Replacing automated medication dispensing machines: how to plan and implement change when equipment reaches end of life  

An overview of the factors to consider when planning and implementing the replacement of ageing pharmacy robots.
Photo of an automated dispensing machine

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In 2001, following the publication of the Audit Commission report, ‘A spoonful of sugar’, automated medication dispensing machines — often referred to as ‘pharmacy robots’ — were recommended for installation into hospital pharmacy dispensaries​[1]​. While both unit dose and original pack robots were available at this time, the latter was considered more appropriate for stocking and picking medicines within the UK healthcare model.

The aims of utilising this technology were to improve the efficiency and accuracy of dispensing, thereby enabling pharmacists and pharmacy technicians to invest more of their time on patient-facing medicine management activities​[2]​. Encouragingly, early adopters of a centralised robot reported a reduction in dispensing error rates from 19 per 100,000 to 7 per 100,000 items and the re-allocation of three pharmacy technicians from supply to clinically focused roles​[3]​.  

Centralised robots are now firmly established as essential to efficient medicine supply and are commonplace in hospitals, with the majority installed 10–15 years ago. Decentralised systems, such as electronic medicine cabinets, are also available, providing secure storage and traceability of medicines for a ward or clinic, with restricted access to approved staff. They have been demonstrated to be particularly effective for controlled drugs reducing the number of missed doses, administration errors and delays in administration of medicines​[4,5]​. Hybrid systems, whereby centralised and decentralised automated dispensing machines are used together to support clinical pharmacy practice, are also in operation. A systematic review, published in 2020, which compared centralised, decentralised and hybrid models, concluded that neither was superior to another in terms of their impact on reducing medication errors but that centralised and hybrid systems were more efficient in terms of staff time​[6]​.   

The importance of using robots to improve efficiency, stock management and reduce waste was highlighted by a review published in 2019 that provided recommendations on preparing the workforce for a digital future​[7]​. Robot technology has developed at pace alongside other digital innovations, such as electronic prescribing systems and electronic patient records. This has facilitated the introduction of high-tech large scale centralised ‘hub and spoke’ type facilities supporting both hospitals and the community​[8,9]​. Guidance for pharmacies providing services at a distance has been published​[10]​.

Automated dispensing, including monitored dosage systems, is increasingly being used in community pharmacies to deliver improved operational performance and to release pharmacists to deliver extended services — such as health checks and vaccination programmes — and to support the management of long-term conditions such as diabetes​[11–13]​.   

The lifespan of a pharmacy robot is typically estimated to be around ten years. Therefore, as robots have become essential to an efficient medicine supply service, many, particularly those installed around 2010, are now reaching end of life. The decision as to when to replace a centralised pharmacy robot and what to replace it with is not straightforward. A new robot requires considerable capital and carries significant associated installation costs. When investing in a robot, consideration should be given to future proofing. This may include deliberation on: whether a centralised, decentralised or hybrid system is optimal; robot capacity and size; stock and waste management capabilities; storage options, including refrigeration, workflows and the number and location of workstations; and compatibility with other technologies or patient interfacing systems. Installing a robot into a new area is a relatively straightforward process compared with its replacement. However, with replacement, a pre-existing workflow needs to be disrupted and agile processes reversed​[14]​.

The following case study and subsequent discussion provides an illustrative example that explores the rationale for robot replacement, how to plan and execute the replacement efficiently and important learning points from the process. 

Case study: Planning and implementing robot replacement at Medway Foundation NHS Trust.

Rationale for robot replacement

The 14-year-old German robot, an ARX VMAX with picking head, had been on the Medway Foundation NHS Trust’s risk register for several years. Breakdowns were becoming more frequent and it was often difficult to obtain replacement parts, leading to sustained unplanned periods of downtime, which negatively impacted on staff wellbeing and the safety and efficiency of medicine supply across the trust.

Various options were considered — continuing with the existing robot, procuring a recommissioned robot or installing a new robot — leading to the investment in a new robot to be approved.

Capital funding was secured from the trust and implementation planned carefully, with every effort made to manage disruption and negative impacts on patients and staff during the switchover period. Interim processes were designed as staff temporarily reverted to manual dispensing as installation and testing works were carried out.

