Centering in on Medical Errors
The number of prescriptions issued each year is rising, yet the number of pharmacists to fill them is not. Or it is so reported. With even more work, these already taxed pharmacists and their assistants are at greater risk of making dispensing errors.
Central-fill and mail-order pharmacies using the latest in automation sound like a potential solution. But human-caused errors could occur there, too, say some experts.
Bruce Johnson’s answer is to add even more automation. Twenty-two years ago as an engineer for Post Cereals, Johnson watched line operators use rakes to comb through toasted cereal for burnt pieces. Owing to normal physical and mental fatigue, the operators routinely missed over-toasted cereal. “I have heard that the average attention span for a person is 11 minutes,” says Johnson. “The best we found was 20 minutes.” He believed automation could help. “The solution was to add four-color in-line cameras. Automation is simply more accurate than human beings. We’ve proven it to be true many times over,” he recounts.
When Johnson joined Maverick Enterprises (Longmont, CO) three years ago to help the company market its automated packaging fulfillment solutions to central-fill and mail-order pharmacies, he says he was amazed that pharmacists were being asked to perform a task not too different from combing through cereal. “They are charged with visually reading every fill to verify them against a written prescription. The biggest challenge for central-fill and mail-order pharmacies today is finding qualified pharmacists for verification. And then we expect them to manually verify hundreds of fills every day in a production-line environment,” he observes.
Drawing from his success with cereal-sorting cameras, Johnson is eager to employ automation and inspection—albeit more sophisticated than cameras and software were 22 years ago—and definitely validatable. “If the automation is good, you can rely on it,” he says.
His ideal solution is for automated systems to scan the bar codes of unit-of-use packages direct from a dispense magazine, match the bar coded National Drug Codes (NDCs) to those prescribed on patient orders, generate and apply master labels on demand, verify the match automatically, take digital images of the order for automated and/or remote pharmacist verification, and proceed directly into packaging. “No hands ever touch the product,” he says. Pharmacists could then be on alert for any system alarms and to conduct statistical sampling.
Johnson says that if he could get individual state pharmacy laws to reflect the automation improvements, he feels he could make a difference. Efficiencies could increase significantly, while errors decrease, he says.
But pharmacy laws aren’t Johnson’s only obstacles. “Only about 15–20% of the packages we see are prepackaged unit-of-use products with bar coded NDCs,” he says. The rest—a whopping 80–85%—are bottles and vials filled from other bar coded containers, he says.
To increase safety and efficiency while reducing the current pharmacy real estate, digital imaging, in-line verification, and hands-off automated packaging supporting the central-fill and mail-order pharmacies will need to be made fail-safe. System validation will be key, but so will be the ability to remove any unnecessary handling of product—including repackaging.