ArticlePDF Available

Nursing Perception of the Impact of Automated Dispensing Cabinets on Patient Safety and Ergonomics in a Teaching Health Care Center

Authors:

Abstract and Figures

Purpose: To evaluate how nursing staff felt about the impact of automated dispensing cabinets (ADCs) on the safe delivery of health care and workplace ergonomics. To identify the main issues involved in the use of this technology and to describe the corrective measures implemented. Methods: Cross-sectional descriptive study with quantitative and qualitative components. A questionnaire that consisted of 33 statements about ADC was distributed from May 24 to June 3, 2011. Results: A total of 172 (46%) of 375 nurses completed the questionnaire. Nursing staff considered the introduction of ADC made their work easier (level of agreement of 90%), helped to safely provide patients with care (91%), and helped to reduce medication incidents/accidents (81%). Nursing staff was particularly satisfied by the narcotic drugs management with the ADCs. Nursing staff were not satisfied with the additional delays in the preparation and administration of a medication dose and the inability to prevent a medication from being administered when stopped on the medication administration record (48%). Conclusion: The nursing staff members were satisfied with the use of ADC and believed it made their work easier, promoted safe patient care, and were perceived to reduce medication incidents/accidents.
Content may be subject to copyright.
http://jpp.sagepub.com/
Journal of Pharmacy Practice
http://jpp.sagepub.com/content/27/2/150
The online version of this article can be found at:
DOI: 10.1177/0897190013507082
2014 27: 150 originally published online 15 October 2013Journal of Pharmacy Practice
Élise Rochais, Suzanne Atkinson, Mélanie Guilbeault and Jean-François Bussières
in a Teaching Health Care Center
Nursing Perception of the Impact of Automated Dispensing Cabinets on Patient Safety and Ergonomics
Published by:
http://www.sagepublications.com
On behalf of:
New York State Council of Health-system Pharmacists
can be found at:Journal of Pharmacy PracticeAdditional services and information for
http://jpp.sagepub.com/cgi/alertsEmail Alerts:
http://jpp.sagepub.com/subscriptionsSubscriptions:
http://www.sagepub.com/journalsReprints.navReprints:
http://www.sagepub.com/journalsPermissions.navPermissions:
What is This?
- Oct 15, 2013OnlineFirst Version of Record
- Mar 19, 2014Version of Record >>
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
Research Article
Nursing Perception of the Impact of
Automated Dispensing Cabinets on
Patient Safety and Ergonomics in a
Teaching Health Care Center
E
´
lise Rochais, DPharm
1
, Suzanne Atkinson, BPharm, MSc
1
,
Me
´
lanie Guilbeault, MSc
2
, and
Jean-Franc¸ois Bussie
`
res, BPharm, MSc, MBA, FCSHP
1,3
Abstract
Purpose: To evaluate how nursing staff felt about the impact of automated dispensing cabinets (ADCs) on the safe delivery of health
care and workplace ergonomics. To identify the main issues involved in the use of this technology and to describe the corrective
measures implemented. Methods: Cross-sectional descriptive study with quantitative and qualitative components. A questionnaire
that consisted of 33 statements about ADC was distributed from May 24 to June 3, 2011. Results: A total of 172 (46%) of 375
nurses completed the questionnaire. Nursing staff considered the introduction of ADC made their work easier (level of
agreement of 90%), helped to safely provide patients with care (91%), and helped to reduce medication incidents/accidents (81%).
Nursing staff was particularly satisfied by the narcotic drugs management with the ADCs. Nursing staff were not satisfied with the
additional delays in the preparation and administration of a medication dose and the inability to prevent a medication from being
administered when stopped on the medication administration record (48%). Conclusion: The nursing staff members were satisfied
with the use of ADC and believed it made their work easier, promoted safe patient care, and were perceived to reduce med-
ication incidents/accidents.
Keywords
hospital medication systems, automated dispensing cabinets, nurses/midwives/nursing staff, perception/satisfaction, focus group
Introduction
Over 50 steps are included in the drug use process in health care
institutions.
1
Many of those steps are related to the distribution,
storage, and stock management of medication, both at the
pharmacy department and on the health care units. Since many
people are involved in the handling of medication, especially
when it comes to ward stock, measures have to be taken to
ensure safe distribution and storage of drugs. Some medication
errors occur when the wrong medication is taken from ward
stock organized with an open bin system. In the past 20 years,
many hospitals have implemented automated dispensing cabi-
nets (ADCs) with the objective of providing a better storage
and distribution system, easier control over narcotics, and more
reliable billing of medication to patients.
2,3
ADCs are meant to contain high-risk medications such as
narcotics, other controlled medications, high-alert medications
as identified by the Institute for Safe Medication Practices,
4
and other ward stock in locked and secured drawers. Each ADC
user is registered and needs an ID and password to access the
device. ADCs are usually interfaced with the pharmacy’s
information system and with the hospital’s admission system.
They prevent nonauthorized access to medications and register
all actions and inform the nursing staff about allergies if they
are recorded in the patient’s pharmacological file. A major
safety attribute is the possibility of bar-code reading, for both
the filling and the distribution of medication. In order to obtain
maximum benefits, some health agencies have proposed
practice models for ADC, addressing configuration, location,
users, interface, and so on.
5,6
1
De
´
partement de Pharmacie, Unite
´
de recherche en pratique pharmaceutique,
Centre Hospitalier Universitaire Sainte-Justine, Montre
´
al, Que
´
bec, Canada
2
Direction des soins infirmiers, Centre Hospitalier Universitaire Sainte-Justine,
Montre
´
al, Que
´
bec, Canada
3
Faculte
´
de pharmacie, Universite
´
de Montre
´
al, Montre
´
al, Que
´
bec, Canada
Corresponding Author:
Jean-Franc¸ois Bussie
`
res, Pharmacy Department, Centre Hospitalier Uni-
versitaire Sainte-Justine, 3175 chemin de la Co
ˆ
te-Sainte-Catherine, Montre
´
al,
Quebec, Canada H3T 1C5.
Email: jf.bussieres@ssss.gouv.qc.ca
Journal of Pharmacy Practice
2014, Vol. 27(2) 150-157
ª The Author(s) 2013
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0897190013507082
jpp.sagepub.com
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
The use of ADCs may be helpful in the safe delivery of care,
especially by reducing the number of times the health care staff
is interrupted and also by reducing walking distances and
facilitating the planning of drug preparation on the floor. The
implementation of any new technology used in support of the
drug use process may impact the staff’s workload and level
of satisfaction.
7,8
ADCs have been used for almost 20 years, especially in
North America. A limited number of studies assessed imple-
mentation and use of ADC in health care institutions,
9-15
and
some associations have published guidelines for a safer use
of these technologies.
7,8
The purpose of this study is to have
a better understanding of the impact of ADCs’ implementation
and to propose solutions for some raised issues.
Methods
Objectives
The primary objective of this study was to evaluate how nursing
staff felt about the impact of ADCs on the safe delivery of health
care and workplace ergonomics. The secondary objective was to
identify the main issues involved in the use of this technology
and to describe the corrective measures implemented.
