scanning.

It also is highly scalable, accommodating from 100 to 500 line items, flexible with three sizes of storage canisters and two sizes of packages with the ROBOT-Ready model.”


(1) Weizer, Michele (June 2006) The bigger packaging picture.Pharmacy Purchasing & Products, pp. 14, 16.

ATP High-Speed Tablet Packager by Swisslog

“Swisslog’s ATP system(available only in North America) is a versatile packaging solution that provides easy filling and refilling of medications through high-speed dispensing, accurate labeling of medication pouches, flexible printing package sizes and bar-coding. The packager interfaces with pharmacy information systems for automatic replenishment of unit-based cabinets, patient carts or nurse servers.”

Additional information can be found here and here (PDF)

AutoPack by Talyst

“AutoPack Oral Solid Packaging System

AutoPackâ„¢ integrates easily with your pharmacy system to provide a fully automated packaging system for oral solid medications.

  • Automate 100-500 oral solid medications with a single AutoPack
  • Delivers unit-dose or multi-dose packages in a compact footprint
  • Provides 19 lines of user-defined label space
  • Processes up to 60 doses per minute, recognizing priority orders for immediate packaging
  • Supports packaging other oral solid medications not stored on the AutoPack with an easy-to-use Special Tablet System tray
  • Works seamlessly with AutoCarousel to expedite cart fills, order replenishment, and canister refills

Comprehensive

  • When used with AutoLabel, supports barcoding virtually 100% of your medications
  • More affordable than contract or outsourced options
  • Scaled to support any size healthcare organization
  • Barcodes can be defined to assure readability by your bedside scanning system

Easy to Use

  • Pharmacy staff can readily support proven, effective barcoding methods
  • Nurses appreciate labeling that is easy to read and scan
  • Administrators, clinicians and patients are assured that a scan-ready bar code makes it all the way to the bedside

ATP Series Automatic Tablet Packager by TCGRx

“ATP SERIES AUTOMATIC TABLET PACKAGER

The industry’s most advanced pouch packaging solution, incorporating TCG’s exclusive SkipMed functionality. The ATP Series takes control of the automation of your entire stock of oral solids by dispensing current and new batches or fill external tray medications on the same screen simultaneously. The system permits narrow dose packaging to fit into nurse carts and cabinets as well as larger, multi-dose dispensing.”

The ATP scalable series is available in 128, 256, 320 and 384 medication canister models.”

More information is available here (PDF). In addition, the website had the nifty little video below. The ATP system by TCGRx offers some nice features that I haven’t seen before. Take a look for yourself.

ATP Series from TCGRx on Vimeo.

It’s interesting to note that the PACMED system from McKesson and the AutoPack system from Talyst are remarkably similar, while the Swisslog and TCGRx system resemble one another.

I found several other systems for bar-code unit dose packaging, but they were smaller units that wouldn’t fall into the same category as those above. An example of these smaller units would be the ever popular Cadet by Euclid. Every acute care pharmacy I’ve ever worked in has a Cadet. In fact, many facilities have both a high-volume unit-dose packager as well as a smaller unit like the Cadet secondary to need.

Feel free to leave information in the comment section below on any other high-volume automated packaging system you’re aware of. I would be happy to update the post with the information.

Update August 28, 2010
===================================

Based on feedback received over the last week I have additional information to share regarding automated unit-dose packagers.

In the original post above I mentioned that it was interesting that PACMED from McKesson and AutoPack from Talyst were remarkably similar, while the Swisslog and TCGRx systems resembled one another. It turns out that the reason for the similarities is that both Talyst and McKesson distribute the JVM packaging system while Swisslog and TCGRx distribute the Sanyo packaging system. To go one step further it appears that the TCGRx ATP series packagers are distributed through Swisslog, and are in fact the same machine.

