Automated Dispensing Cabinets Research Articles

Automated dispensing cabinets and their impact on the rate of omitted and delayed doses: A systematic review

Use of automated dispensing cabinets (ADCs) is increasing in hospital settings. ADCs bring various potential benefits, among which are improvements to patient safety and reduction of medication errors. A core function of ADCs is to prevent medication stock outs by triggering an order when stock is reaching low levels. A quantifiable patient safety measure is the occurrence of omitted or delayed doses, which can range in severity from being negligible, to potentially fatal. The purpose of this review is to identify and synthesise the existing evidence regarding the impact of ADCs situated in secondary and tertiary care inpatient settings, on the rate of omitted and delayed doses as a specific subsection of medication errors. In April 2024 searches were conducted in Embase, PubMed and CINAHL, with additional articles discovered through citation searching and from colleagues. A total of 375 articles were returned from the search. Nine articles met the inclusion criteria. The most common reason for exclusion was due to lack of relevance. The included papers were focused on centres which had implemented six or fewer ADCs. The studies mostly presented findings which suggest ADCs have a positive impact on the rate of omitted or delayed doses, although crucially only two papers correlated missed doses due to unavailability of medications The studies highlighted other factors which should be considered prior to the implementation of ADCs. Factors included staffing requirement, type of stock held in the cabinets, and interoperability with other systems. Studies only reported omitted or missed doses, none reported results on delayed doses. It is widely accepted that ADCs can prevent medication unavailability but there is a paucity of evidence linking the improved availability of medications through the utilisation of ADCs with the perceived impact on missed or delayed doses. Further multi-centre studies are needed to determine this causality.

Factors influencing nurse satisfaction with Automated Medication Dispensing Cabinets

To improve efficiency, quality and safety of medication administration systems, hospitals have been implementing automated dispensing cabinets (ADCs) in healthcare units. The purpose of this study was to evaluate nursing staff’s level of satisfaction with ADCs by analyzing several aspects and differences in perceptions between groups of users. It being a fact that nurses are the end users of the ADC system, their perceptions and opinions are crucial to the success of this technological implementation. A cross-sectional survey was conducted in units with ADCs from a Spanish hospital (n = 97, 32.12%. response rate). Data were analyzed using comparisons between groups and principal component analysis (PCA). The results show that, in general terms, nursing staff have a high degree of satisfaction with ADCs, with order and organization being the most valued aspect. The type of clinical unit and personnel seniority explain some of the differences in valuation. PCA revealed the existence of two general dimensions of nurse satisfaction: efficiency and safety. From this study, conclusions can be drawn to help hospital managers achieve success in implementing ADCs in their centers.

Impact of automated dispensing solutions in long-term care facilities and closed-door pharmacies: A mixed methods study of medication management

BackgroundFinancial, operational, and clinical workflow impacts of deploying an automated dispensing cabinet (ADC) in long-term care (LTC) facilities based on actual observations have not been documented in peer-reviewed literature. ObjectivesTo evaluate the impact of a closed-door pharmacy (CDP) implementing an ADC with unique secure, removable, and transportable locked pockets in an unstudied setting (LTC facilities) for management of first and emergency dose medications. Practice DescriptionThis study was conducted in 1 CDP and 2 LTC facilities. Practice InnovationEnhancing emergency medication management and inventory tracking in an unstudied setting through implementation of an ADC system featuring unique electronically encoded medication storage pockets that can be prepared in the CDP, locked and securely transported to the LTC, and when inserted into ADC it informs staff of its presence, position, and contents. Evaluation MethodsMixed methods, pre- and poststudy to assess the impact of replacing manual emergency medication kits with an ADC. Outcomes were evaluated using rapid ethnography with workflow modeling; inventory and delivery reports; a nursing perception survey; and transactional data from the ADC during postimplementation phase. ResultsPharmacy technician preparation time and pharmacist checking time decreased by 59% and 80%, respectively, and standing inventory was reduced by more than $10,000 combined for the CDP and 2 LTCs by replacing emergency medication kits with the ADC. In the LTCs, this change led to a 71% reduction in emergency medication retrieval time, an increase in emergency medication utilization, and a 96% reduction in the cost of unscheduled deliveries. Over 70% of the nurses surveyed favored replacement of the emergency medication kits with the ADC system. ConclusionReplacing manual emergency medication kit with the described ADC system improved workflow efficiency in the CDP and LTC. It also significantly reduced unscheduled (STAT) deliveries and standing inventory and increased the availability of medications commonly used.

