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Effect of an automated dispensing cabinet system on drug distribution effectiveness in a surgical unit.

ABSTRACT: The use of the automated dispensing cabinet (ADC) for drug distribution in hospitals has become increasingly common and has numerous benefits. This retrospective study assessed the effectiveness of an ADC that uses integrated information technology in the drug distribution process in a surgical unit as part of a smart medical process improvement project at Taichung Veterans General Hospital in 2019. The outcomes include medicine delivery time, working time of healthcare professionals, transportation manpower, dispensing errors, and satisfaction of nursing staff with the medication distribution process. After ADC implementation, the average waiting time of standing orders decreased significantly for both on and off duty periods (40.0 ± 27.6 to 3.0 ± 3.9 min, P < 0.001; 45.2 ± 25.8 to 2.9 ± 2.9 min, P < 0.001; respectively). Similar results were observed with immediate or temporary medication orders (54.4 ± 31.5 to 2.0 ± 3.0 min, P < 0.001; 64.0 ± 47.5 to 1.5 ± 1.8 min, P < 0.001; respectively). The average time spent by operation room and post-operation room (OR/POR) nurses on communicating with ward nurses for medication delivery to OR/POR was shortened by 46.9 ± 4.4 h per month, and the average time pharmacists spent on dispensing immediate or temporary medication orders was shortened by 5.6 ± 0.2 h per month. The satisfaction of nursing staff with the OR/POR drug delivery process was significantly improved after ADC implementation (3.2 ± 0.8 vs 4.2 ± 0.7, P < 0.001). Our results showed that ADC implementation in surgical units simplified drug delivery processes, shortened drug delivery time, improved drug delivery timeliness for surgical patients, decreased dispensing errors, and increased nursing staff satisfaction. In conclusion, the implementation of ADC was beneficial for surgical units. To the best of our knowledge, there have been no studies on a similar ADC system.

SUBMITTER: Liou JH

PROVIDER: S-EPMC10660017 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

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Effect of an automated dispensing cabinet system on drug distribution effectiveness in a surgical unit.

Liou Jaw-Horng JH Wang Shuw-Chuan SC Hou Yu-Chi YC Yen Chih-Ho CH Chen Hsiu-Mei HM Liou Wen-Shyong WS Wu Ming-Fen MF

Heliyon 20231028 11

The use of the automated dispensing cabinet (ADC) for drug distribution in hospitals has become increasingly common and has numerous benefits. This retrospective study assessed the effectiveness of an ADC that uses integrated information technology in the drug distribution process in a surgical unit as part of a smart medical process improvement project at Taichung Veterans General Hospital in 2019. The outcomes include medicine delivery time, working time of healthcare professionals, transporta ...[more]

PMID: 38027635

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Project description:Medication administration errors (MAEs) occur frequently in hospitals and may compromise patient safety. Preventive strategies are needed to reduce the risk of MAEs. The primary aim of this study was to assess the effect of central automated unit dose dispensing with barcode-assisted medication administration on the prevalence of MAEs. Secondary aims were to assess the effect on the type and potential severity of MAEs. Furthermore, compliance with procedures regarding scanning of patient and medication barcodes and nursing staff satisfaction with the medication administration system were assessed. We performed a prospective uncontrolled before-and-after study in six clinical wards in a Dutch university hospital from 2018 to 2020. MAE data were collected by observation. The primary outcome was the proportion of medication administrations with one or more MAEs. Secondary outcomes were the type and potential severity of MAEs, rates of compliance with patient identification and signing of administered medication by scanning and nursing staff satisfaction with the medication administration system. Multivariable mixed-effects logistic regression analyses were used for the primary outcome to adjust for confounding and for clustering on nurse and patient level. One or more MAEs occurred in 291 of 1490 administrations (19.5%) pre-intervention and in 258 of 1630 administrations (15.8%) post-intervention (adjusted odds ratio 0.70, 95% confidence interval 0.51-0.96). The rate of omission fell from 4.6% to 2.0% and of wrong dose from 3.8% to 2.1%, whereas rates of other MAE types were similar. The rate of potentially harmful MAEs fell from 3.0% (n = 44) to 0.3% (n = 5). The rates of compliance with scanning of patient and medication barcode post-intervention were 13.6% and 55.9%, respectively.The median overall satisfaction score of the nurses with the medication administration system on a 100-point scale was 70 (interquartile range 63-75, n = 193) pre-intervention and 70 (interquartile range 60-78, n = 145) post-intervention (P = 0.626, Mann-Whitney U test). The implementation of central automated unit dose dispensing with barcode-assisted medication administration was associated with a lower probability of MAEs, including potentially harmful errors, but more compliance with scanning procedures is needed. Nurses were moderately satisfied with the medication administration system, both before and after implementation. In conclusion, despite low compliance with scanning procedures, this study shows that this intervention contributes to the improvement of medication safety in hospitals.