Settings
The study was carried out at the Centre Hospitalier Universi-
taire Sainte-Justine, a mother and child hospital of about 500
beds in Montreal, Canada. More than 1400 nurses work in 6
different health care programs on 2 sites, one offers acute care
and the second offers long-term health care. In total, 7 ADCs
were introduced between November and December 2009, in
3 critical care units, neonatology (n ¼ 3), intensive care (n ¼
2), and emergency department (n ¼ 2).
In our center, controlled drugs and about 20 high-risk medi-
cations are identified by bar-code reading before they are added
to stock in the ADC. With the exception of the emergency
department, every prescription has to be transmitted to the phar-
macy and is entered in the patient’s pharmacological file (ie,
health record). The orders are then displayed on the unit care’s
ADC, and the drug can be selected by the nurse. Users may
access ADCs with biometry technology or with a username and
password combination. Medication may also be accessed prior
to pharmacist validation, when the order is made outside of the
opening hours of the pharmacy or in case of an emergency.
Design
This is a cross-sectional descriptive study with quantitative and
qualitative components. The initial (quantitative) analysis
involved delivering a questionnaire to the users. The second
(qualitative) analysis involved setting up a focus group to dis-
cuss the results of the questionnaire.
Quantitative Analysis: Questionnaire
The self-administered questionnaire included 33 statements
that respondents had to tick off using a 4-level Likert-type
scale, totally agree (TA), partially agree (PA), partially dis-
agree (PD), and totally disagree (TD). It was also possible to
answer ‘not applicable.’ The 33 statements were organized
into 9 themes. At the end of the questionnaire, the participants
could make comments and suggestions about the ADCs.
Given that a similar research project was carried out after
the introduction of medication carts, the questionnaire was
developed to evaluate both the technologies.
Quantitative Analysis: Questionnaire Administration
The questionnaires were administered to the nursing staff in the
3 health care units where the ADCs were installed. We esti-
mated that about 375 nurses (including staff on maternity and
sick leave, etc) regularly used the ADCs in those 3 units. The
targeted sample size was set to approximately 125 respondents
(at least a third of the users).
The unit’s head nurses and nursing advisors were asked to
help distribute the questionnaire over a 2-week period from
May 24 to June 3, 2011. The nurses, nursing assistants, and
assistant head nurses (AHNs) received a copy of the question-
naire at the beginning of their shift and had to fill it out and
hand it back in an envelope provided for this purpose before
the end of their shift. Nurses from all 3 working shifts
were included (day—7:30
AM to 3:30 PM, evening—3:30 PM
to 11:30 PM, and night—11:30 PM to 7:30 AM).
Qualitative Analysis
During the same time frame, a focus group was organized in order
to identify the problems that were raised following the ADC’s
implementation and the solutions to be implemented in each unit.
Each unit’s head nurses were asked to find 2 members of their team
to volunteer as participants in the focus group. In addition, the focus
group also included 2 pharmacists, a pharmacist assistant and a
nursing advisor. The research assistant presented the aim of the
meeting, confirmed the voluntary, free, and informed participation
of the participants, and presented the agenda. The results obtained
from the questionnaire of the quantitative analysis were given to
the participants in the focus group at the beginning of the meeting
in ord er to stimulate discussion. Each participant was given about
10 minutes to become familiar with these results. The semistruc-
tured discussion was moderated by the research assistant who
selected specific themes according to the quantitative analysis
results. The meeting was set up to last for 90 minutes. The inter-
view was not recorded to allow the participants to express them-
selves freely (either for or against the implementation). Their
remarks were noted by the research assistan t and 2 pharmacists.
Ethical Considerations
According to the local regulations, no formal ethical scrutiny
was required.
Rochais et al 151
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
Data Analysis
The proportion of respondents per level of agreement was cal-
culated for each of the 33 statements using the questionnaires
that were handed in. We considered that the respondents were
in favor of a statement if over 50% of the respondents agreed
with a positively formulated statement or if fewer than 50%
of the respondents agreed with a negatively formulated state-
ment. In addition, in order to present the data succinctly, we
consolidated the TA and PA (agree) and the PD and TD (dis-
agree) levels. No inferential statistical analysis was done.
Validity and Reliability/Rigor
Given the absence of a validated tool to evaluate how the
respondents felt about ADC, a questionnaire was developed
jointly by 1 research assistant, 2 pharmacists responsible for the
project, and 1 member of the Nursing Directorate. The vari-
ables that pertain to the evaluation of the patient’s safety and
workplace ergonomics for the user were identified. Approxi-
mately 20% of the statements were formulated in a negative
formulation in order to verify the consistency of the responses
obtained. The questionnaire was pretested with 6 nurses to
ensure that the statements were pertinent and well understood.
The questionnaire was then revised based on the comments
received in order to come to a consensus for the final version.
Results
Population
Among the 375 nurses targeted by the questionnaire, 172 com-
pleted it and handed it back, which is a 46% participation rate
(ie, neonatology unit [40% participation rate], intensive care
unit [53%], and emergency care unit [56%]). All data from the
172 respondents were included in the analysis. The population
details are presented in Table 1.
Quantitative Analysis
The results for each statement were consolidated into 2 levels
of agreement (agree/disagree) and are presented in Table 2. The
level of agreement was above 50% for 24 of the 33 statements.
In general, the nursing staff considered that the introduction of
ADC made their work easier (level of agreement of 90%),
helped to safely provide patients with care (91%), and helped
to reduce medication incidents/accidents (81%). We also
noticed that the nursing staff was particularly satisfied by the
narcotic drug management with the ADCs. These results, there-
fore, show a consensus as to the adoption of ADC technology
and its benefits.
Of the 33, 9 statements (statements #11, 15, 16, 17, 21, 22,
25, 27, and 30) indicate nursing staff dissatisfaction (level of
agreement below 50%). Dissatisfaction was noted with
additional delays in the preparation and administration of a
medication dose with ADC, although it was only by a small
majority (52% and 54%). They also considered that ADC did
not prevent a medication from being administered when
stopped on the medication administration record (48%). In
addition, staff reported not knowing the procedures and poli-
cies in the event of failure or breakdown (61%).
Data analysis for each units and work shifts generally
revealed no difference among the respondents depending on
the care unit or the work’s shift.
Qualitative Analysis
The respondents made a total of 90 written comments. These
comments focused on inadequacy between stored medications
and activity of the unit care (insufficient supply, medication
missing, etc; n ¼ 26) and the biometry system which is often
nonfunctional (n ¼ 21). In general, the comments were consis-
tent with the levels of agreement for specific topics.
As for the focus group, a total of 6 people were targeted and
agreed but 5 could participate (eg, neonatology [n ¼ 2), inten-
sive care unit [n ¼ 2), and emergency care unit [n ¼ 1]). Table 3
presents the highlights of the focus group, including the com-
ments on the results from the questionnaire, a description of
issues related to ADC use, and an identification of possible
solutions.
At the end of the focus group, all the participants seemed to
be very satisfied with the introduction of the ADC. Based on
the problems identified during the discussion, the question was
raised as to give access to the ADC or not to the orderlies.
Members of the group were not sure whether it would be rele-
vant, because it does not take that much more time to go to the
ADC and retrieve a drug. The topic will need further discussion
with olderly representative and nursing administration.
Participants were reminded that the purpose of implement-
ing technologies such as ADCs is to introduce safety measures
for the patient like traceability, double checks, and bar-code
Table 1. Population.