A Comparison of Inventory Management Models in Automated Dispensing Cabinets at a Large Academic Medical Center.

Purpose: To compare and evaluate 2 methods of inventory management in automated dispensing cabinets (ADCs). Methods: Ten profiled ADCs had 2 inventory management models implemented over 2 months. Implementation of the models on each ADC involved adjustment of par levels (desired accessible quantities of medication) and removal of medications not used in the past 90 days or more. The par levels of 5 ADCs were adjusted using a formula developed based on the economic order quantity model. The par levels of the other 5 ADCs were adjusted using a formula based on historical average daily usage. The study endpoints include stock out rate, vend:fill ratio, quantity of expired medications, and inventory carrying cost. Results: The total of number of medications stocked in the 10 ADCs was reduced from 3035 in a 2-month pre-implementation period to 2932 in a 2-month post-implementation period yielding a reduction of inventory carrying cost by $11 011. The mean stock out rate in both study groups increased and vend:fill ratio decreased after implementation. The quantity of expired medications increased in the modified economic order quantity formula inventory management model and decreased in the average daily usage inventory management model. Conclusion: The implementation of 2 inventory management models on ADCs had a negative impact on stock out rate and vend:fill ratio, a mixed impact on quantity of expired medications, and a positive impact on inventory carrying cost reduction.

Where’s my med? Improving patient-specific medication storage for emergency department boarders

BackgroundThere have been an increased number of patients boarding in the emergency department (ED) who often experience delays in receiving nonurgent medications not typically stocked in the ED automated dispensing cabinets (ADC). ObjectivesTo describe a quality improvement project designed to decrease the amount of time it takes nursing staff to obtain patient-specific medications for patients boarding in the ED at a community hospital. Practice descriptionPrior to this quality improvement project, standard practice was for pharmacy staff to send all medications to the ED based on inpatient cart fill lists, resulting in a 24-hour supply being sent at 1 time. Medications that were not immediately due were often misplaced by ED staff as there was no standard location to store them. Practice innovationA separate location for each examination room in the ED was created in 1 central ADC to store patient-specific medications. Pharmacy staff were instructed to load medications directly into the ADC for expected long-term behavioral health boarders. Nursing staff were instructed to place future doses in the newly created locations and were educated on how to locate medications utilizing the electronic medication administration record. Evaluation methodsED nursing staff timed how long it took them to obtain medications for 40 boarding patients before and after implementation of the quality improvement initiatives. ResultsThe postimprovement intervention decreased the amount of time it took to obtain medications for forty ED boarding patients by 66%, from an average of 37.7 minutes at baseline to 12.9 minutes postintervention. This was a statistically significant improvement via an unpaired t-test (P < 0.0001 with a 95% CI from 15.3 to 34.47). This was rechecked after 1 year and the improvement was sustained. ConclusionA multidisciplinary team-based quality improvement initiative was successful in reducing the time it took to obtain medications for ED boarding patients.

Initial observations on the impact of implementation of automated dispensing cabinets for Human Normal Immunoglobulin on data and inventory management

