alixaRx on-site Pharmacy ADU System
Prior to the incorporation of AlixaRx, Design Integrity (DI) was retained by Golden Living, one of the largest operators of nursing homes in the US, to perform a design audit on an automatic medication dispensing machine that was being manufactured in Korea. Golden Living was studying the possibility of installing the machines, commonly referred to as automatic dispensing units (ADUs), in each of their nursing home facilities.
In addition, the parent organization of Golden Living was considering the launch of a new national pharmacy. Following the completion of the design audit, our team at DI assisted Golden Living and the new AlixaRx pharmacy with several product design refinements and related initiatives in support of the final development efforts prior to the national market launch.
Phase 1 – Initial Design Assessment
The first phase of the program centered on an initial design assessment of the candidate medication dispensing machine, which was being manufactured and marketed by Cretem in Korea. The goal for the initial study was to invest a modest amount of time and determine the likelihood of the Cretem ADU machine meeting the needs of the intended Golden Living application and installation.
DI tailored a streamlined design assessment process and developed the necessary supporting documentation for the study, including a specification checklist and a questionnaire. One DI mechanical engineer and one electrical engineer visited the Cretem facility in Florida, where a sample Cretem ADU machine was available for inspection. Cretem technical staff members were present to answer questions outlined on the initial questionnaire.
Following the preliminary design assessment, our team concluded that the Cretem ADU machine showed promise and was worth further investigation.
Phase 2 – Design Audit
A deep dive design audit was then conducted. The Cretem ADU machine and each separate subsystem, including the firmware architecture, were studied in great detail. The design history records at Cretem including all available engineering testing documentation were reviewed. A detailed assessment was made as to how well the Cretem machine stacked up against each product requirement.
Key team members visited Cretem headquarters and manufacturing facilities in Korea. Senior engineering, manufacturing, management and quality personnel were interviewed, and a quality management system assessment was conducted.
DI summarized our team’s findings in a formal report, which concluded that the Cretem machine was a viable candidate for implementation by Golden Living, though several design refinements were required.
Design Refinement
DI assisted with the implementation of several design improvements to the Cretem ADU machine on a consulting basis. In parallel with the overall program, the AlixaRx pharmacy company was launched as a separate entity, and a contractual agreement was documented between AlixaRx and Cretem. A majority of the refinement work was conducted by the engineering team at Cretem. Extensive testing was performed in Korea and at Golden Living’s facilities in the USA, including the testing of machine functionality and software/firmware updates.
As part of the design refinement process and at AlixaRx’s request, DI managed an expedited design failure modes and effects analysis (dFMEA) on the machine. As engineering development work and testing was being done on the machine on an ongoing basis, the list of action items and priorities was continually evolving, shrinking and growing. Senior team members from AlixaRx, Cretem, and DI participated in the dFMEA over a two day period, after which AlixaRx and Cretem had a prioritized road map to guide their design development efforts.
Successful Market Launch
The AlixaRx On-Site ADU machine was launched successfully across the marketplace with an initial focus on the chain of Golden Living facilities. The AlixaRx system has since been deployed in skilled nursing, assisted living, and independent living facilities.
AlixaRx is the only national post-acute pharmacy that provides an on-site dispensing system utilizing proprietary hardware and software. The AlixaRx machine can enable immediate access to over 400 medications. AlixaRx is the first post-acute care pharmacy to combine an automated dispensing unit that packages patient-specific oral-solid medications on-demand with an electronic medication cabinet (EMC) that stocks unit-dose medications, such as IV kits and refrigerated items, for first and STAT doses.
AlixaRx System Details
The AlixaRx ADU is a medication packaging system that stores bulk oral solid medications (tablets and capsules) in canisters and packages/labels patient-specific, multi-dose packets. The ADU is used for new, STAT, PRN, Leave-of-Absence (LOA) and ongoing routine orders.
Medication canisters are stored in a locked storage unit that is only accessible to authorized pharmacy personnel. The pharmacy monitors the inventory and utilization and delivers canisters to the facility, where a local AlixaRx pharmacy service technician receives the canisters and restocks the unit.
When a nurse requests a medication from the ADU, the canister releases the medication down through a channel, where it is packaged with other medications for that patient and administration time. The ADU packages and labels the medications in patient-specific, easy-to-open, multi-dose packets that are delivered to the nurse through a slot on the lower left door.
Projected Market Growth
The market for automatic dispensing machines is projected to grow to upwards of $4B by 2030, according to research conducted by Prescient & Strategic Intelligence circa 2021. The largest projected markets by country are the US, Japan, Germany, China and India.
Main players in the market positioned to benefit include AlixaRx, McKesson, Becton Dickinson, Baxter, Pearson Medical, and Swisslog, among others.
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