Respondents, % (n)
Health care units
Neonatalogy 52 (89/172)
Intensive care unit 30 (52/172)
Emergency department 18 (31/172)
Job title
a
Nurses 71 (120/170)
Nursing assistants 19 (32/170)
AHNs 10 (18/170)
Work shift
Days 39 (67/170)
Nights 29 (49/170)
Evenings 32 (54/170)
Work experience
More than 5 years 64 (105/165)
1-5 years 32 (53/165)
Less than 1 year 4 (7/165)
Abbreviation: AHN, assistant head nurses.
a
These proportions reflect the representation of the job titles within the
institution (ie, 74% nurses, 18% nursing assistants, and 8% AHNs).
152 Journal of Pharmacy Practice 27(2)
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
Table 2. Nursing Staff in Agreement or Disagreement With Statements About Automated Dispensing Cabinets.
Topics
# Statements (n ¼ 172) Agree, % Disagree, % NA, %
Secure access to
medication
1 The ADC locking system prevents parents and patients from accessing the
medications
97 0 3
2 The procedure for obtaining a user code for a new employee is quick and
easy
61 29 10
3 The ADC access code system makes it possible to easily share an access
code with another employee in case the code is forgotten
27 60 13
4 The ADC’s automatic locking system reduces the risk of medication theft 98 2 0
Interruptions 5 The ADC’s location reduces the risk of my colleagues disturbing me
(interruptions)
74 22 4
6 The ADC’s location reduces the risk of patients disturbing me
(interruptions)
82 15 2
Filling and medication
selection
7 Use of the ADC helps to reduce medication filling errors by the Pharmacy 78 10 12
8 Filling the ADC on a periodic basis creates operational issues (delays, access,
etc)
28 50 23
9 Use of the ADC helps to reduce medication selection errors by health care
personnel
93 7 1
10 Use of the ADC prevents a medication from being administered
inappropriately when a patient is allergic
60 17 23
11 Use of the ADC prevents a medication from being administered when it is
stopped on the medication administration record
36 48 17
12 The choice of medications in the ADC is appropriate 91 9 0
Access delays and
walking distances
13 Use of the ADC reduces the time it takes to access initial doses when a new
medication is prescribed
82 12 6
14 Use of the ADC increases the time it takes to access medication doses
stored on the floor (‘‘common drugs’’)
49 38 14
15 Use of the ADC creates additional delays (ie, identification, selection,
opening of drawers, etc) in the preparation and administration of a
medication dose
52 46 2
16 Use of the ADC creates additional delays (ie, waiting while another user
accesses the ADC) in the preparation and administration of a medication
dose
54 44 2
17 Use of the ADC reduces the necessary walking distance (ie, moving to and
from) to prepare and administer a medication dose
39 50 11
Narcotics management 18 Use of the ADC reduces the time needed to manage narcotics, controlled
medications, and targeted substances for the shift count
77 7 16
19 Use of the ADC reduces the time needed to manage narcotics, controlled
medications, and targeted substances for medication dose selection
81 8 10
20 Using a witness when discarding narcotics protects me in the event of future
accusations of diverting medications
67 12 20
Location and
configuration
21 The location of the ADC makes it possible to document (ie, record the
prepared/administered dose) the medication administration record more
accurately
44 43 13
22 Use of the ADC makes it easier to prepare medication doses using the work
surface made available
15 60 25
23 There is enough lighting around the ADC for optimal use 89 6 5
24 The location of the ADC is appropriate for my work needs 84 15 1
Procedures and
breakdowns policies
25 The policy/procedure to use in the event of ADC-related breakdowns,
failures, or technical issues is known and accessible
19 61 19
26 Breakdowns, failures, and technical problems frequently occur with the
ADC
19 60 21
27 Technical support provided when breakdowns, failures, or technical
problems occur is adequate
30 21 49
28 Full and easy-to-use documentation on how to use medical ADCs is
available on the Pharmacy’s intranet
59 11 30
29 Adequate training is given on how to use the ADC 84 15 1
Maintenance 30 Regular ADC maintenance is performed 42 6 52
Global satisfaction
and perception on
patient safety
31 Introducing medical ADCs helps to provide patients with care safely 91 4 4%
32 Introducing medical ADCs makes the health care staff’s work easier 90 8 2
33 The SARDM (automated robotic drug distribution system) project helps to
reduce medication incidents/accidents
81 14 6
Abbreviations: ADC, automated dispensing cabinet; SARDM, Syste
`
me automatise
´
et robotise
´
pour la distribution des me
´
dicaments; NA, not applicable.
Rochais et al 153
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
Table 3. Profile of Problems and Solutions Raised by the Focus Group.
Themes Problems Proposed solutions
Secure access to medication Delays to obtain access code and to be registered with biometry Implementing a single office for all hospital information system inscription
has failed so far. Thus, the solution is to keep reminding the procedure
to obtain an access code at the pharmacy during opening hours and the
procedure to create temporary user at the ADC
Filling and medication selection Unclear description for liquid-form medication that have to be distributed
either by unidose format or multidose bottles (which need to be
selected in mL and not in unit); leads to discrepancies and filling
problems
Modifying the product description to clarify the way the liquid has to be
distributed, either in bottle or mL
Filling errors from the pharmacy have been declared Making syringes and other material to handle liquids readily available near
the ADC
Difficulty for the pharmacy technician to find a witness for narcotics refill Extending bar-code reading to most of the drugs (for the moment only
some controlled drugs are scanned before they are stocked in the
ADC)
Out of stock issues Avoiding certain hours (eg, lunchtime) to have a witness available for
refilling
In the emergency care unit, too many medications allocated to fictive
patients like ‘patients with trauma’
Activating the ‘pharmacy request’ button on the ADC’s screen should
allow to send a message about out of stock pockets
Ignoring ‘allergy’ information on ADC by the participants because it does
not seem relevant
Implementing regular audits for distribution to fictive patients and follow
up with users
Creating with the distributor a pharmacological class system of the
‘allergy’ information
Access delays and walking distances Restricted access to nurses while orderlies were used before to help
nurses in emergency situation of for some ‘kit’ preparation that
included drugs
Giving access to orderlies
Location and configuration Refrigerated drugs stocked outside of the ADC lead to filling and
inventory problems
Managing refrigerated drugs with the ADC panel without the physical
linked padlock
Procedures and breakdowns policies Occasional breakdown or reading problems of the biometry system Consulting with the distributor for biometry breakdowns
Training too short and too fast Reviewing the training instructions
Abbreviation: ADC, automated dispensing cabinet.
154
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
reading in all steps of the drug use process. Based on this idea,
the participants seemed interested in the idea of computeriza-
tion of the complete drug use process. In fact, they were con-
vinced that it would help to plan their work, give a sense of
responsibility to all health care professionals, and maybe it
would help to reduce potential medication errors.
Discussion
Impact of ADCs on the Safe Delivery of Health Care
The nursing staff considered that the introduction of ADC
helped with safe patient care and helped to reduce medication
incidents/accidents. Indeed, the use of biometry, bar-code read-
ing, witnesses, secured pockets, and profile selection are all
novelties that create an idea of security and that, if well used,
do secure the distribution process. But one should not forget
that technology has faults and that users easily find work-
arounds to limitations. Furthermore, no study has demonstrated
that ADCs reduce the risk of medication errors and that the
technology improves patient safety significantly. Thus, ADCs
may sometimes create a false sense of security and patient
safety.
