Improving hospitals with cobots

Automation has helped improve industrial production and the work of operators, so why not bring this know-how to hospitals and pharmacies? This is what Sinteco, a company specialising in automatic machines and robotic lines for the assembly and testing of any industrial application, has decided to do, bringing its knowledge to a very different world, that of hospitals. To do this, it asked its partner Sinta for help. Sinta supplied a TM collaborative robot, ideal for the application which was created: a unit dose management system.

In keeping with the best traditions, Sinteco was founded in 1984 in a garage in the village of Longarone, near Belluno. Over the years, it continued to grow, with a turning point in 2003, when Sinteco became part of the Bucci Group. “The Bucci Group,” Stefano Giacomelli, Sinteco’s General Manager, explained, “has not only helped us in economic terms, but also in terms of mentality, transforming us into an international company; in fact, 60% of our business is abroad”. Sinteco now employs 200 people in four production units. The sectors in which it is now concentrating are medical, hospital, cosmetics, pharmaceutical, automotive, electrical engineering and general mechanics. “About ten years ago,” Giacomelli said, “we entered the medical device sector very strongly; albeit very complex, it is giving us great satisfaction”.
For robotics, Sinteco has for many years turned to Sinta, distributor on the Italian market of several brands in the world of industrial handling: EPSON for SCARA and anthropomorphic robots, and TM for collaborative robots, as well as IAI for solutions with electric axes and Cartesian robots. The partnership between the two companies is very strong, and made up above all of human relations. “We are aware,” Andrea Casari, General Manager of Sinta, said, “that machines must be taken care of. There is a very loyal relationship between us: we know that with Sinteco this bond is always maintained with fairness in behaviour, product quality and with a certain flexibility, which is sometimes necessary because there are situations requiring program changes. This is a trend which has been consolidated over time: when Sinteco calls we must be able to respond practically immediately. We do not want to lose sight of the machines, especially now that many complex systems are being created, so our presence is necessary”.
The two partners have worked in synergy to create a solution dedicated to pharmacies and hospitals for the management of the unit dose to the patient: “A single medication,” Giacomelli explained, “linked to a single patient with a unique code, so that the entire history can be traced and no dispensing errors can be made”. The system is modular and flexible, and allows the distribution of drugs in a personalised formula, that is, it allows the prescribed drugs to be grouped together and identified with the patient’s name. It is not a simple serial system (packaging-storage-delivery), but a network of automation where each component is connected to all the others. For this system, Sinta supplied Techman cobots, ideal machines for delicate operations and in contexts where the constant presence of an expert programmer is not possible.
The hospital and pharmaceutical sector is certainly very different from the classic industrial sector to which Sinteco was accustomed, especially in terms of its approach to the market and to the customers: the latter do not have the same technical knowledge as in the industrial sector, so very often they do not even know what they want. “We have to be able to do things”, Diego Allera, Hospital Automation Sales Manager at Bucci, explained, “to guide the customer step by step, becoming real consultants and entering heavily into workflows”.
The demand for unit dose plants was not born with the pandemic; rather, Sinteco has been receiving requests in this area for a number of years, especially from abroad. Today, Sinteco supplies this type of plant to Europe, the Middle East and Latin America. A very important factor which has contributed to the explosion of the market is the emergence of logistic centres: “Until a few years ago,” Allera explained, “a single hospital would contact us to ask for a plant to prepare the unit dose, and Sinteco would propose its own solution located in the hospital; in recent years, however, especially in France, we have seen a relocation of production, that is, sites have been set up to produce the unit dose which is then distributed to several hospitals”.
Sinteco offers two types of machines for the system: one for unit dose packaging, and another for personalising therapies. The first is a computerised and automated system for cutting and packaging drugs in unit doses, which makes it possible to produce finished single-dose packs ready for storage; the drugs are identified by means of a QR code to ensure total traceability, making drug administration safe and fast, and reducing waiting times to zero. The second, on the other hand, was created to optimise the storage and distribution system for personalised therapies: the unit dose is stored and managed by the computerised cabinet, which is able to personalise and distribute the drugs in the form of therapies; this system allows hospitals to provide the right drug, in the right dose, to the right patient, all in real time.
Until a few years ago, the packaging machine and the therapy machine were both inside the hospital pharmacy; today, however, the packaging equipment is often located in the logistics centre, while the therapy production machine is still inside the hospital. The greater space allowed by a logistics centre has given a considerable boost to the automation of packaging and volumes: we are talking about numbers as high as 30 million drugs produced in a year, so about 20 hospitals are involved. “These are figures,” Allera stated, “which also lead to a very different plant concept. For this new generation of logistics centres, in addition to EPSON SCARAs and linear handling systems, we have implemented TM cobots, which have an integrated vision system on board allowing individual barcode reading”.

