Background The introduction of robotic dispensing systems in outpatient pharmacies (OP) has increased in recent years. However, there are no data available on its impact on patient safety using a prospective risk analysis.
Purpose To evaluate safety after implementation of a robotic dispensing system in an OP, and stratification of residual risks to drive future developments.
Material and methods Setting: OP of a 1300 bed tertiary teaching hospital provided with a computerised prescription order entry program and online pharmacy validation. Before the implementation of the robot, dispensing was performed entirely manually by nursing assistants using barcode technology.
Design: Comparative risk analysis of the drug dispensing process before and after implementation of the robotic dispensing system (Rowa Vmax), according to the failure modes, effects and criticality analysis method.
Measurements: The failure modes were defined and their critically index (CI) calculated on the basis of the likelihood of occurrence, potential severity for patients and detection probability. CI of manual and robotic dispensing were compared, and new measures were proposed.
Results In the pre-implementation phase, the sum of CI of 17 identified failure modes was 1141. After implementation of the robot, 23 failure modes were identified and the CI was reduced to 780 (31.64% reduction). The major safety improvements were observed for the following errors during the dispensing process: incorrect drug because of barcode control omission (-100), omission of dispensing due to lack of stock (-90), insufficient quantity (-81) and expired drug (-52). Of the 6 failure modes exclusively detected after implementation of the robot, only failure to deliver the drug to the correct dispensing point achieved a significant risk (CI=48).
Improvement actions identified included: (1) monitoring during robotic dispensing on a monthly basis (drug delivered to the wrong point, interruptions of robotic dispensing and stock-outs), (2) establishing periodic maintenance checks and (3) establishing a double-checking system for manual dispensing of drugs that cannot be managed by the robot.
Conclusion A robotic dispensing system has increased the safety of the process. FMECA is a useful method for evaluating the impact of robotic implementation, and identifying further improvement strategies.
References and/or Acknowledgements
Complying with the FMEA requirements of the new patient safety standards. http://www.jointcommission.org/
References and/or AcknowledgementsNo conflict of interest.
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