16-20
In fact, an evaluation carried out in 2 intensive care
units demonstrated a small but statistically significant differ-
ence in medication errors between pre- and postimplementa-
tion of ADC.
15
In a systematic review about medication
administration technologies, the authors have concluded that
further evidence is required to accurately assess the actual
contribution of medication administration technologies for
improving patient safety.
21
A pre–per–post evaluation was conducted to compare the
number of medication errors reported before, during, and after
the implementation of ADCs in our center.
22
The study covered
2411 days from 2004 to 2010 with 11 731 reported medication
errors. Dispensing medication errors accounted for 42% of the
medication errors reported in our hospital in 2009 to 2010 and
39% in 2010 to 2011. There was no significant difference in the
mean number, nature, causes, and gravity of events before and
after installation for services equipped with ADC.
Also, during the implementation of ADCs in our center, we
conducted a descriptive study to examine compliance with pub-
lished guidelines on the implementation of decentralized ADCs
(Acudose
1
; Mckesson, Canada).
23
The 2008 guidelines of the
US Institute for Safe Medication Practices concerning the safe
use of decentralized ADCs and the associated self-assessment
tool (2009) were used to evaluate compliance. Overall, compli-
ance increased from 66% to 74%, 30 and 120 days after imple-
mentation. This gap in compliance illustrates one of the ADC
technology limitations.
In this study, nurses were not convinced that the ADCs
helped them not to give a medication when a patient is allergic.
The compliance audit has shown that allergy detection was
inefficient with the current technology. ADCs provide a list
of the patient’s allergies, but it does not provide an interactive
detection of allergies. When a nurse wants to take a drug from
the inventory list instead of the patient profile, the ADC shows
all the patient’s allergies, whether or not it is relevant with the
medication chosen. Adequate allergy detection software should
detect and alarm only real allergy risks. The detection software
should also detect allergy risks for drugs family, not only single
drugs. This would require a whole new database from the man-
ufacturer. A confirmation screen of the action taken by the
nurses when faced with an allergy alert might increase allergy
recognition and would increase patient safety.
Impact of ADCs on Workplace Ergonomics
Nursing staff members were satisfied with the use of the tech-
nology and found that it facilitated their work. In terms of work
ergonomics, the results are generally good.
24,25
In this study,
the biggest improvement has been the narcotics management.
Eliminating or reducing the manual count at the end of each
shift by the AHN has given them more time for other tasks. But
the ADCs are not meant to handle bulk liquid forms, especially
narcotics with a blind count. Thus, we had to leave the oral
liquid narcotics, more common in pediatrics, out of the ADC,
and a manual count is still mandatory for these products. Some
negative answers came from the perception that it takes more
time for the nurses to take medication out of the ADC than it
used to with the open bins. This has led to workarounds such
as using the ‘off profile’ option instead of waiting for the
pharmacy to validate the prescription and making it available
on the patient’s profile.
Corrective Measures for the Main Issues Identified
With the results of this study, we have adopted various correc-
tive measures that will be implemented in the months to come
in order to improve staff satisfaction with the use of ADC.
Among the measures considered are reviewing the process to
get an access code for a new nurse (eg, user, password, and bio-
metry), requiring bar-code reading for more products when
restocking to increase replenishing stock safety procedure, clari-
fying the description of drugs in liquid format at the ADC to
ensure safe distribution, implementing different audits to verify
compliance with procedures and regulations, adding refrigerated
medications to ADC lists, and discussing whether or not we will
authorize access to orderlies. A review of maintenance policies
and procedures will also be conducted with housekeeping staff.
Other planned measures are specific to the Pharmacy
Department, especially the development of a periodic report
that will make it possible to analyze users and access irregula-
rities, the introduction of a biannual visit to the units by tech-
nical staff in order to evaluate the unit’s compliance with a
list of predefined criteria, and a review of technical duties in
order to ensure better follow-up of the management of medica-
tion returns.
Limits
The study relies on a questionnaire that was pretested on a lim-
ited number of respondents but has never been used by other
Rochais et al 155
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
research groups. Its validity could, therefore, be challenged, but
to our knowledge there are no other validated tools to measure
staff perception. A pre–post evaluation would have made it
possible to better measure satisfaction levels after ADCs were
introduced. Nevertheless, when a technology is being intro-
duced or is already introduced, such a study cannot be con-
ducted. In the case of focus group, we did not proceed with
either recording or retranscription and coding the statements
expressed by the participants. A systematic use of a retran-
scribed verbatim report which is then coded may increase the
accuracy of the observations. Nevertheless, the cost of such
an approach exceeds any potential benefits. Finally, the focus
group participants were chosen by the unit’s head nurses based
on their interest in participating in the focus group. The absence
of random choice may have biased favorably or unfavorably
the representative character of the group.
Conclusion
There are few data on the use of ADC in health care institu-
tions. This cross-sectional observational study describes the
opinion of 172 nursing staff members from all 3 shifts in 3
health care units. Generally, the nursing staff members were
satisfied with the use of the technology and believed it made
their work easier, promoted safe patient care, and were per-
ceived to reduce medication incidents/accidents. Interfacing
ADC with pharmacological file is good but not enough.
Computerization of the patient’s entire file including prescrip-
tions (with a computerized physician order entry) and bar-code
reading at administration could provide safer control of all the
drug circuit. Other studies are necessary to evaluate the true
impact of this technology on patient safety.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship,
and/or publication of this article.
References
1. Jodoin J, Lantin S, Bussie`res JF, et al. Les syste
`
mes automatise
´
set
robotise
´
s utilise
´
s pour la distribution des me
´
dicaments dans les
e
´
tablissements de sante
´
au Que
´
bec. Rapport et recommandations
du groupe de travail. MSSS. Quebec, Canada: Sante´ et Services
Sociaux; April-October 2005.
2. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national
survey of pharmacy practice in hospital settings: dispensing and
administration—2011. Am J Health Syst Pharm. 2012;69(9):
768-785.
3. Hall K, Harding J, Bussie`res JF, et al. Hospital pharmacy report in
Canada 2009-2010. [online] http://www.lillyhospitalsurvey.ca.
Accessed May 1, 2012.
4. Institute for Safe Medication Practices. ISMP’s list of high-alert
medications. [online] http://www.ismp.org/tools/highalertmedi
cations.pdf. Accessed December 18, 2012.
5. Institute for Safe Medication Practices Canada. Automated dispen-
sing cabinets in the Canadian environment. ISMP Can Saf Bull.
2007;7(3):1-3.http://www.ismp-canada.org/download/ISMPCSB
2007-03ADCs.pdf. Accessed May 1, 2012.
6. Canadian Agency for Drugs and Technologies in Health. Tech-
nologies to reduce errors in dispensing and administration of med-
ication in hospitals: clinical and economic analyses. CADTH
Technol Overv. 2010;1(3):e0116. http://www.cadth.ca/media/
pdf/H0472_med-errors_tr_e.pdf. Accessed May 1, 2012.
7. American Society of Health-System Pharmacists. ASHP guidelines
on the safe use of automated dispensing cabinets. Am J Health Syst
Pharm. 2010; 67:483-490. http://www.ashp.org/DocLibrary/Best-
Practices/AutoITGdlADDs.aspx. Accessed May 1, 2012.
