Overview
Introduction: Community pharmacists are healthcare professionals located in the heart of communities and integrated with daily life. Slaintecare, plans to further utilise the expertise and skills of the community pharmacist but the community pharmacy workforce is stretched beyond capacity.
A pharmacy based Workforce Intelligence Report 2023[2] identified process innovations and digital solutions as necessary for the future sustainability of the pharmacy workforce. In pharmacy, a core task is medication dispensing, which is time consuming and, as with any manual process, is open to human error. A digital solution to reduce the manual input in the dispensing process and designed to enhance capacity was implemented via the introduction of a dispensing robot.
Objectives: To determine the impact of the robot on workforce capacity and operational efficiency via monitoring of pharmacy throughput and patient satisfaction within the pharmacy post implementation
Method: A dispensing robot was installed in a large dispensing volume pharmacy in Dublin. In conjunction with the physical and technical installation process, a clear communication plan was implemented to support with optimisation and management of the change. This included a feedback mechanism to support, troubleshoot and address any concerns or queries, which centered on the pharmacy team.
A full dispensary refurbishment was undertaken to create the infrastructure to host the robot. Training and upskilling involved the creation of guidance documents and providing of face-to-face information sessions. Metrics were identified to monitor the capacity centered deliverables of the project, which were based on volumes of both patient facing and non-patient facing activities and patient satisfaction. These were tracked over a period of two years.
Results: In the two years post robot installation, the volume of both medication dispensing and pharmacist led patient consultations increased. Despite this, staffing levels remained constant, and patient satisfaction with the pharmacy increased by 9%. The dispensing robot automated repetitive tasks within the dispensing process with efficiency and accuracy.
This was evident in the improvement in operational metrics. Conclusion: Installation of a dispensing robot in a community pharmacy can improve operational efficiency of the medication dispensing process and enhance accuracy. Increased patient volumes in conjunction with a rise in patient satisfaction has demonstrated its value in creating capacity within the pharmacy team and could be considered a sustainable workforce solution. Maher-Loughnan: Use of dispensing robot to enhance capacity for community pharmacy workforce Community pharmacists have a wealth of skills and expertise. With government health strategies worldwide now recognising the role of the pharmacist in an integrated care model, action must be taken to create capacity to step into this evolving role.
Next steps: Community pharmacy to continue to digitally innovate to further enhance the capacity of the pharmacy team, allowing for more patient facing activities that optimise the provision of integrated patient centered care. The IPU Pharmacy Practice Working Group (PPWG) is a group of community pharmacists, pharmacy technicians and IPU staff with an interest in improving pharmacy.
In this article, Áine Maher-Loughnan, Boots Ireland’s Future Pharmacy Operations Manager, pharmacist and member of the PPWG, discusses use of a dispensing robot to enhance capacity in the community pharmacy setting. In pharmacy, one of our core tasks is medication dispensing, getting the right medication to the right patient, with the right advice at the right time. There are many challenges with this task, the mechanics involved are time consuming, which can in turn be tedious, repetitive, and as with any manual process, open to human error.
At a time of increased administration, medication shortages, resourcing challenges and a growing demand for pharmacy clinical services; pharmacy teams are working harder than ever to ensure they continue to operate safe, efficient and profitable pharmacies. To overcome these challenges, we raised a question and explored a solution; how do we manage the existing workload for our pharmacies and pharmacists so they can continue to evolve as healthcare professionals and enhance the patient offering in our pharmacies?
How do we minimise the tedious and repetitive tasks to create space for more rewarding, fulfilling and enjoyable activities for our colleagues. Enter automation via dispensing robot.
Choosing a dispensing robot, where to start?
