The Introduction of Robotics to an Outpatient Dispensing and Medication Management Process in Saudi Arabia: A Pharmacy-led Multidisciplinary Six Sigma Performance Improvement Project (Preprint)

Abstract

Outpatient pharmacy management aims for improved patient safety, improved quality of service and cost reduction. The Six-Sigma method improves quality by eliminating variability, with the goal of a nearly error-free process. Automation of pharmacy tasks potentially offers greater efficiency and safety. We describe the process of introducing automation to a large outpatient pharmacy department in a university hospital. The Six Sigma approach was used as it is focused on continuous improvement, and also produces a road map that integrates tracking and monitoring into its process.

The goal was to measure the impact that integration of automation made to service, safety and efficiency, staff reallocation and reorientation, and workflow in the outpatient pharmacy department. The Six Sigma problem definition to be resolved was that: The current system of outpatient dispensing denies quality to patients in terms of waiting time and contact time with pharmacy professionals, incorporates risks to the patient in terms of mislabelling of medications and the incomplete dispensing of prescriptions, and is potentially wasteful in terms of time and resources.

A review of activity in the outpatient department focused on non-value-added pharmacist tasks, improving the patient experience, and improving patient safety. Metrics to measure the impact of change were established, and a Process Map Analysis with Turnaround Times for each stage of service was created. Discrete events were selected for correction, improvement, or mitigation. From the review the team selected key outcome metrics including storage, picking and delivery dispensing rates, patient and prescription load per day, average packs and lines per prescription, and lines held. Our goal was total automation of stock management. Two robotic dispensing units were deployed to feed nine dispensing desks. The automated units were integrated with Hospital Information Technology that supports appointments, medication records, and prescriptions.

Post automation, total patient time in the department, including time interacting with pharmacist for medication education and counselling dropped from 17.093 to 11.812 digital minutes with an appreciable increase in patient-pharmacist time. The percentage of incomplete prescriptions dispensed versus orders decreased from 3.0% to 1.83%. The dispensing error rate dropped from 1.00% to 0.24%. Assessed via a ‘basket’ of medications wastage cost was reduced by 83.93%. During implementation it was found that non-value-added tasks that were replaced by automated processes were responsible for extensive loss of pharmacist time. The productivity ratio post-automation was 1.26.

The six-sigma methodology allowed for rapid transformation of the medication management process. The Risk Priority Numbers for ‘Wrong Patient-Wrong Medication Error’ was reduced by a ratio of 5.25:1 and to 2.5:1 for ‘Patient leaves unit with inadequate counselling’ post-automation. Automation has allowed for ringfencing of patient-pharmacist time. This time needs to be structured for optimal effectiveness.