Errors in the administration of medications to residents of long-term care facilities (LTCFs) threaten resident safety and add significant unnecessary costs to the healthcare system. Use of unit dose medications that require LTCF staff to manually sort and assemble specific patient medications ~4 times per day can result in error rates as high as 42%, with 7% of total errors having significant potential for harm. Just preparing medications for administration consumes an estimated 6-8 person hours/day in a typical 100 resident LTCF, or an estimated 16,000 full time equivalents in all US LTCFs, reducing staff time available for other functions. Another unnecessary cost, estimated at $5 billion in US nursing homes alone, arises from medications that are wasted due to prescription changes and patient turnover. New regulations from the Centers for Medicare and Medicaid Services, effective 1 January 2013, target reduced medication waste by requiring "short cycle" fills (d14 days) instead of the traditional 30 day "bingo cards". However, even if this has the desired result of reducing prescription drug waste, industry sources predict that use of shorter cycle bingo cards may increase LTCF staff time and possibly errors associated with manual sorting of unit dose packaging. Proposed Solution: Short-cycle custom medication packaging (CMP), containing all the "right medications needed for the right patient at the right time", has the potential to reduce risk of medication errors and LTCF staff time required for medication assembly as well as prescription drug waste. Altaic's goal is to create the Pill Stream, a novel robot for high accuracy, high throughput production of CMPs in a variety of facility-specified formats, enabling more Central-Fill (C-F) pharmacies to provide their LTCF customers with shorter turnaround times at reduced cost. Specific Aims: In this 6-month Phase I SBIR we propose to 1) to build a small scale prototype of the PillStream, and 2) evaluate its performance with respect to CMP filling accuracy, rate of production, and costs. The PillStream will incorporate proven advanced agile manufacturing technology, utilized in Artaic's successful TileJet robot developed for high speed low-cost mosaic manufacturing. Feasibility of PillStream approach will be demonstrated if the prototype can produce CMP blisters containing different mixtures of pills at a rate of at least 100 CMP blisters/min with an accuracy of at least 99.9%. Assuming Phase I success, in Phase II we will develop a commercial scale PillStream capable of handling 50% of the workload of a typical C-F pharmacy, and pilot it in two C-F pharmacies serving a total of 10,000 beds.
Public Health Relevance: Current packaging of prescription medications provided to long-term care facilities (LTCFs) by central fill pharmacies generally utilizes unit dose packaging. This requires LTCF staff to manually assemble the medications to be taken by a given resident at each administration time (typically 7-12 medications and 4 times per day), a task that: 1) is associated with high error rates, some harmful to the recipient; 2) significantly decreases time available for other nursing functions; and 3) increases costs. The proposed PillStream robot is expected to allow central fill pharmacies to create custom multi-medication packaging (single blisters containing all medications required by a single resident at a single time during his/her day), thereby removing the error-prone manual assembly tasks from the LTCF staff, freeing time and reducing waste.
Public Health Relevance Statement: Current packaging of prescription medications provided to long-term care facilities (LTCFs) by central fill pharmacies generally utilizes unit dose packaging. This requires LTCF staff to manually assemble the medications to be taken by a given resident at each administration time (typically 7-12 medications and 4 times per day), a task that: 1) is associated with high error rates, some harmful to the recipient; 2) significantly decreases time available for other nursing functions; and 3) increases costs. The proposed PillStream robot is expected to allow central fill pharmacies to create custom multi-medication packaging (single blisters containing all medications required by a single resident at a single time during his/her day), thereby removing the error-prone manual assembly tasks from the LTCF staff, freeing time and reducing waste.
NIH Spending Category: Bioengineering; Clinical Research; Health Services
Project Terms: Age; base; Beds; Bulla; Capital; capsule (pharmacologic); Cells; Cessation of life; Color; Computer software; cost; Custom; design; Discipline of Nursing; dosage; Dose; Drug Packaging; Drug Prescriptions; Eating; flexibility; Generations; Goals; Healthcare Systems; Hour; Individual; Industry; Label; Letters; Long-Term Care; Manuals; Marketing; Measurable; Medication Errors; Methods; novel; Nursing Homes; Nursing Staff; Oral; Patient Rights; Patients; Performance; Persons; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacy facility; Phase; pill (pharmacologic); Production; prototype; Regulation; Research; Risk; Rivers; Robot; Robotics; Safety; Services; Site; Skilled Nursing Facilities; Small Business Innovation Research Grant; Solid; Solutions; Sorting - Cell Movement; Source; Specific qualifier value; Speed (motion); Stream; success; System; Technology; Time; Travel; United States Centers for Medicare and Medicaid Services; wasting; Workload