Once testing and training had been completed, the new robot was commissioned and brought online. The overall installation took four months and was delivered on-time and to budget. The benefits are already being realised, including a reduction in downtime owing to the robot’s improved reliability.  

General advice and reflections on best practice for robot replacement 

The experience of replacing the pharmacy robot at Medway Foundation NHS Trust allowed for several factors to be identified that contributed towards the successful installation of the new automated system.


A clear rationale for the change must be articulated to ensure buy-in from all levels of the organisation. Early planning, including detailed appraisal of the various models on the market, can support decisive decision making and implementation to take advantage of available budgets and funding. Procurement options include a managed service scheme, lease or capital schemes. Financial impact and functionality (technical features and capacity) should be considered. When creating the specification for the replacement robot, budget, capacity, infrastructure — such as compatibility with electronic prescribing systems, air conditioning, communication and power networks — need to be considered. Staff training, post-installation technical support and future-proofing also need to be taken into account. Funding to support the project does not need to be secured before these preparatory steps are initiated.  

In the case study example, a new robot was preferred because it offered improved inventory management, reduced medicine waste and increased financial assurance regarding stock management, in addition to staff efficiency savings and significantly decreased risk with regards to medicine errors. All procurement options were considered, but a capital scheme was chosen because the trust could not commit to the revenue funding for the managed service scheme and leasing would have been more costly in the long run.

Having selected a preferred model, the trust initiated discussions with the manufacturer relating to its design and specification. The end result was a bespoke robot, trough, conveyer and lift system, with a pre-built easy load unit, configured to fit the space available and maximise workflows.  

Securing funding

Capital investment is generally set at around 5% of the NHS budget; although in the 2024 spring budget, an additional £3.4bn of long-term capital investment was announced, specifically for upgrading medical equipment and supporting technology and innovation​[15]​.

Budgets can sometimes be opportunically accessed mid-year or at short notice, so it is wise to have a well-developed, fully costed plan to capitalise quickly should a funding opportunity arise. A ballpark figure for the replacement of an automated dispensing system is £1m, which includes the robot itself, associated enabling works and any associated additional staff costs.

In addition to the cost of the robot itself, funding will also need to be secured for completion of the enabling works, which may include the instalment of additional power cables, water and data supplies, as well as the construction of new working areas. Capital estates project teams — including fire specialists and quantity surveyors — scope requirements, develop a specification and lead on the procurement process. Tenders are then reviewed before suitable contractors are appointed.

For this example, capital funding for the robot became available late on in the financial year owing to the cancellation of another project. The replacement was then approved in principle, provided all legal requirements and financial regulations were met.  

Working with stakeholders

The NHS quality improvement guide recommends that stakeholders who are deemed critical for achieving the aims and objectives of a project should be identified and involved in the project planning stage. How they will contribute to, or be affected by, the project should be carefully considered and strategies to mitigate any adverse effects should be developed​[16]​.

During the preparatory stage, it is critical to communicate with all stakeholders involved or potentially affected by the planned works so that they are engaged and informed of the project scale and its timelines. This may include teams both within (such as estates, information technology, the fire officer, security, communications, divisional general manager, clinical areas and pharmacy staff) and outside of the trust (such as the integrated care board, which needed to approve any request to close pharmacy outpatients, and community pharmacies within the area serviced by the hospital, which may be affected by this decision).

It is also essential to inform patients about any disruption to ‘normal service’. In the case study example, the trust’s communications department ran a social media campaign to advise patients of the project and posters were displayed in patient areas.

Communication and teamwork

During installation, efficient and effective communication with all stakeholders will minimise any potential disruption. A project lead with authority to make decisions should also ensure that unforeseen problems can be tackled efficiently with agreed solutions then implemented at pace, minimising risk of delays. Adopting an agile management approach to the project will also increase the team’s capacity to react to unforeseen problems​[14]​.

Optimised skill mix 

Ensuring there is an optimised skill mix across the project team — ideally including experience in procurement, and health and safety — can reduce the risk of delays and increase the capacity to successfully troubleshoot and solve problems as they arise. When engaging in ‘first of its kind’ projects, such as a robot replacement, it is expected that there will be knowledge gaps within the team.