8. Institute for Safe Medication Practices. Institute for Safe Medica-
tion Practices has issued Guidance on the Interdisciplinary Safe
Use of Automated Dispensing Cabinets. Canada: Institute for Safe
Medication Practices; 2008. http://www.ismp.org/Tools/guide-
lines/ADC_Guidelines_Final.pdf. Accessed May 1, 2012.
9. Schwarz HO, Brodowy BA Implementation and evaluation of an
automated dispensing system. Am J Health Syst Pharm. 1995;
52(8):823-828.
10. Borel JM, Rascati KL. Effect of an automated, nursing unit-based
drug-dispensing device on medication errors. Am J Health Syst
Pharm. 1995;52(17):1875-1879.
11. Ray MD, Aldrich LT, Lew PJ. Experience with an automated
point-of-use unit-dose drug distribution system. Hosp Pharm.
1995;30(1):18,20-23,27-30.
12. Klibanov OM, Eckel SF. Effects of automated dispensing on
inventory control, billing, workload, and potential for medication
errors. Am J Health Syst Pharm. 2003;60(6):569-572.
13. Bedouch P, Baudrant M, Detavernier M, et al. Drug supply chain
safety in hospitals: current data and experience of the Grenoble
university hospital. Ann Pharm Fr. 2009;67(1):3-15.
14. Hull T, Czirr L, Wilson M. Impact of medication storage cabinets
on efficient delivery of medication and employee frustration.
J Nurs Care Qual. 2010;25(4):352-357.
15. Chapuis C, Roustit M, Bal G, et al. Automated drug dispensing
system reduces medication errors in an intensive care setting. Crit
Care Med. 2010;38(12):2275-2281.
16. Oren E, Shaffer ER, Guglielmo BJ. Impact of emerging technol-
ogies on medication errors and adverse drug events. Am J Health
Syst Pharm. 2003;60(14):1447-1458.
17. Hawthorne G. Medication Delivery Systems. Canada: Search
Canada; 2008. http://www.searchca.net/users/folder.asp?FolderID
¼2673. Accessed May 1, 2012.
18. Gaunt MJ, Davis MM. Automated dispensing cabinets: don’t
assume they’re safe; correct design and use are crucial. Am J
Nurs. 2007;107(8):27-28.
19. Hamilton D. Do Automated dispensing machines improve patient
safety? Can J Hosp Pharm. 2009;62(6):516-519.
20. Novek J, Bettess S, Burke K, et al. Nurses’ perceptions of the
reliability of an automated medication dispensing system. J Nurs
Care Qual. 2000;14(2):1-13.
156 Journal of Pharmacy Practice 27(2)
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
21. Wulff K, Cummings GG, Marck P, et al. Medication administra-
tion technologies and patient safety: a mixed-method systematic
review. J Adv Nurs. 2011;67(10):2080-2095.
22. Rochais E, Lebel D, Atkinson S, et al. Perspective sur les
accidents et incidents me´dicamenteux en centre hospitalier uni-
versitaire. Risques Qual. 2011;8(4):243-252.
23. Brisseau L, Bussie` res JF, Lebel D, et al. Utilisation de lignes
directrices dans le cadre de l’implantation de cabinets automatise´s
de´centralise´s en e´tablissement de sante´. Can J Hosp Pharm. 2011;
64(2):104-115.
24. Mahoney CD, Berard-Collins CM, Coleman R, et al. Effects of an inte-
grated clinical information system on medication safety in a multi-
hospital setting. Am J Health Syst Pharm. 2007;64(18):1969-1977.
25. Skibinski KA, White BA, Lin LI, et al. Effects of technological
interventions on the safety of a medication-use system. Am J
Health Syst Pharm. 2007;64(1):90-96.
Rochais et al 157
at UNIVERSITE DE MONTREAL on March 24, 2014jpp.sagepub.comDownloaded from
... Six studies reported on the impact of ADCs on work processes of clinicians in dealing with controlled medications. 6,42,46,47,49,51 Of these, two were qualitative, 42,51 two were quantitative, 6,49 and two used mixed-methods. 46,47 Qualitative data from three studies suggested that the introduction of ADCs resulted in the elimination of manual end-of-shift counts of controlled medications. ...
... 6,42,46,47,49,51 Of these, two were qualitative, 42,51 two were quantitative, 6,49 and two used mixed-methods. 46,47 Qualitative data from three studies suggested that the introduction of ADCs resulted in the elimination of manual end-of-shift counts of controlled medications. 42,46,47 In a study that compared time spent on clinical tasks before and after the introduction of ADCs, a large reduction in nursing time spent compiling and correcting errors in drug registries was observed post-ADC (36 vs. 2 h/month). ...
... 46,47 Qualitative data from three studies suggested that the introduction of ADCs resulted in the elimination of manual end-of-shift counts of controlled medications. 42,46,47 In a study that compared time spent on clinical tasks before and after the introduction of ADCs, a large reduction in nursing time spent compiling and correcting errors in drug registries was observed post-ADC (36 vs. 2 h/month). 6 Pharmacy time dedicated to inspecting stock and responding to ward requests also reduced from roughly 9 h per month to 1 h per month. ...
Article
Full-text available
Background Technology in the form of Automated Dispensing Cabinets (ADCs), Barcode Medication Administration (BCMA), and closed-loop Electronic Medication Management Systems (EMMS) are implemented in hospitals to assist with the supply, use and monitoring of medications. Although there is evidence to suggest that these technologies can reduce errors and improve monitoring of medications in general, little is known about their impact on controlled medications such as opioids. Objectives This review aimed to fill this knowledge gap by synthesising literature to determine the impact of ADCs, BCMA and closed-loop EMMS on clinical work processes, medication safety, and drug diversion associated with controlled medications in the inpatient setting. Methods Eight databases (Medline, Pubmed, Embase, Scopus, Web of Science, PsycINFO, CINAHL, and ScienceDirect) were searched for relevant papers published between January 2000 and May 2019. Qualitative, quantitative, and mixed-methods empirical studies published in English that reported findings on the impact of ADCs, BCMA and/or closed-loop EMMS on controlled medications in the inpatient setting were included. Results In total, 16 papers met the inclusion criteria. Eleven studies reported on ADCs, four on BCMA, and only one on closed-loop EMMS. Only four studies focused on controlled medications, with the remainder reporting only incidental findings. Studies reported the elimination of manual end-of-shift counts of controlled medications after ADC implementation but cases of drug diversion were reported despite introducing ADCs. Three quantitative studies reported reductions in medication errors after implementing BCMA, but medications labelled with wrong barcodes and unreadable barcodes led to confusion and administration errors. Conclusions More quality, targeted research is needed to provide evidence on the benefits and also risks of implementing technology to safeguard against inappropriate use of controlled medications in the inpatient setting. Processes need to be in place to supplement technological capabilities, and resources should be made available for post-implementation evaluations and interventions.
... In general, the nurses were satisfied with ADCs and expressed they have made their work easier. This is consistent with the findings of Rochais et al. (2014) and Zaidan et al. (2016), who have investigated nursesṕ erceptions of, and satisfaction with, the use of ADCs [9,10]. ...
... In general, the nurses were satisfied with ADCs and expressed they have made their work easier. This is consistent with the findings of Rochais et al. (2014) and Zaidan et al. (2016), who have investigated nursesṕ erceptions of, and satisfaction with, the use of ADCs [9,10]. ...