Project description:IntroductionPeople in many low-income countries access medicines from retail drug shops. In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system.MethodsUsing mixed methods, we collected data in four regions. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child's respiratory symptoms.Results and discussionOf 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. Although health facilities and ADDOs had similar availability of antimicrobials, ADDOs had more pediatric formulations available (p<0.001). The common perception was that drugs from ADDOs are more expensive, but the difference in the median cost to treat pneumonia was relatively minimal (US$0.26 in a public facility and US$0.30 in an ADDO). Over 20% of households said they had someone with a chronic condition, with 93% taking medication, but ADDOs are allowed to sell very few chronic care-related medicines. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a referral (90%), or both (45%), which are recommended practices for managing pediatric pneumonia. However, one-third of the dispensers needlessly sold antibiotics for cold symptoms, and 85% sold an antibiotic on request. In addition, the pneumonia scenario elicited more advice on handling the illness than the cold symptoms scenario (61% vs. 15%; p<0.0001), but overall, only 44% of the dispensers asked any of the shoppers about danger signs potentially associated with pneumonia in a child.ConclusionADDOs are the principal source of medicines in Tanzania and an important part of a multi-faceted health care system. Poor prescribing in health facilities, poor dispensing at ADDOs, and inappropriate patient demand continue to contribute to inappropriate medicines use. Therefore, while accreditation has attempted to address the quality of pharmaceutical services in private sector drug outlets, efforts to improve access to and use of medicines in Tanzania need to target ADDOs, public/nongovernmental health facilities, and the public to be effective.

Project description:IntroductionAutomated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals.MethodsThe medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers.Main outcome measuresPerson discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident.ResultsFrom January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag.ConclusionA proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident.

Project description:BackgroundOverdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates.MethodsAll patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis.Results106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment.ConclusionsMobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit's buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments.

Project description:BackgroundAn automated dose dispensing (ADD) service has been implemented in primary healthcare in some European countries. In this service, regularly used medicines are machine-packed into unit-dose bags for each time of administration. The aim of this study is to review the evidence for ADD's influence on the appropriateness of medication use, medication safety, and costs in primary healthcare.MethodsA literature search was performed in April 2012 in the most relevant databases (n = 10), including the Medline, Embase, and Cochrane Library. The reference lists of the studies selected were manually searched. A study was included in the review if the study was conducted in primary healthcare or nursing home settings and medicines were dispensed in unit-dose bags.ResultsOut of 328 abstracts, seven studies met the inclusion and reporting quality criteria, but none applied a randomized controlled study design. Of the four controlled studies, one was a national register-based study. It showed that the patient group in the ADD scheme more often used three or more psychotropic drugs and anticholinergics than patients using the standard dispensing procedure, while women in the ADD group used less long-acting benzodiazepines and both genders had fewer drug-drug interactions. In another, regional controlled study, the ADD group consisted of patients with higher risk of inappropriate drug use, according to all indicators applied. The third controlled study indicated that ADD user drug treatments were more likely to remain unchanged than in patients using a standard dispensing procedure. A controlled study from Norway showed that ADD reduced discrepancies in the documentation of patient medication records. Costs were not investigated in any of the studies.ConclusionsA very limited number of controlled studies have explored ADD in primary healthcare. Consequently, the evidence for ADD's influence on appropriateness and safety of medication use is limited and lacking in information on costs. The findings of this review suggest that patients using the ADD have more inappropriate drugs in their regimens, and that ADD may improve medication safety in terms of reducing the discrepancies in medication records. Further evidence is needed to draw sound conclusions on ADD's outcomes.