The added value of the collaborative robot

The solution patented by Sinteco, which includes the TM5-700 cobot supplied by Sinta, was developed to meet the needs of the logistics centre. It is a six-axis collaborative robot, therefore anthropomorphic, with a payload of 6 kg, an outreach of 700 mm and an integrated proprietary vision system. “If a hospital logistics centre,” Allera explained, “wants to prepare millions of doses of different types of drugs, which are shipped inside a package with the data matrix of each individual dose, it is important to have an almost perfect traceability system: thanks to the integrated camera, the cobot reads the data matrices, eliminating human error. The system is extremely complex, because there are normally several packaging machines, so the cobot, by reading the codes, is able to communicate on which storage machine a drug should go. Total traceability, starting from the package in the logistics centre and ending at the patient’s bedside”. Not only that, but the integrated vision allows a reduction in commissioning times, because there is no need for the many checks required for two different machines. “This vision – Gabriele Cepile, Product Manager Robotics of Sinta, underlined – allows a simplification in terms of components and an improvement in terms of aesthetics, something that should not be underestimated because the hospital must be a welcoming environment with a positive visual impact”.
Integrated vision is not the only reason why it was decided to include a TM cobot in this solution: ease of use and, above all, compactness also play a role. “Collaborative machines – Casari explained – are developed with a programming mode designed for end users who are not familiar with the world of robotics, such as pharmacists and doctors. Sinteco, through its programmers, develops and makes the programs executable as if they were simple phone apps, with very intuitive functional blocks”. In Sinteco’s system, the user interface encompasses all its functionalities, and has obviously been created for users who are not accustomed to technology or work in an industrial environment.
As mentioned, compactness was the main reason why Sinteco chose the TM cobot proposed by Sinta. “Cobots are light and compact machines,” Gabriele Cepile explained, “and they have a whole series of integrated safety functions which make it possible to save space, creating a totally safe and collaborative cell in non-industrial contexts where space is valuable. The first element to exploit is the robot’s collaborative nature with the healthcare workers, who do not feel the need for a very fast cycle time: their priorities are different”. Often these machines are installed in hospital pharmacies, which were built at a time when it was not thought that part of the space should be reserved for robotic cells: the more space is taken up by robots, the less space is available for healthcare equipment, and this is not good from the hospital or pharmacy standpoint. Specifically, the cobot was chosen for its compactness with regard to the security infrastructure: if it had been necessary to install protection, such as cages or fences, it would not have been possible to install three lines side by side, whereas with cobots this is possible. By placing up to three lines side by side, the ‘slowness’ of the collaborative robot is counterbalanced, making it possible to achieve a significant single-dose production, which is particularly important for logistics centres.

More automation means more time dedicated to the patient

The unit dose was created with clear objectives in mind. The first is the reduction of errors through the traceability of the drug, the second is represented by the economic advantages: thanks to a precise management, which takes into account the numbers and expiry dates, there is a significant reduction of expired, stolen, forgotten drugs, together with a reduction of stocks; in this way the hospital can have a significant economic saving. “However,” Allera continued, “managing the unit dose means a different logistical and personnel flow from what hospitals have been accustomed to: to date, the pharmacy of a hospital, especially an Italian one, is simply a warehouse, there is no important interaction from the clinical standpoint, something which, on the contrary, is very highly considered in other countries, where the pharmacist is a professional who intervenes during the therapy phase by checking that the drugs do not conflict with each other or provides an equivalent in case of absence of the drug”. Unfortunately, Italy is still a little behind, due to a cultural issue: there is often a fear that automation might steal jobs. “I would like to emphasise,” Allera continued, “that the machine does not take away jobs; on the contrary, it increases the useful time of healthcare staff: they no longer need to check how many and which medicines they have to dispense, the doses are prepared by the machines; they can devote the time they have saved entirely to patients, listening to them and treating them in the true sense of the word”.

Besides, the increased time for patients and the automation of drug management is synonymous with safety. “Sinteco,” Giacomelli explained, “takes part of the responsibility for the dispensing of the drug, because these machines are loaded with software and management controls of our own creation, which dialogue with the hospital. We are the first to have to ensure that the dose and the composition are correct, so we also have a legal responsibility”. This translates into a drastic decrease in deaths due to human error, and in costs for the hospital in terms of insurance and legal fees. “Scientific reserch carried out in the hospital field some years ago,” Allera explained, “it was estimated that 7% of deaths in hospital are due to human error. With the machines, we aim to get close to 0%, which is basically the goal of automation in general, not just hospital automation”.

It is interesting to note,” concludes Casari, “that Sinteco is very open-minded: they were able to make this machine for hospitals and pharmacies thanks to all the experience in mechanics and industrial robotics they have behind them. And in my opinion this is no accident: there are not many similar stories, these are not things that can be left to improvisation. Sinteco’s skill is that they have managed to tailor and adapt the automation process to a sector that is totally new to them”.