Jerry Fahrni

Pharmacy technology – Automated dispensing

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Jerry Fahrni

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PROmanager-Rx is an automated system from McKesson designed for dispensing unit-dosed oral solids. PROmanager-Rx has a 12,000-dose capacity and uses a conveyor system and bar-code scanner to fill orders generated through the pharmacy information system.

The system automates storage, dispensing, restocking, and various inventory management functions via the McKesson Connect-Rx software platform. And of course the system interfaces with McKesson’s pharmaceutical distribution system.

According to the McKesson product brochure:

The PROmanager-Rxâ„¢ system helps hospital pharmacies get the most out of manufacturer packaged oral solid medications. And relieves the burden of medication packaging.

It’s the only fully automated system that directly stores and dispenses pre-packaged oral solids. PROmanager-Rx is ideal for patient-centric filling. Bar-code-driven robotics scan every dose for the greatest possible safety and accuracy.

Pharmacists are freed from packaging and dispensing activities so they can play more integral roles on the clinical care team. Bar-code scanning also simplifies tasks such as managing returns, expired meds, and overall inventory.


There are some things I don’t necessarily like about this system, but the design and the technology could offer some tremendous benefits to facilities like ours. If the system could be used to fill and dispense more than just oral solids and be modified to pull items for an automated dispensing cabinet (ADC) replenishment, then I think we’re on to something.

The PROmanager-Rx has a footprint of 15 ft. x 8 ft. with an 8 ft. height clearance and weighs in at about 4,300 lbs. That’s a lot of machine to dedicate to oral solids. Modifying the machine to manage topicals, injectable vials, ophthalmic and otic preparations, etc. would go a long way to increasing the potential for this device. Addition of a refrigerated compartment would simply be icing on the cake.

Our facility doesn’t use a cart fill model. Instead we dispense greater than 95% of our medications through ADC units, i.e. Pyxis, on the floor. Not only do we dedicate a large amount of technician time to pulling the Pyxis fill, we also devote a fair amount of time to pharmacists to check it. There are pros and cons to this model, but ultimately it works well for us.

The value of a system like PROmanager-Rx is diminished in a model such as ours. However, if this technology could be used to perform the Pyxis replenishment functions currently done by our technicians then we could potentially alter our workflow and free up pharmacist and technician time. In other words, let the technology free up people to perform other non-automated tasks. The addition of tech-check-tech to this model could potentially generated even more pharmacist time.

I’ve been around carousel and robot technology for a couple of years now and have seen great advances in terms of technology designed to store, retrieve, and dispense medications more efficiently. While I’m optimistic that we’re headed in the right direction, I think we still have a ways to go.

Comments

4 responses to “Pharmacy technology – Automated dispensing”

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  2. Anandhi Sarangan

    Thanks for your interesting commentary on PROmanager-Rx. It would be nice to know more about how you handle unit dose medications in your pharmacy and how many manual picks do you have in a day. If you are interested in a discussion then you can email me in the above address.

    Thanks,
    Anandhi

  3. Jim Longo

    Jerry – I have been reading your blogs for a while, and I wanted to clarify a few items on PROmanager-Rx. The system is 9-1/2 feet wide and 3 feet deep. The conveyor system at the back of the unit adds another 1.67 feet to the depth. A 15′ x 8′ area provides ample space for pharmacy techs to work with PROmanager-Rx and provide access for any needed maintenance activities. PROmanager-Rx operates on a single 120 volt circuit and does not require external compressed air, and all components will go through a standard 3′ door, so PROmanager-Rx is very practical for hospital pharmacies with limited space or limited resources for facility renovations.

    The idea behind PROmanager-Rx is to use manufacturer packaging, so that pharmacists don’t have to verify medications packaged in-house, and to fully automate dispensing and restocking to eliminate the human potential for error.

    PROmanager-Rx is designed to directly dispense manufacturer unit-dose bar-coded oral solid medications, which typically comprise 60% to 70% of the patient-specific dispensing volume in acute care hospitals, so the system fully automates the majority of the dispensing requirements. McKesson offers a number of other barcode-based systems for central pharmacy that can be used in conjunction with PROmanager-Rx to increase the safety and accuracy of all dispensing activity, either for a patient-centric (cart fill)or cabinet-centric (ADC) model such as yours.

    PROmanager-Rx and all McKesson central pharmacy solutions CAN process cabinet replenishment AND patient specific orders, but all automation has a “sweet spot” that makes it most suitable for a particular application. PROmanager-Rx can dispense 700 oral solid doses per hour in a fully automated fashion, taking advantage of the accuracy and integrity of manufacturer packaging, while scanning EVERY dose. Those doses would be delivered to cabinets already separated, not left in the perforated cards for nurses to separate by hand. Nurses could dispense separated doses faster, and more of them will fit in an ADC pocket. However, if the hospital requires nurses to count medications remaining in the cabinet after dispensing, nurses may prefer to count cards rather than individual doses. High speed packagers and carousels may dispense at a faster rate, but they are not fully automated nor error-proof, essentially they are not “robotic”, so their output should be checked by a pharmacist, as you noted.

    Hopefully the above provides some additional understanding of PROmanager-Rx. If you have any thoughts on the above, please feel free to contact me directly if you’d like.

  4. Jerry Fahrni

    Wow Jim, thanks for the education. You certainly clarified some of the things that were not obvious from the McKesson website or the video. I apologize if the physical dimensions in my post were inaccurate, but I took them straight from the PDF datasheet on the McKesson website. I suppose to get a real feel for it I would have to stand next to it in person. I took a quick jaunt to the McKesson display at Midyear, but there were simply too many people crowded around the devices for me to get any hands on time.

    The idea that PROmanager-Rx can be used for ADC replenishment certainly adds value to the product, but the need to separate each dose just seems clumsy and time consuming to me. Like many hospitals across the country we dispense tens of thousands of unit-dosed oral solid medications monthly, which would take a significant amount of time to pull apart and separate prior to loading in the machine. I would be interested in seeing data on that. Maybe I’m just not seeing the big picture with hardware like PROmanager-Rx. I suppose you have to decide where the time is best spent. We use a carousel and automated packager setup, and like all “automation” it certainly has both pros and cons.

    Some things I do like about the PROmanager-Rx is the idea of a fully automated mode and the ability to scan every dose. Both are important to efficiency and safety. I’ll how the California State Board of Pharmacy sees it. They aren’t always the most progressive group when it comes to using technology in place of human eyes even though it is clearly more accurate and less biased.

    Maybe I’ll get the chance to see the PROmanager-Rx in action sometime. Thanks for stopping by and leaving a comment. I appreciate you taking the time to add to the information about PROmanager-Rx.

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