Project description:The Energy Independence and Security Act of 2007 targets use of 36 billion gallons of biofuels per year by 2022. Achieving this may require substantial changes to current transportation fuel systems for distribution, dispensing, and use in vehicles. The U.S. Department of Energy and the National Renewable Energy Laboratory designed a system dynamics approach to help focus government action by determining what supply chain changes would have the greatest potential to accelerate biofuels deployment. The National Renewable Energy Laboratory developed the Biomass Scenario Model, a system dynamics model which represents the primary system effects and dependencies in the biomass-to-biofuels supply chain. The model provides a framework for developing scenarios and conducting biofuels policy analysis. This paper focuses on the downstream portion of the supply chain-represented in the distribution logistics, dispensing station, and fuel utilization, and vehicle modules of the Biomass Scenario Model. This model initially focused on ethanol, but has since been expanded to include other biofuels. Some portions of this system are represented dynamically with major interactions and feedbacks, especially those related to a dispensing station owner's decision whether to offer ethanol fuel and a consumer's choice whether to purchase that fuel. Other portions of the system are modeled with little or no dynamics; the vehicle choices of consumers are represented as discrete scenarios. This paper explores conditions needed to sustain an ethanol fuel market and identifies implications of these findings for program and policy goals. A large, economically sustainable ethanol fuel market (or other biofuel market) requires low end-user fuel price relative to gasoline and sufficient producer payment, which are difficult to achieve simultaneously. Other requirements (different for ethanol vs. other biofuel markets) include the need for infrastructure for distribution and dispensing and widespread use of high ethanol blends in flexible-fuel vehicles.

Project description:BackgroundEvolving automated technologies in the dispensing process promise effective solution to reduce medication error rates. The Unit-Dose-Dispensing-System (UDDS) is an essential element of the "Closed Loop Medication Management System" that enables the tracking of single medication items across the entire medication workflow thereby improving transparency, patient safety and healthcare efficiency".ObjectiveThe aim of this study was to determine hospital nurses' attitudes towards the unit dose dispensing system implemented by the hospital pharmacy department, examine their perceptions of opportunities and barriers in everyday practice and explore their experiences with its implementation.MethodsA qualitative interview study with 23 nurses from the Barmherzige Brüder Hospital Linz, Austria was conducted. The validated and piloted semi-structured interview guide was based on best practice guidelines for qualitative interview studies and the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed verbatim and mapped against the Framework of Implementation of Services in Pharmacy (FISpH) by two researchers independently.ResultsTwenty-three nurses were interviewed. Despite the overwhelmingly positive experiences with ease of use, resultant time saving, improved collaboration, patient safety, patient autonomy and a better facilitated discharge process considered as some of the positive attributes, several barriers were identified. Nurses commented on a lack in standardised workflow, erosion of knowledge and sustainability.ConclusionNurses highlighted key factors for implementation success and advantages of the unit dose dispensing system, suggesting a need to adapt to local conditions and full electronic integration into patient care. Suggestions to further improve the reliability and efficiency were made.What does this paper contribute to the wider global clinical community?•There is no research qualitatively exploring the implementation facilitators and barriers of a unit dose dispensing system at hospital ward level from the nurses' perspectives.•Insights are provided into the significance of good collaboration between all ward staff to ensure the necessary workflow adaptations, the necessity of a seamlessly integrated IT system and the adaptability of the system depending on the patient population.•The findings highlight key factors for a successful implementation of a unit dose dispensing system at ward level while underlining its advantages for workload, staff shortages and patient safety.

Dataset Information

Effect of an automated dispensing cabinet system on drug distribution effectiveness in a surgical unit.

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Effect of an automated dispensing cabinet system on drug distribution effectiveness in a surgical unit.

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