Two additional packagers to add to the list thanks to reader comments:

Medication Packager from Omnicell

The Omnicell® Medication Packager is a bar code system for the central pharmacy that enables pharmacists to improve dispensing accuracy, increase their productivity, and lower their overall costs.
Features

  • Automated unit-dose medication packaging.
  • Intelligent Order Routing option establishes picking processes based on user-defined settings.
  • Automatic packaging resume capability allows replenishment of medications or packaging supply without restarting the batch.
  • Supports patient-specific dispensing with labeling and contiguous medication packaging.
  • Adapts to any distribution model.
  • Automated Canister Recognition System (ACRS).
  • Special Tray System (STS) allows preloading of infrequently used medications into a universal tray for in-line packaging with other canister medications—there is no need to stop production.
  • WorkflowRx server available in physical server and virtual server platforms (VMware Ready).

AutoPharm by CrePharm

This can be a little confusing as CrePharm refers to their system as AutoPharm, which is same name used by Talyst for the medication management software used on their carousels here in the US.

The English is a little rough on the CrePharm site as it is a translation from Korean, but you can get the idea by reading through the information for yourself.

A couple of things that caught my eye about this packager was the use of “Free Shape Packaging” (FSP) and CrePharm’s “T slider system”. According to the manufacturer’s website the FSP technology allows automated packaging of “half tablet and all shapes of tablets, and medicines without cassette. When you fill FSP with all sorts of tablets such as half, specific shapes, or low frequency tablets and only put the container on a cup holder at the lower part, AutoPharm automatically completes dispensing and leftover tablets will be automatically collected.” It sounds like a concept similar to the STS system used by AutoPack from Talyst, but appears to use a different methodology. Unfortunately I couldn’t find more specific information at the CrePharm website.

The “T slider system” gives users access to a small number of canisters at one time instead of having to open large shelving units to access a single canister. It’s nothing earth shattering, but it is a neat concept.

52 thoughts on “Automated unit-dose packagers for acute care pharmacy”

  1. Both Talyst and McKesson distribute JVM packaging systems from Korea. Both TCGRx and Swisslog distribute Sanyo packaging systems from Japan.

  3. and you left out the new entry from Omnicell, I thought I’d point it out before someone from Omnicell posts something nasty! :grin: http://www.omnicell.com/Solutions/Central-Pharmacy-Automation/Pharmacy-Workflow/Pages/MedicationPackager.aspx It looks like a Yuyama, also Japanese. Another new entrant to the market is a korean company called Cretem http://www.autopharm.co.kr/product/index.htm which has had some quality problems in initial installs but seems like a lot of people are seeing the same trends you’ve identified.

    Cheers!

  4. Thanks Carla. Appreciate the information. The Cretem system looks intriguing. I like the opaque canisters. I tried running the site through Google Translate to get more detailed information, but no luck. Difficult to get any real information from the Omnicell website, it’s a little vague.

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  13. Crepharm(cretem) From what I know, FSP(free shape packager) works out of vibration.
    it’s very unique because it helps pharmacist from touching the pills. like, other company has to use manually tray to put a pill one by one each column by hands but FSP, frees from all that. Pharmacist just dump the pills in to the bowl and it self calibrates and packages it self. thanks

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  16. As a long time user of Tosho, I am very interested in CRETEM FSP as it may represent a major step forward in throughput. Anyone have practical experience with the system? Thanks.

  18. I think you’ve left out a very large player, possibly the largest: AutoMed (AmerisourceBergen Technology) which sells its own version of the ATP under the name FastPak….AutoMed was the pioneer in packaging wiht the ATC 212 and ATC Profile way back in the late 90’s (technology bought from Baxter).

  20. Hi,
    Thanks for your information. I am not familar with these product and would like to know about this products. By this way, in Japan, which are the companies offer this kind of automated dispensing machine? please share your information…

  21. James, Since you’re a long time user of the Tosho Packager I’d like to communicate with you by e-mail. Thank you.

  23. What about the independent dose packagers like Safecor and Medical Packaging, Inc.? Are their days numbered or is there a role for them to play? I know that MCK uses Safecor as an intermediary packager and Safecor then ships to the hospital.
    Peter

  24. Hi Peter – Actually I think re-packaging houses like Safecor are probably on their way up for the foreseeable future. Using a bulk packager can be a bit of a headache at times, and inconvenient. I’ve talked with many DOP’s that prefer the simplicity of using these re-packaging companies. That’s my opinion anyway. – Jerry

