Recently, our pharmacy revisited our strip packaging robotics: our current packager was getting long on the tooth, and we were interested in either upgrading or investigating other options. Ultimately, we added a new product to our arsenal.
Target Market
There are a few different strip packaging options available in the market today, and while they all create a similar end-product, their design and operation might influence the type of practice they best compliment. For simplicity, I divide the market into two groups — Long Term Care (LTC) focused pharmacies, and Community / Retail focused practices. The difference between these two groups, for my purposes, are primarily centered on the duration of packaging provided. A LTC pharmacy supplying medications for facilities will provide strip packaging frequently: the day supply provided to facilities generally ranges from 1 to 14 days at time. In contrast, community pharmacies doing compliance packaging would package no more frequently than every 14 days with most patients receiving 28 to 30 days’ worth of medication at a time.
The packaging machines that are required to support these two examples are designed very differently. Machines designed for the LTC style of practice ideally can house hundreds of medications at time. An example is the Parata Pass family of devices. The RxSafe RapidPakRx was designed with community pharmacy compliance packaging in mind. Both machines could technically be used in either environment, but their operation outside their focus space would less than optimal.
Canisters
The volume driven Parata machines house a large number of small containers (208 to 576 drugs) that contain a carousel optimized for a specific size and shape of medication. There are thousands of possible cassette wheels available. For a given canister, even small changes in tablet or capsule size mean that the canister will either work poorly or not at all. Without a canister, the efficiency of the packaging operation drops precipitously.
The RxSafe RapidPakRx, on the other hand, takes a very different approach. Instead of hundreds of canisters, the RxSafe product has only 20, 30 or 40 canisters. The mechanism in the canister is also much more elegant–it is capable of dispensing a wider range of different sizes and shapes, including half-tablets. The dispensing wheel used in the RxSafe product comes in just 5 variants that optimize efficiency for very small to very large dosage forms.
The RapidPak canisters are large, accommodating larger quantities of medications needed the longer day supply used in the community setting. They are also easier to clean, which is important, as the canister is not typically dedicated to one medication. While you can assign a few canisters in the RapidPak to be fixed — staying on the machine between batches like a Parata canister, most of your stock remains in the manufacturer’s stock bottle, optimizing product shelf life and limiting overall inventory. Infrequently used Parata canisters can go weeks to months between refills, meaning the drugs spend extended times outside of the sealed, desiccated bottle. Inventory management is more difficult when product stays in the machine.
Smarter
The difference in canister design also ties in another important feature. A machine like the Parata uses an optical sensor to register the drop of the medication. If the cassette was loaded incorrectly but the dosage form fits the canister, it will drop the wrong medication into the pouch. I have had this happen more than a few times, and it is as scary as it sounds. The RapidPakRx uses a very different, and much smarter and safer mechanism.
The RapidPakRx canister wheel picks up the tablet or capsule and it rides up the wheel until it is deposited onto a platform. Here, a camera inspects what was presented by the canister. It first checks that only one item was dropped, emptying the platform, and trying again if it did not receive a single unit. With one unit present, it inspects the size, shape, color, and markings to ensure that the correct medication is on the platform. If it doesn’t match with a very high level of certainty, it rejects the unit and tries again. If it fails multiple times in a row, it will alert the operator so the drug can be corrected, or the canister size changed (wrong canister size results in poor drug capture — too many or two few reach the platform). Once the product is correctly identified, it is then dropped into the awaiting package pouch.
In practice, this mechanism is nothing short of amazing. If one accidentally put the wrong medication in a canister, or even a different generic manufacturer version of the right medication, it will almost always know (and flag an error). If one or two tablets of a different medication are introduced into the canister accidentally, it will reject them. Only in a case where the medications that are virtually identical to each other might the machine logic fail to notice the change. Using this mechanism, you have a very high degree of certainty that the right medications made it into the medication packs, despite any introduced human error.
Workflow and Speed
The RapidPakRx was designed with a retail / community pharmacy workflow in mind. With only 20 to 40 canisters, you load each canister every time you package. At first glance, this might appear to be a large inefficiency compared to a Parata style machine with hundreds of medications loaded, but the difference is not as significant as you might think. Working with the Parata, you typically replenish multiple cassettes before a given run, and if the inventory number is off, you may end up having to replenish them during the run as well. For volume runs (large numbers of patients for short time frames), the Parata still has an edge, but the RapidPakRx is respectably efficient if the drug storage shelves are located close to the robot.
The RapidPakRx also comes with an optical tablet counter: we opted for the GSE EyeCon device (spoiler alert, the parent company of the EyeCon also purchased RxSafe). In a community / retail setting, the pharmacy management system integrates tightly with the EyeCon, documenting the initial product verification. The EycCon saves the images of the count (including NDC and a check on the size and shape of the product) back to your pharmacy system: there is a robust electronic paper-trail. After the initial verification, the RxSafe software collects additional information on the product (like Beyond Use Date), the product is dropped directly into the cassette and placed on the robot. The workflow on a Parata is similar but counting is done by weight (less accurate) and the audit trail is not quite as robust.
Packaging Materials and Cost
On the subjective side, my patients are almost completely in agreement: they prefer the RapidPak pouches. This is due to their stiffer paper backing and the exceptional quality of the printing. The Parata strip packs are all cellophane. Parata offers a white / clear cellophane that offers similar readability, but it in my judgment, it is less legible than that RxSafe. The Parata cellophane is also more prone to wrinkling, making them harder to read after they have been rolled up and boxed. Here the edge goes to the RxSafe product.
Cost of materials for the RxSafe is also better. When we did a cost analysis of the packaging materials used versus standard prescription vials, the Parata packaging was roughly the same. The RxSafe packaging supplies are less expensive, creating a net savings versus rx bottles with time.
Integrated Checking
When we first started with our Parata packager, we did all checking by hand. This was a tedious process and was prone to fatigue. Eventually we purchased a Parata Perl imaging workstation. This allowed us to image each envelope and use the images to do the final verification more quickly. This was a significant added cost as the device is not included with the robotic packager.
The accuracy of the Perl’s integrated verification (where it flags things it doesn’t recognize as correct) drops significantly as the number of doses in each pouch goes up. We found that if we had more than 4 or 5 tablets in a pouch, the accuracy dropped quickly. While the pharmacist had to look at every pouch, the pre-check (when it worked) would dramatically decrease the time required to check the product.
The RxSafe has integrated product imaging and verification included in the cost of the robot. As mentioned earlier, the verification taking place when the product is dropped dramatically decreases the chance that a wrong product is dropped. It also decreases the chance of extra doses falling, something that was common with the Parata device. After the pouches are sealed, a photo is created of the commingled product. Like the Parata Perl, the RxSafe verifies what is in the pouch and flags issues.
Both units have decent software interfaces for checking. The Perl relies on many camera tweaks and once set properly it does a decent job. The RxSafe’s software is newer, and suffers a few minor annoyances, mostly because I have seen both and like some things and miss others. The checking experience on the RxSafe is marginally better than the Perl, but the Perl’s software is probably a little more refined.
If your pharmacy is doing packaging and looking for a strip packaging solution, both devices deserve your consideration. Depending on your workflow and your market niche, one product may serve you better than the other. For community pharmacies doing compliance packaging, the RxSafe product is probably the winner. If you are servicing many different facilities with frequent med exchanges, the Parata would win hands-down. When you are considering purchasing a robot that costs as much or more than a nice house, it is important to understand the niches the machine services best.