In the case study example, prior to taking on the project manager role, the operations manager had little knowledge and awareness of the legalities regarding procurement or health and safety considerations in relation to construction management. It was a steep learning curve and, in hindsight, it is clear that greater knowledge of these areas would have been valuable at the beginning. A better understanding of procurement processes would have obviated the need for urgent chase sign-off at chief executive level for various large orders; for health and safety reasons only one contractor at any one time can be responsible for the site​[17]​. Therefore, when multiple contractors were working, as in this case, the principal contractor needed to be agreed and communicated. 

Implementation: the benefit of workstreams 

While each robot installation programme will raise different organisational challenges, within this case study it became evident during set-up that establishing three main workstreams to work in parallel with each other would improve efficiency, which are:

  1. Estates were responsible for drawing up plans for the tendering process and appointing third party contractors;
  2. The trust’s IT department ensured that hardware, software and interfaces between the robot’s software and the trust’s internal IT systems were working;
  3. The pharmacy department had to plan their services so that supply of medicines to patients was maintained throughout the closure of the main dispensary.  

The latter included arranging the temporary relocation of the dispensary and fluid store, the transfer of the majority of outpatient prescriptions to community pharmacies, training pharmacy staff to manually dispense medicines during the interim process, and managing and testing the transition back to automation.  

Each workstream met independently and had their own action log and project plan. This ensured that the goals of each group were clear, workstream meetings were focused and participants fully engaged as all discussions were perceived as relevant to them. The pharmacy operations manager — who had designated authority for the project — attended all meetings to ensure that important information was communicated between groups, such as a delay in one workstream that could impact on another. This enabled swift decision making and effective communication. Less frequently, project board meetings were also scheduled, which were chaired by the pharmacy operations manager and attended by all representatives.

The compatibility of the robot’s software with the servers of the host organisation is an important point, which needs to be planned during the preparatory phase of implementation. This point was initially overlooked in the case study example. It was identified that the new robot operated using similar processes to the original version although the robot software was different and therefore that staff training on the software would be required prior to roll out; however, the fact that the robot’s software was incompatible with the servers used at the trust was identified fairly late on. Fortunately, the trust’s IT department were able to work with the company to find a solution and the project timeline was kept on track. This oversight could have been catastrophic and it is strongly recommended that anyone considering robot replacement/installation considers this point earlier in the planning stage.

The logistics of how a service can be maintained during the installation work also needs to be planned in the preparatory phase. It is important to identify where logistical issues may arise so they can be avoided, or if this is not possible minimised.

In the case study example, the outpatient dispensary was closed, and the IV fluid store was moved out of the main building so that a temporary dispensary could be installed, with shelving suitable for medicines obtained on a buy-back basis from an external supplier. The robot was emptied and stock relocated to the temporary dispensary gradual emptying the robot over a one-week period. When planning these moves, greater consideration needs to be applied than what moves to where and when. In this example, risk assessments for the new fluids store had to be written, and moving and handling tools — such as pallet movers — had to be procured and training provided. Stock layout on the temporary shelves should be arranged to avoid selection errors​[18]​.

At one stage, the dispensary terminals and assembly area were in the main dispensary, but all the stock had been moved to the new location, resulting in some frustration and a lot of back and forth for dispensary staff. These challenges were anticipated and temporary staff were employed in the dispensary for the duration of the project, as described earlier, to provide additional manpower to manage and mitigate such circumstances.  

Optimising the timeline

Where possible — and to minimise disruption — technology change should be timetabled to coincide with quieter times of the year. In this project, that was not possible: it began in August and therefore the requirement to get back to a state of ‘business of usual’ was particularly challenging because the planned robot completion date was early December — the trust’s busiest time of year. It was also anticipated that during installation workload pressures would be further amplified by the ongoing junior doctor strikes. To circumvent these challenges, a select team received onsite training on the new robot software then manually added all drugs details. Over one week, 20,000 packs were inputted into the robot, which enabled the dispensary team to start utilising the new robot two weeks before Christmas. The project team still continued to meet regularly to troubleshoot any issues; for example, timing problems were experienced with the conveyer line, but these were resolved quickly. This was crucial in ensuring that the robot met its full functionality within a relatively short timeframe. 