  25. Thanks Jerry. Yes, I would tend to agree with you, at least in the short to intermediate term. Would you be available to chat directly?
    Peter

  27. Hi Peter – I tried emailing you, but was rejected. Feel free to email me directly or call – Jerry (fahrni1 at gmail dot com – 559.838.6014)

  28. Hi,

    I am looking into starting Closed Door Pharmacy and I am interested in Finding out more detail on Pacmed and cost. Please let me know. Thanks
    Harminder

  29. Hi Harminder – Sorry, but I can’t help you out. I have nothing to do with Pacmed. I just blog about cool technology. I would recommend that you do a quick Google search, get the contact information for the company and give them a call. – Jerry

  30. hi,carla, we could supply the printable film used in the packager in bulk quantity from China. Is there any interest? Thanks!

  31. hi,Jerry, your topic about the tablet packager is really great! I do learn something from it. Thanks!

  34. Is there also a list available with companies/institutions which are using the high-volume unit dose packaging machines?

  35. Not that I am aware of, Tony. I put this list of vendors together quite some time ago, as you can see by the date on the post. Pharmacy Purchasing & Products magazine sometimes has articles about facilities using this type of technology – http://www.pppmag.com/ – but that won’t get you what you want.

    Jerry

  36. Keep in mind the expense of the packaging material; runs very high and you have no control of the cost; usually have to purchase from the machine seller; they also nail you good on their REQUIRED maintenance contract (TCG); not worth it for their horrible support; also keep in mind that their ‘references’ are their “happy” customers; you need to speak with their unhappy ones as well to get a fair perspective. We are most unhappy with ours. (TCG)

  37. KP –
    You are correct on all counts. The concept of high-speed packers may have convinced many to purchase these devices, but the reality hasn’t matched the hype. I’d be happy to let you vent on this site as a “guest blogger”. Let me know if you’re interested.
    – Jerry

  38. KP

    You are right. But there is possibility to purchase consumables from other suppliers,not the machine seller. Like us, we are supplying packing paper and ink ribbon for almost all the the machines available in the market, Tosho, JVM,Parata,Cretem, Tylst,Americansource bergan, Robotic and more. You could control the cost in some way.

  39. Thanks a ton for this post, I found it very helpful. Out of curiosity there any automated systems which could be installed in a mobile clinic? I have also had a tough time finding info on how much these systems cost – would you happen to know a price range for smaller capacity systems?

  40. There are several systems out there, Trevor. I can’t think of any specific reason why they couldn’t be installed in a mobile clinic. Logistics might be a problem, but I’m sure the companies in this space would be happy to speak with you about it.

    In regards to pricing, it’s difficult to say. Even the least expensive will run more than $10K up front plus additional fees for support, packaging materials, and so on.

  41. Hi Jerry,

    Do you have any approximated cost for individual packaging (variable cost)? Thanks

  42. Costs are quite variable depending on several factors. However, numbers that I have seen run around 3-5 cents per tablet packaged.

  43. Thanks, that´s very useful.

    Are you referring to Pouch Packaging?

    Did this numbers includes everything (equipment, packaging, labor) or just packaging?

    Thanks!

  46. Hi there

    Thanks for an awesome post! Does anyone know who manufactures the RxSafe machines?

    I’m looking into purchasing one of these for our pharmacy & am trying to figure out which is the best one? Any advice would be much appreciated!

    Thanks so much!

  47. Hi Sally – I don’t know who manufactures RxSafe, but I’m sure you can find out via their website (http://rxsafe.com/). I’ve never seen an RxSafe device in an actual pharmacy, only at trade shows. Best of luck. -Jerry

  49. Unfortunately, I do not. I have heard of pharmacies finding used equipment through services like eBay, but haven’t ever done it myself. Sorry.

  50. Hi Jerry, you seem to have comprehensive market knowledge in the pharmacy automation space. I was wondering if you know what manufacturer makes the machine that care/of is using for their personalized nutraceutical application. This stand-alone pouch is more elegant than the strip-pouches that most of the other machines seem to be using. The image of the pouch can be found on their website here: https://takecareof.com/

    Any guidance you can provide would be most appreciated!

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