Article
Full-text available
Background: Thirty-two automated dispensing cabinets (ADCs) were introduced in May 2015 in Kuopio University Hospital, Finland. These medication distribution systems represent relatively new technology in Europe and are aimed at rationalising the medication process and improving patient safety. Nurses are the end-users of ADCs, and it is therefore important to survey their perceptions of ADCs. Our aim was to investigate nurses' perceptions of ADCs and the impacts of ADCs on nurses' work. Methods: The study was conducted in the Anaesthesia and Surgical Unit (OR) and Intensive Care Unit (ICU), of a tertiary care hospital, in Finland. We used two different research methods: observation and a survey. The observational study consisted of two 5-day observation periods in both units, one before (2014) and the other after (2016) the introduction of ADCs. An online questionnaire was distributed to 346 nurses in April 2017. The data were analysed using descriptive statistics including frequencies and percentages and the Chi-Square test. Results: The majority (n = 68) of the 81 respondents were satisfied with ADCs. Attitudes to ADCs were more positive in the ICU than in the OR. Nearly 80% of the nurses in the ICU and 42% in the OR found that ADCs make their work easier. The observational study revealed that in the OR, time spent on dispensing and preparing medications decreased on average by 32 min per 8-h shift and more time was spent on direct patient care activities. The need to collect medicines from outside the operating theatre during an operation was less after the introduction of ADCs than before that. Some resistance to change was observed in the OR in the form of non-compliance with some instructions; nurses took medicines from ADCs when someone else was logged in and the barcode was not always used. The results of the survey support these findings. Conclusions: Overall, nurses were satisfied with ADCs and stated that they make their work easier. In the ICU, nurses were more satisfied with ADCs and complied with the instructions better than the nurses in the OR. One reason for that can be the more extensive pilot period in the ICU.
... Technology improves the quality of patient care itself by controls and alerts and by freeing up healthcare professionals to perform tasks that improve patient care in other ways 3 17 Medications are ready to dispense after pharmacist's verification 17 The risk of an unnecessary medication being administered was reduced due to redesigned cartfill process 33 Decentralised system may improve safety and quality of care 13 16 27 Electronic systems can have benefits in drug administration and safety aspects 31 BCs increased confirmation of patient identity before administration 30 31 39 Nurses believed that safety improved and system helped to reduce medication incidents 35 Collaboration is essential to ensure safe patient experiences 32 New technologies may compromise patient safety or create a false sense of security 23 35 System increased documentation discrepancies 31 ...
... It also frees up technicians to do other duties 17 33 Transition from hybrid system to decentralised system would result in decreased technician labour requirements and greater increase in nursing staff workload, which inreases costs 18 Technology implementations need additional work compared with traditional system 23 The automated dispensing systems improved the productivity of pharmacists and nurses. 25 27 ADCs reduced pharmacists' dispensing time 16 Nurses believed that the system made their work easier 35 To improve nurses' working conditions and knowledge about medications will reduce MEs 13 16 Cost Carousels seem to reduce inventory costs and increase the inventory turn rate 40 Has best total human resource utilisation and employee skill mix. Decentralised is more expensive compared with hybrid system 18 With ADDS, costs are easier to control or are even reduced 14 Gives better tools to manage medication inventories, evaluate charging, decrease returns to pharmacy, reduce waste and enable just-in-time delivery 17 33 Better stocking enables improved safety: system stores and controls medications, fewer unnecessary medicines are stored in the ward 17 33 Automation improved storage, stock control and security 22 27 29 31 37 Less time is spent searching for medicines 37 ADDS decreased storage errors 13 14 Narcotics management has been improved with ADC. ...
Article
Objectives To systematically review automated and semi-automated drug distribution systems (DDSs) in hospitals and to evaluate their effectiveness on medication safety, time and costs of medication care. Methods A systematic literature search was conducted in MEDLINE Ovid, Scopus, CINAHL and EMB Reviews covering the period 2005 to May 2016. Studies were included if they (1) concerned technologies used in the drug distribution and administration process in acute care hospitals and (2) reported medication safety, time and cost-related outcomes. Results Key outcomes, conclusions and recommendations of the included studies (n=30) were categorised according to the dispensing method: decentralised (n=19 studies), centralised (n=6) or hybrid system (n=5). Patient safety improved (n=27) with automation, and reduction in medication errors was found in all three systems. Centralised and decentralised systems were reported to support clinical pharmacy practice in hospitals. The impact of the medication distribution system on time allocation such as labour time, staffing workload or changes in work process was explored in the majority of studies (n=24). Six studies explored economic outcomes. Conclusions No medication distribution system was found to be better than another in terms of outcomes assessed in the studies included in the systematic review. All DDSs improved medication safety and quality of care, mainly by decreasing medication errors. However, many error types still remained—for example, prescribing errors. Centralised and hybrid systems saved more time than a decentralised system. Costs of medication care were reduced in decentralised systems mainly in high-expense units. However, no evidence was shown that implementation of decentralised systems in small units would save costs. More comparable evidence on the benefits and costs of decentralised and hybrid systems should be available. Changes in processes due to a new DDS may create new medication safety risks; to minimise these risks, training and reallocation of staff resources are needed.
... Nevertheless, in order to secure the pharmaceutical circuit, automated dispensation has proven its efficacy for solid drugs [30]. The problem remains for liquid formulations [31]. ...
Article
Full-text available
Homicidal poisonings remain rare and can be difficult to detect, especially in the elderly or in medical settings. In this atypical poisoning series, a young nursing assistant purposely poisoned thirteen residents of a nursing home and killed ten of them. The medications used were a mix of psychotropic medications (cyamemazine, loxapine, tiapride, risperidone, and mirtazapine), under liquid formulation, which were inducing malaise and coma. The forensic investigation included analysis of blood, urine, hair, and bone marrow and exhumations of seven corpses up to 3 years after the inhumation. Hair collected from a hairbrush of a cremated victim have been analyzed. Bone marrow sample preparation was based on a liquid/liquid triple extraction. Hair were incubated after decontamination overnight at 55 °C in methanol. Segmentation was possible for seven samples, except for delayed exhumation samples (n = 4) and hairbrush hair sample (n = 1). The extracts were then analyzed using gas chromatography coupled with mass spectrometry (GC–MS) for unknown screening and using liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS) for a targeted screening and quantification. Screenings revealed the presence of the same mix of psychotropic medications. Cyamemazine, mirtazapine, loxapine, tiapride, and risperidone hair concentrations were 6–17,458 pg/mg, 74–1271 pg/mg, 9–1346 pg/mg, 13–148 pg/mg, and 3–5 pg/mg, respectively. Cyamemazine bone marrow concentrations were 229 and 681 ng/g and 152–717 ng/mL in blood. Patients’ medications were also identified and quantified. This poisoning series provide analytical data that could support subsequent toxicological result interpretation in similar forensic cases.
... Difficulties with the ADCs in relation to multidose liquids (not exclusively CDs) and refrigerated drugs have also been reported elsewhere. 18 Nurses and pharmacists perceived CD governance to be more efficient with the ADC than with safe and registers. This is consistent with nurses' perceptions and time and motion studies in other clinical contexts. ...
