Patient-centred medication management: How to enhance patient safety and reduce the work burden for medical staff by digitalised closed-loop cabinets

Abstract

Medication management is both an economic challenge and a patient safety issue. In German hospitals between 19 per cent and 35 per cent of all failures causing harm to patients are attributable to medication errors. As a consequence, an estimated 15,000 patients die each year. In addition, about 14 per cent of the average length of stay is assignable to unplanned drug interactions. Independent of patient risks, health impairments and outcome deficits, every non-fatal medication error leads to additional costs totalling €3,000 on average. Nurses, in particular, who typically suffer from work overload, are affected by error-prone medication logistics. Between 26 per cent and 44 per cent of all failures occurring in the medication administration process result from activities in which nurses are substantially involved. International best-in-class hospitals like the Mayo Clinic (Phoenix), Scripps (San Diego), OLVG (Amsterdam) and Guy’s and St. Thomas’ (London) have been using automated dispensing systems (smart cabinets) for medication safety reasons for many years. Moreover, in the USA, automated medication dispensing cabinets are ubiquitous in various types of hospitals and have an implementation rate of 89 per cent. But in German hospitals, this technology is still nowhere to be seen. In 2020, the German government, via legal act, decided that all hospitals must implement a closed-loop medication administration system in combination with a unit dose drug delivery by January 2025 in order to minimise medication errors. Otherwise, a penalty of 2 per cent of the total hospital revenue would have to be paid. Derived from best-practice reports in the literature, this paper explores the benefits of smart cabinets in terms of economic efficiency, patient safety, reduced work burden and employee acceptance. Furthermore, the reasons why many German hospital decision makers refuse to implement smart cabinets are presented and analysed. Finally, based on all this information, a generic medication administration process has been developed to provide a blueprint for a successful implementation of smart cabinets as an electronically based backbone in a closed-loop medication administration system.