Abstract Introduction Human Normal Immunoglobulin (HNIg) is a plasma-derived blood product used to treat a variety of diseases. Global supply problems1 have increased focus on HNIg stewardship, including mandatory recording of HNIg usage on the National Immunoglobulin Database2 (NIgD). This is a dispensary-based process and determines HNIg stock allocation and remuneration. Departmental audits identified significant delays and inconsistencies in data uploaded to NIgD. Inventory management issues caused a number of stock losses in the last financial year. A paper-based HNIg recording system was replaced with the use of Automated Dispensing Cabinets (ADCs). This enabled the development of an electronic ADC batch number report, from dispensing data, that matched fields required for electronic upload to NIgD, making the process more robust and proficient. Aim To measure the impact of implementation of ADCs for HNIg on data and inventory management. Objectives included identifying: Percentage of HNIg dispensed uploaded accurately to NIgD within one month of dispensing; Number of HNIg stock adjustments; Staff time required for activities associated with HNIg management. Methods Approval was obtained from the Trust Pharmacy Research and Audit Committee. The need for ethical submission was waived. Pre-implementation (May-July 2022) and post-implementation (February-April 2023) HNIg dispensing data was compared to the data uploaded to the NIgD for discrepancies. Electronic inventory reports were generated to identify the number of unexplained stock adjustments made. Time and motion methods were used to observe staff time associated with dispensing, stock management of HNIg in ADCs and data upload activities. Results Pre-implementation: 20.7% (3762.5g/18,217g) of HNIg (23.7% of dispensing episodes; 66/279) were inaccurately uploaded or absent on the NIgD and three stock adjustments were made. Post-implementation: 12% (2325g/19,347g) of HNIg (10.8% of dispensing episodes; 31/286) were inaccurately uploaded or absent on the NIgD and zero stock adjustments were observed; Mean time for dispensing HNIg reduced from 17 minutes/prescription to 8 minutes/prescription; Time spent uploading data to NIgD reduced from 5 hours to 1.75 hours/month. Discussion/Conclusion The use of ADCs has improved accuracy and completeness of data upload to NIgD. Direct observations have cited unregistered or finished patient episodes, dispensing procedural compliance, and user familiarity with the system as common reasons for incomplete data uploads to NIgD. Training is vital in assuring data quality and completeness. The new ADC process had unexpected consequences of forcing dispensing procedure compliance to improve uploads, whilst reducing dispensing times. It led to improved stock control and removed upload burden from dispensers. ADC stock discrepancy alerts allowed staff to proactively resolve discrepancies in real time. Time taken for additional processes to support management of stocks in ADCs, including monthly cycle counts, were important considerations for implementation. The key advantage of using ADC batch number reports is being able to upload as a single batch monthly without having to log into individual patient records on the system. It facilitates early identification of failed upload attempts, supporting resolution. Further work focusing on fully aligning naming conventions to NIgD should deliver additional efficiencies; minimising manipulations currently required prior to upload.

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

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.

Hiding in Plain Sight: Quantifying Salbutamol and Ipratropium Inhaler Wastage in Hospitals.

Previous studies have found significant inhaler wastage in the inpatient setting, which contributes to unnecessary health care expenditures. Wastage may involve inhalers available in automated dispensing cabinets (ADCs). To evaluate whether salbutamol and ipratropium inhalers were unnecessarily withdrawn from ADCs for hospital inpatients. This cross-sectional study included patients from 16 health care facilities in British Columbia. ADC reports were run for the period August 2021 to January 2022 to identify salbutamol and ipratropium inhalers removed from ADCs. Over the study period, 8.3% (2180/26 324) of salbutamol and ipratropium inhalers were withdrawn from ADCs unnecessarily for the same patient encounter within a 2-day timeframe, and another 1118 (4.2%) represented instances when multiple inhalers were withdrawn for the same patient at the same time. Overall, 12.5% (3298/26 324) of all salbutamol and ipratropium inhalers were withdrawn unnecessarily. The total cost of these inhalers was about $31 600 over the 6-month period. This evaluation revealed considerable wastage of inhalers, leading to wasted expenditures. Other health authorities should conduct similar analyses to determine whether similar problems exist in their settings.

Issues Faced by Pharmacy Technicians While Maintaining Automated Dispensing Cabinets and How to Overcome Them in the National Guard Health Affairs in Riyadh: A Qualitative Study.

Objectives Technology is rapidly evolving to improve patient safety and increase healthcare providers' efficiency. Automated dispensing cabinets (ADCs) are an example of a technology that has been used to facilitate patient safety. As with any other technology, there are benefits and drawbacks associated with the use of ADCs. In this study, we aim to identify the issues related to maintaining ADCs in National Guard Health Affairs (NGHA) hospitals from the pharmacy technicians' perspective and find some solutions to overcome the problems that complicate the usability of the ADCs. Methods A cross-sectional qualitative study was conducted using an open-endedquestionnaire. It was completed by 30 pharmacy technicians who deal with ADCs in NGHA hospitals. Results Three themes were extracted from the questionnaire: "issues faced by pharmacy technicians before filling the ADCs,""issues faced by pharmacy technicians during filling the ADCs,"and "issues faced by pharmacy technicians after filling the ADCs." Discussion and conclusion This study portrayed a better understanding of the issues faced by pharmacy technicians who deal withADCs based on their experience. It will help stakeholders to make appropriate decisions and improve the workflow for a successful ADCimplementation.