Given that the majority of hospital dispensing robots were installed over a decade ago, many staff have only ever known dispensing with a robot and therefore are not familiar with large amounts of manual picking. The optimal assembly processes to minimise error rates — with one individual being responsible for checking the accuracy of the dispensing label against the prescription and assembling the medicines for one patient at a time — should be adopted​[18]​. In this case study example, training was identified as a major issue and additional staff were recruited on temporary contracts to allow for the additional time required for manual dispensing and for new and permanent staff to be trained. 


Once the installation has been completed and the robot is fully functional, it is important to evaluate the project to share any learning and monitor the quality and efficiency of the new robot on the dispensing service. For the case study example, the benefits are already being realised, including a reduction in downtime owing to the robot’s improved reliability. Stock can also be loaded into the robot more quickly and accurately. Picking ward supplies and medicines for the main dispensary are now separated, owing to the installation of an additional conveyor line, and a pharmacy out-of-hours chute has also been added so that on-call pharmacists can issue stock to a secure out-of-hours room for collection by ward staff without being physically present in the hospital.  

More items can be stored in the robot, owing to better cameras and scanners, and 2D matrix barcode functionality is enabled to facilitate the identification of falsified medicinal products and that medicines are rotated correctly with shorter date medicines used first, reducing waste​[19]​. Additional workstations and chutes have been installed and these build in increased speed and capacity for the future. Looking to the future, the software will allow the expansion of inventory management to all pharmacy stock within central pharmacy, using handheld barcode scanners that give greater oversight of stock management and logistics, enabling reduced stockholding and better stock management.

Useful resources

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    Cairns C. Robots and automation: a UK perspective. Hospital Pharmacy Europe. 2002. (accessed June 2024)
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    Schwarz HO, Brodowy BA. Implementation and evaluation of an automated dispensing system. American Journal of Health-System Pharmacy. 1995;52:823–8.
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    Borel JM, Rascati KL. Effect of an automated, nursing unit-based drug-dispensing device on medication errors. American Journal of Health-System Pharmacy. 1995;52:1875–9.
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    Ahtiainen HK, Kallio MM, Airaksinen M, et al. Safety, time and cost evaluation of automated and semi-automated drug distribution systems in hospitals: a systematic review. Eur J Hosp Pharm. 2019;27:253–62.
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    Topol E. The Topol Review.  Preparing the UK workforce to deliver the digital future. Health Education England. 2019. (accessed June 2024)
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    Robots are a pharmacist’s best friend. NHS Greater Glasgow & Clyde Health. 2017. (accessed June 2024)
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    Goundrey-Smith SJ. Technologies that transform: digital solutions for optimising medicines use in the NHS. BMJ Health Care Inform. 2019;26:e100016.
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    Guidance for registered pharmacies providing pharmacy services at a distance including on the internet. General Pharmaceutical Council. 2022. (accessed June 2024)
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    Baird B, Buckingham H, Charles A, et al. A Vision for Community Pharmacy. Nuffield Trust . 2023. (accessed June 2024)
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    Graham R. Robots benefit patients and staff in hospital and community pharmacies. Pharm J. 2004;273:28.
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    Automated hub-and-spoke dispensing: technology set to transform the business model of community pharmacy. Pharmaceutical Journal. 2016.
  14. 14
    What is agile project management?  . Association of Project Management. (accessed June 2024)
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    Anandaciva S. The spring Budget 2024: what does it mean for health and care services? King’s Fund. 2024. (accessed June 2024)
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    The Handbook of Quality and Service Improvement Tools. NHS Institute for Innovation and Improvement. 2010. (accessed June 2024)
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    Construction – Construction Design and Management Regulations 2015. Health and Safety Executive. 2015. (accessed June 2024)
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    Design for patient safety: A guide to the design of the dispensing environment. NHS National Patient Safety Agency. 2007. (accessed June 2024)
  19. 19
    Application of the Falsified Medicines Directive: Safety Features in Northern Ireland. Medicines and Healthcare products Regulatory Agency. 2018. (accessed June 2024)
Last updated
The Pharmaceutical Journal, PJ, June 2024, Vol 312, No 7986;312(7986)::DOI:10.1211/PJ.2024.1.315603

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