Drug-dispensing ‘robot’ dishes out the doses

St. Francis Hospital and Medical Center, like many American hospitals these days, tries to emphasize the human touch -- except in the pharmacy. That’s where the human touch, with the potential for human error, can do more harm than good.

On a recent morning, pharmacist Michael Culligan, the intravenous team leader at the Hartford, Conn., hospital, motioned to a glass-walled machine about the size of a bus shelter in the hospital’s bright, bustling basement pharmacy. “It takes out the human element,” he said.

The device is the IntelliFill i.v., a $650,000 Rube Goldberg-like device that can turn out up to 60 drug-filled, patient-specific syringes an hour in a process designed to ensure that the right medicine in the right dose gets to the right patient every time. St. Francis put the IntelliFill in service earlier this month and is one of only seven U.S. hospitals with such a device.

The syringes are used to pump drugs into intravenous lines that have been inserted into patients. The hospital goes through millions each year.

The machine, manufactured by ForHealth Technologies Inc. of Daytona Beach, Fla., represents a larger movement to computerize the ordering, filling and delivery of medicines in hospitals and pharmacies. In 1999, the Institute of Medicine estimated that as many as 98,000 Americans die each year because of medical errors, with about 7,000 resulting from medication errors. Since then, hospitals have moved to computerized systems that eliminate handwriting errors in prescription orders. Hospitals and community pharmacies alike also are increasingly using devices that automate the prescription-filling process.

“It’s growing almost daily,” said Robert McCarthy, dean of the University of Connecticut School of Pharmacy.

In the IntelliFill i.v. machine, each vial of medicine moves along a kind of production line until the machine spits out the finished syringe. Load the device with vials of the most prescribed medicines, and it begins filling a prescription by grabbing the appropriate drug vial and reading the bar code. The machine then shoots four digital photographs of the vial label, removes the cap and swabs the vial with alcohol. If the drug is a powder or concentrated liquid, the machine will mix in the correct amount of liquid. Then the device inserts a needle into the vial, extracts the needed amount of medicine and fills an intravenous syringe.

That syringe -- spinning on a carousel -- gets labeled with the name of the medication and its appropriate bar code, the dose amount and other information, which can include the expiration date, the patient’s name, room number and the time when the medication needs to be given. Each syringe is verified by weight. Vials and syringes that fail any such test are rejected. Pharmacists can scan a finished syringe label and get a digital photograph of the vial used to make up the syringe.

The machine also alerts pharmacists -- by means of a ceiling-mounted light panel in the main work area that glows blue -- when a first-time prescription has been filled. These are typically drugs that are needed quickly, and pharmacists can grab the syringe and get it into the hospital’s pneumatic-tube delivery system right away.

“The main advantage is the patient-safety aspect of the machine,” said Culligan. Also, the machine can use large-quantity drug vials, which means that the hospital can save money by buying drugs in bulk.

The robotic pharmacist also can fill syringes from large bags of fluid. In this mode, it can turn out up to 300 an hour. Through the end of this month, the new machine is on a kind of shakedown cruise, used only to make generic saline and heparin “flushes,” which are used to clean out intravenous lines between different drugs. Gary Neilan, medication safety pharmacist at St. Francis, said the hospital goes through about 750,000 a year.

In the new year, the machine will be linked to a new-generation computerized prescription system at St. Francis that will allow nurses to double-check prescriptions on the patient floors using bedside bar code scanners.

Waldron Palmer, vice president for marketing and business development at ForHealth Technologies, said the hospital industry is much more attuned to the need to reduce medication errors, but it is also struggling with shortages of nurses and pharmacists.

“You’ve got people who are doing more with less, so they are under more strain,” he said. “This is a robotic, automated process that always comes to work, isn’t under stress and will produce an accurately filled syringe and [perform] seven different safety inspections throughout the process.”