At Boots, as in any pharmacy, in addition to the dispensing process there are many other daily dispensing associated activities that need to be completed each and every day, fundamental to the smooth running of the pharmacy business. Failure to complete these tasks can have significant consequences on patient safety, pharmacy revenue and legislative compliance. It is through this lens that dispensing robots were researched. Selection of a dispensing robot should not just focus on a desire to dispense more efficiently, factors such as its impact and integration with other core daily activities are important considerations. Another question in any decision for investment in this technology is how does automation through use of a dispensing robot add value to your business and when and how will the business see a return on this investment.
Key measures when selecting a dispensing robot As an output from process mapping operational activity in the dispensary, the following four measures key to the selection of a robot were defined:
1. Pharmacy dispensing system software integration: Ease of integration with the dispensing system software provider was a fundamental requirement when choosing a dispensing robot. Pharmacy is already overburdened with non-integrated systems. A non-integrated robot was not an option;
2. Stock management functionality: Effective dispensary medication stock manage ment is the backbone of a well-run dispensary but relies on time-consuming use of resource. Use of live-stock, whilst a game changer in optimum stock management, requires a manual process of stock counting, date checking and managing high cost, unused and slow moving stock. A poorly managed stock-file results in a mismatch of stock to patient need. Identifying and optimising how many of these medicine stock management tasks would be automated by the robot and putting a monetary value to the consistent completion of these tasks was undertaken;
3. Time savings: Dispensing robot marketing materials often boast enticing statistics of packs dispensed per second — speeding dispensing up and reducing waiting times thereby resulting in an incremental return in prescription items and pharmacy services. Quantifying in real world terms, in a specific pharmacy, how many tasks and how much time back would be generated by the robot was completed; and
4. Retention of staff and resilience to unpredicted resourcing changes, for example, unplanned absence: Retention and attraction of both pharmacist and pharmacy support roles within community pharmacy is an ongoing
Obtaining real world insights
Having identified a robot that satisfied the above criteria, a site visit was made to a pharmacy that had installed a similar robot. This was of huge benefit, providing an opportunity to ask questions based on practice and understand first-hand what the day-to-day experience was like. The site visit was invaluable, providing insight on the implications on workstations, workflow and what layout changes would be required to optimise the use of the robot and necessary dispensary refurbishment to be undertaken to create the infrastructure to host the robot.
Change management project
Successful change management projects require clear communication, strong leadership support, employee involvement and a phased approach to implementation. The pharmacy team who would be working with the robot were central to the communications plan. This included assessing staff readiness, provision of a comprehensive training plan, creating opportunities to address their fears and concerns and communicating the benefits of the technology. The team were understandably cautious. In a busy pharmacy, room for malfunction, delay or unnecessary complexity. A clear timeline with each required activity mapped against the week was hugely beneficial to coordinate the project. This included preparation activity, creation of temporary infrastructure to support continued operations of the pharmacy and patient engagement activities to reassure patients throughout the process.
Metrics of success
Following installation and initial testing once the project went ‘live’, metrics were identified to monitor the success of the project. These metrics centred on volumes of both patient facing and non patient facing activities as well as patient satisfaction. This was then traced over a period of two years to measure the true impact of the dispensing robot. A less quantifiable but equally important measure for us is the sentiment of our dispensary team post-installation. While change and new technology can be there is no daunting and automation evokes fear, the experience has been positive.
Team members now say they couldn’t imagine life in the dispensary without the robot and they enjoy greater time to support and care for patients. A review based on this has demonstrated that the installation of a dispensing robot has delivered a faster dispensing process, automated stock management and a reduced error rate.
The time saved resulted in improved patient experience for prescription customers, a reduced more tightly controlled stock-file and more time for pharmacy colleagues to focus on patient facing activities to support growth of their pharmacy business and improve pharmacist and support staff job satisfaction.
This dispensing automation project has delivered successfully in line with the Boots Ireland ambition to streamline pharmacy operations, deliver clear efficiencies and simplify processes for our pharmacy teams.
Written by: Áine Maher-Loughnan, Pharmacy Future Operations Manager, Boots Ireland
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