Recent growths in the number of home patients have increased the amount of single-dose dispensing. However, pharmacies are struggling to keep up with manual dispensing, because the number of cassettes in conventional dispensing machines cannot cover the wide variety of medications. In this interview, we spoke with Ms. Murata of Sugi Pharmacy Tokorozawa Koku Koen Store, who introduced Yuyama’s UC to improve the efficiency of dispensing operations.

The Tokorozawa Koku Koen Store is along a tree-lined avenue, a short walk from Koku Koen Station (Seibu Shinjuku Line, Tokyo) in a neighborhood lined with schools and government offices. I arrived at the store just as it opened, and it was already full of customers (patients).

“We are a general dispensing pharmacy and have patients from both the local community and various clinics or hospitals who come in to fill their prescriptions. We do not cater to any one specific hospital or clinic. Our pharmacy provides home care for terminal cancer patients and handles medical narcotics or intravenous infusions that are mixed in a sterile dispensing room. We handle more fluid replacements than most pharmacies and have a wide variety of medications.”

One of the most unique features of the Tokorozawa Koku Koen Store is the large number of home patients.

“There are several Sugi Pharmacy stores in Tokorozawa City, but we have far more medical-at-home patients than any other store in the company. Our pharmacists deliver medicines to patients’ homes every day.”

On the other hand, the large numbers of home care patients have also given rise to issues.

“Most of our dispensing is single-dose due to the number of home patients. The two nursing facilities and other home facilities we dispense for also require single-dose packaging and, on a busy day, we would typically manually dispense single-dose packages for 30 patients in facilities, 20 for patients at home, and 5 to 6 for outpatients. This was exceptionally time-consuming and draining.”

The decision to introduce the Yuyama’s UC was prompted by the desire to improve efficiency and reduce the workload of manual single-dose packet dispensing.

“We introduced it because we thought that automated packaging would be more far efficient with less errors than manual dose dispensing. Now, with the UC, we no longer have to dispense everything by hand. We still have a dispensing machine for manual dose dispensing but we don’t use it anymore because the UC is far more efficient.

Single-dose medications accounts for half of the average 60-70 prescriptions received per day, and they are now using UC for about 30 of these, which is most of them.”

“We handle a wide variety or medications which means that, with only a fixed-cassette machine, we still need to manually dispense medications that don’t come in cassettes. Yuyama’s dispensing machine has five universal cassettes that, when used together with the fixed cassettes, allow us to dispense all types of tablets. Half tablets still need to be dispensed manually, but it handles most medications and is easy to use.”

UC automatically determines the size of the drug and changes the shape of the dispensing slots to match that of medication being dispensed. A single cassette can handle a variety of drugs, reducing the need for manual dispensing.

“In addition, the display on the front of the cassette that shows the name of the medication, the number of tablets, and the patient’s name as per the prescription, is easy to read and helps to prevent errors. It also shows how many tablets are missing when there is a shortage of the medication, which is makes it easy to use.”

Ms. Murata describes how introducing the UC has improved efficiency as well as safety.

“Before the UCs, we prepared everything by hand, and sometimes the substances (powder) would fly into the next cell, and we would have to dispense it again. The UC eliminates these dispensing mistakes.”

Mr. Murata’s words, “Automating manual dose preparation reduces inspections times, which is a relief,” illustrates how the UC is solving the challenge of having so many home care patients.

“We have five to six pharmacists working each day. Half of them cover home care and the other half take care of outpatient services. Compared to other Sugi Pharmacies, I think we have a relatively large team for the number of prescriptions we handle. However, there are times when a pharmacist is alone for the period between when our part-time staff leaves and when the pharmacists in charge of home care return. It’s difficult and nerve-wracking to manually dispense and inspect single-dose prescriptions, if someone comes in at that time. Now that dispensing is automated, I only need to do the inspections, which is a relief.”

The UC has become an indispensable asset due to the wide variety of home patients, sometimes a 30-40 minutes drive each way, and limited staff onsite.

“We are getting more requests for home visit, so if we are going to operate with the same number of pharmacists, we need to streamline operations. We’re investing more time and effort into working with doctors and nurses and providing direct care to our patients, so I’m glad that we have the UC to make dispensing more efficient.”

The Tokorozawa Koku Koen Store has strong ties with local prescribing physicians and medical personnel. Last month there were 34 new medical-at-home patients, and these numbers are expected to increase as the store continues to take root in the area.

“I used to feel frustrated when patients asked me questions that I was unable to give a proper answer to. Now, I am studying for certification in palliative care pharmacotherapy, and I can have discussions with doctors with my own opinion of what I think should be done.
Many of the other pharmacists are studying to become certified in dementia care or to enhance their skills in other specialty areas. We have gained the trust of the doctors and nurses, because most of our staff can talk to them on their level.

The UC implementation has helped Sugi Pharmacy to earn the trust of medical professionals and the community. Ms. Murata’s story illustrates how taking the pressure, time, and anxiety out of dispensing can free up time to interact with patients and their prescribing physicians, leading to an overall improvement in business performance.

Information as of July 2020