Article
Full-text available
Background Governance of controlled drugs (CDs) in hospitals is resource intensive but important for patient safety and policy compliance. Objectives To explore whether and how storing CDs in an automated dispensing cabinet (ADC) in a children’s hospital intensive care unit (ICU) contributes to the effectiveness and efficiency of CD governance. Methods We conducted a mixed-methods exploratory study, comprising observations, interviews and audits, 3 months after ADC implementation. We observed 54 hours of medications activities in the ICU medication room (with 42 hours of timed data); interviewed nurses (n=19), management (n=1) and pharmacy staff (n=3); reviewed 6 months of ICU incident reports pertaining to CD governance; audited 6 months of CD register data and extracted logs of all ADC transactions for the 3 months following implementation. Data analysis focused on four main CD governance activities: safekeeping/controlling access, documenting use, monitoring, and reporting/investigating. Results Nurses and pharmacists perceived spending less time on CD governance tasks with the ADC. The ADC supported CD governance through automated documentation of CD transactions; ‘blind counts’; automated count discrepancy checks; electronic alerts and reporting functionalities. It changed quality and distribution of governance tasks, such as removing the requirement for ‘nurses with keys’ to access CDs, and allowing pharmacists to generate reports remotely, rather than reviewing registers on the ward. For CDs in the ADC, auditing and monitoring appeared to be ongoing rather than periodic. Such changes appeared to create positive reinforcing loops. However, the ADC also created challenges for CD governance. Most importantly, it was not suitable for all CDs, leading to workarounds and parallel use of a safe plus paper registers. Conclusions ADCs can significantly alter CDs governance in clinical areas. Effects of an ADC on efficiency and effectiveness of governance tasks appear to be complex, going beyond simple time savings or more stringent controls.
... The fact that these systems can improve the efficiency of drug distribution, as well as their ability to reduce medication errors, is controversial and depends on many factors, including how users design and implement systems (Fung et al. 2009). Nevertheless, several studies have shown a positive impact on the reduction of dispensing errors after the introduction of Automated Dispensing Systems (ADSs) in care units (Helmons, Dalton, and Daniels 2012); (Cousein et al. 2014) (Oswald and Caldwell 2007); (Rochais et al. 2014); (Tsao et al. 2014); (Grissinger 2012a). ...
Article
In this article, we propose to study one of the real problems of combinatorial optimization in public healthcare and also include in topics of supply chain management in healthcare sector; the assignment of drugs to different compartments of drawers. The aim is to place a set of drugs in the compartments of a drawer, making sure not to place two similar drugs (drugs with packaging or similar sounds but with different contents) in neighbouring compartments. During this research, we were able to establish analogies between the drug assignment problem and the SUDOKU grid filling problem. We will show and justify the interest of using Sudoku approach with some guidelines and effectiveness of this easy method through concrete examples in different cases.
Article
Background: Automated medication dispensing cabinets are ubiquitous in hospitals in the United States and prevalent in Canada, but they are still relatively new to health services elsewhere. The automation of medication management using distributed dispensing units is aimed at improving stock management and patient safety; however, the evidence for the latter remains equivocal, and the impact on nursing workflow is poorly understood. Objective: This study evaluated the impact on the nursing workflow of a distributed automated medication dispensing system. The research aimed to explore the acceptability and utility of this system in a variety of clinical settings and to investigate similarities and differences in the use of the dispensing cabinets across different clinical areas. Design: A cross-sectional design was employed. Setting: The setting was a newly constructed 450-bed regional Australian tertiary hospital. Participants: The study involved 174 registered nurses and 12 pharmacy assistant staff from general ward and specialty areas who were using the automated medication dispensing cabinets. Methods: Methods included a hospital-wide survey of users and an observation study of nursing workflow around the automated medication cabinets in specific clinical areas. Results: The majority of staff were satisfied with the system and were positive about the overall safety and security. Key concerns related to access delays, and increased time needed due to walking distance and interruptions from other staff. Staff perceived that the automated medication dispensing cabinet use slowed medication administration processes as a result of queueing, and it also had other impacts on workflow. The system was found to expedite processes around controlled/narcotic drug administration. Re-stocking requirements presented operational issues; pharmacy assistants were observed waiting for opportunities to complete re-stocking tasks in the face of competing clinical requirements. Nurses from general wards were more satisfied with the system than those from specialty areas. Conclusions: Automated medication dispensing cabinets were widely accepted by nurses in a large newly opened hospital in a variety of acute clinical areas despite disruptions to workflow. Adaptations for access were more acceptable to nurses in general wards than those in specialty areas prompting consideration of redesign to improve suitability. Tweetable abstract: Automated medication cabinets change nursing workflow because of queueing, interruptions from other staff and increased walking. Ward nurses are more accepting of such workflow disruptions than speciality area nurses #medicationsafety #nurseworkflow #nursesatisfaction (268 char).
Article
Résumé Afin de sécuriser le circuit du dispositif médical (DM), le déploiement d’armoires sécurisées au sein d’un bloc opératoire a été réalisé. L’objectif de cette étude est de déterminer l’impact sécuritaire, organisationnel et économique de la mise en place d’armoires sécurisées dédiées aux dispositifs médicaux (ASDM). La mise en place a eu lieu au sein d’un bloc de chirurgie cardiaque. L’impact sécuritaire a été évalué en comparant les taux de traçabilité des dispositifs médicaux implantables pré- et post-implantation. Un questionnaire de satisfaction réalisé auprès de la totalité des infirmières a complété cette analyse. Le montant des réapprovisionnements, l’évolution des stocks ainsi que les investissements à consentir pour le déploiement de l’ASDM ont fait l’objet d’une étude coût–bénéfice. D’un point de vue sécuritaire, le taux de traçabilité obtenu en un an a été excellent (100 %). Les utilisateurs ont été satisfaits à 87,5 % par ce nouveau système. L’ASDM a permis une diminution de la valeur des stocks, avec une réduction de 30 % pour les DM achetés et de 15 % pour les dispositifs médicaux implantables en dépôt-consignation. L’analyse coût–bénéfice a montré un retour sur investissement rapide. La réduction du stock réel (DM achetés) correspond à 46,6 % de l’investissement. Le déploiement d’armoires sécurisées dédiés aux dispositifs médicaux permet de sécuriser le stockage et la dispensation de ceux-ci. Cette technologie a aussi un impact économique non négligeable et est apprécié par les utilisateurs.
Chapter
Prozesse sind der zentrale Ansatzpunkt für risikoreduzierende Maßnahmen. Hierzu zählen auch die Implementierung und Optimierung der DNQP-Expertenstandards, Standardisierung Expertenstandards und die Standardisierung der Patientenübergaben und -identifikation. Es gilt die vielen Schnittstellen inner- und außerhalb des Krankenhauses durch geeignete Maßnahmen zu optimieren, um eine Sicherstellung der Versorgungskontinuität zu gewährleisten. Die interdisziplinäre und mittels Triage-System prioritätenorientierte ZNA spielt als erste Anlaufstelle eine wichtige Rolle. Ebenso müssen die Abläufe im Schockraum z. B. analog dem ATLS-Format geregelt sein. Chirurgische und diagnostische Fehler gilt es durch geeignete Maßnahmen soweit wie möglich zu reduzieren. Sichere Kommunikationstechniken ergänzen das Spektrum. Ein Medikamenten- und Hygienemanagement sowie ein proaktives Krisenmanagement runden die Maßnahmen ab. Stehen Behandlungsvorwürfe im Raum, hat sich die Zusammenarbeit mit Gutachterkommissionen und Schlichtungsstellen bewährt.
Article
Résumé Introduction De nombreuses technologies permettent de sécuriser le circuit du médicament telles que l’identification par radiofréquence (RFID). L’objectif principal est de décrire l’utilisation de la RFID en pharmacie hospitalière. Matériel et méthodes Il s’agit d’une revue de la littérature. Une recherche manuelle a été effectuée sur Google Scholar et sur PubMed afin de décrire le concept de RFID et de recenser l’utilisation de la RFID en pharmacie hospitalière. Résultats Sept articles ont été inclus. Trois décrivaient des preuves de concept sans évaluation. Une étude présentait une mesure objective favorable de retombées avec une exactitude de l’inventaire dans 100 % des cas et un gain de temps de remplissage. La RFID était utilisée dans le circuit du médicament afin d’optimiser les processus, d’accroître la traçabilité et la sécurité. Discussion Notre revue de la littérature a mis en évidence un nombre limité de publications sur l’utilisation de la RFID en pharmacie. La technologie RFID pourrait s’avérer utile dans la gestion de médicaments à coût élevé, incluant le remplissage de plateaux de réanimation et de plateaux pour les blocs opératoires. Conclusion D’autres études sont nécessaires afin de confirmer le rapport avantage–coût de cette technologie dans le circuit du médicament.
Article
Full-text available
Drug supply chain safety has become a priority for public health which implies a collective process. This process associates all health professionals including the pharmacist who plays a major role. The objective of this present paper is to describe the several approaches proven effective in the reduction of drug-related problem in hospital, illustrated by the Grenoble University Hospital experience. The pharmacist gets involved first in the general strategy of hospital drug supply chain, second by his direct implication in clinical activities. The general strategy of drug supply chain combines risk management, coordination of the Pharmacy and Therapeutics Committee, selection and purchase of drugs and organisation of drug supply chain. Computer management of drug supply chain is a major evolution. Nominative drug delivering has to be a prior objective and its implementation modalities have to be defined: centralized or decentralized in wards, manual or automated. Also, new technologies allow the automation of overall drug distribution from central pharmacy and the implementation of automated drug dispensing systems into wards. The development of centralised drug preparation allows a safe compounding of high risk drugs, like cytotoxic drugs. The pharmacist should develop his clinical activities with patients and other health care professionals in order to optimise clinical decisions (medication review, drug order analysis) and patients follow-up (therapeutic monitoring, patient education, discharge consultation).
Article
Full-text available
Results of the 2011 ASHP national survey of pharmacy practice in hospital settings that pertain to dispensing and administration are presented. A stratified random sample of pharmacy directors at 1401 general and children's medical-surgical hospitals in the United States were surveyed by mail. In this national probability sample survey, the response rate was 40.1%. Decentralization of the medication-use system continues, with 40% of hospitals using a decentralized system and 58% of hospitals planning to use a decentralized model in the future. Automated dispensing cabinets were used by 89% of hospitals, robots were used by 11%, carousels were used in 18%, and machine-readable coding was used in 34% of hospitals to verify doses before dispensing. Overall, 65% of hospitals had a United States Pharmacopeia chapter 797 compliant cleanroom for compounding sterile preparations. Medication administration records (MARs) have become increasingly computerized, with 67% of hospitals using electronic MARs. Bar-code-assisted medication administration was used in 50% of hospitals, and 68% of hospitals had smart infusion pumps. Health information is becoming more electronic, with 67% of hospitals having partially or completely implemented an electronic health record and 34% of hospitals having computerized prescriber order entry. The use of these technologies has substantially increased over the past year. The average number of full-time equivalent staff per 100 occupied beds averaged 17.5 for pharmacists and 15.0 for technicians. Directors of pharmacy reported declining vacancy rates for pharmacists. Pharmacists continue to improve medication use at the dispensing and administration steps of the medication-use system. The adoption of new technology is changing the philosophy of medication distribution, and health information is rapidly becoming electronic.
Conference Paper
The Notes section welcomes the following types of contributions: (1) practical innovations or solutions to everyday practice problems, (2) substantial updates or elaborations on work previously published by the same authors, (3) important confirmations of research findings previously published by others, and (4) short research reports, including practice surveys, of modest scope or interest. Notes should be submitted with AJHP's manuscript checklist. The text should be concise, and the number of references, tables, and figures should be limited.
Article
Context: Few data are available on the use and consequences of decentralized automated dispensing cabinets (ADCs) in institutional settings. Method: This descriptive study examined compliance with published guidelines on the implementation of decentralized ADCs. The primary objective was to evaluate overall compliance, as well as compliance with specific steps in the medication cycle. The study was carried out at the Centre hospitalier universitaire (CHU) Sainte- Justine, a 500-bed mother-and-child hospital. The 2008 guidelines of the Institute for Safe Medication Practices (US) concerning the safe use of decentralized ADCs and the associated self-assessment tool (2009) were used to evaluate compliance at 30 days and at 120 days after implementation. Results: From November 2009 to April 2010, 7 decentralized ADCs were brought into service at the CHU Sainte-Justine. Overall compliance with published guidelines increased from 66% to 74% between January and April 2010. For each process related to the safe use of the ADCs, the criteria were briefly described, along with the non-compliance components related to technological or organizational aspects of implementation. For each component for which practice was noncompliant with guidelines, the actions required to modify the equipment (i.e., technological aspects) were determined and conveyed to the manufacturer; similarly, modes of use requiring modification (i.e., organizational aspects) were determined and conveyed to the institution. Conclusion: This study has described the compliance of practices at the CHU Sainte-Justine with published guidelines of the Institute for Safe Medication Practices. The use of published guidelines can help to guide both the technological and organizational aspects of implementing decentralized ADCs.
Article
CONTEXT: Few data are available on the use and consequences of decentralized automated dispensing cabinets (ADCs) in institutional settings. METHOD: This descriptive study examined compliance with published guidelines on the implementation of decentralized ADCs. The primary objective was to evaluate overall compliance, as well as compliance with specific steps in the medication cycle. The study was carried out at the Centre hospitalier universitaire (CHU) Sainte-Justine, a 500-bed mother-and-child hospital. The 2008 guidelines of the Institute for Safe Medication Practices (US) concerning the safe use of decentralized ADCs and the associated self-assessment tool (2009) were used to evaluate compliance at 30 days and at 120 days after implementation. RESULTS: From November 2009 to April 2010, 7 decentralized ADCs were brought into service at the CHU Sainte-Justine. Overall compliance with published guidelines increased from 66% to 74% between January and April 2010. For each process related to the safe use of the ADCs, the criteria were briefly described, along with the non-compliance components related to technological or organizational aspects of implementation. For each component for which practice was noncompliant with guidelines, the actions required to modify the equipment (i.e., technological aspects) were determined and conveyed to the manufacturer; similarly, modes of use requiring modification (i.e., organizational aspects) were determined and conveyed to the institution. CONCLUSION: This study has described the compliance of practices at the CHU Sainte-Justine with published guidelines of the Institute for Safe Medication Practices. The use of published guidelines can help to guide both the technological and organizational aspects of implementing decentralized ADCs. [Publisher's translation].