MT10 Clinical, Operational, and Economic Impacts of Automated Medication Dispensing Cabinets in Perioperative and Ambulatory Surgical Center Settings: A Systematic Literature Review

Implementation of automated dispensing cabinet (ADC) technology in hospitals has shown to improve clinical, operational, and economic outcomes. Safety and professional organizations recommend the adoption of ADCs in outpatient care areas, such as Ambulatory Surgical Centers (ASCs) and perioperative settings outside of the hospital. However, implementation of this technology in these settings has lagged significantly. The objective of this study was to assess the documented impact of ADCs in ASCs and perioperative care areas.

Reducing Medication Errors by Adopting Automatic Dispensing Cabinets in Critical Care Units

Medication errors can have severe consequences and threaten patient safety. The patient safety-related benefits of automated dispensing cabinets (ADCs) have been reported by several previous studies, including a reduction in medication errors in intensive care units (ICUs) and emergency departments. However, the benefits of ADCs need to be assessed, given the different healthcare practice models. This study aimed to compare the rates of medication errors, including prescription, dispensing, and administrative, before and after using ADCs in intensive care units. The prescription, dispensing, and administrative error data before and after the adoption of ADCs were retrospectively collected from the medication error report system. The severity of medication errors was classified according to the National Coordinating Council for Medication Error Reporting and Prevention guidelines. The study outcome was the rate of medication errors. After the adoption of ADCs in the intensive care units, the rates of prescription and dispensing errors reduced from 3.03 to 1.75 per 100,000 prescriptions and 3.87 to 0 per 100,000 dispensations, respectively. The administrative error rate decreased from 0.046 to 0.026%. The ADCs decreased National Coordinating Council for Medication Error Reporting and Prevention category B and D errors by 75% and category C errors by 43%. To improve medication safety, multidisciplinary collaboration and strategies, such as the use of automated dispensing cabinets, education, and training programs from a systems perspective, are warranted.

Pharmacy practice in hospital settings in GCC countries: Dispensing and administration

PurposeTo outline dispensing and administration practices in hospital pharmacy across the Gulf Cooperation Councils (GCC) countries’ hospitals. Paucity of data in appraising hospital pharmacy practice in GCC regions motivated us to conduct this study. MethodsA modified survey questionnaire was prepared from the American Society of Health-System Pharmacist (ASHP) survey questions. Three major domains of questions for general characteristics of the medication use process for dispensing and administration were identified. These were, (1) medication distribution system, and medication distribution technology, (2) technology used to compound sterile preparations, compounding I.V. medication and method of compounding nutrition support preparations, (3) medication administration practices, medication orders, medication administration records (MARs), and technician activities. A list of hospitals was obtained from the Ministry of Health of the targeted GCC countries. A secure invitation link containing a survey questionnaire was sent to the participants directly. ResultsSixty-four hospitals responded to this survey. The overall response rate was 52%. Most surveyed hospitals have centralized inpatient medications distribution system (75.0%). About 37.5% of hospitals used automated dispensing cabinets (ADCs) in their patient care areas. Compounding sterile preparations in the pharmacy, barcode verification technology, workflow management technology, and robotic technology were used by 17.2%, 15.6%, and 4.7% of hospitals, respectively. In using safety technology for medication administration, almost all hospitals have partially or completely implemented an electronic health record (EHR). About 40.6% of hospitals used electronic medication administration records (e-MARs), 20.3% used bar-code-assisted medication administration (BCMA), and 35.9% used smart infusion pumps. ConclusionThe results of this survey revealed an opportunity to improve the medication use management process on dispensing and administration practices in hospitals in GCC countries.

439: TIME TO FIRST ANTIBIOTICS ADMINISTRATION IN THE ICU

Introduction: The Surviving Sepsis Guidelines recommend IV antibiotics (ABX) be administered within 1 hour to patients with sepsis or septic shock. Delays in ABX administration in this patient population have been shown to increase mortality. We sought to determine the time to first IV ABX in ICU patients and to identify barriers resulting in delayed IV ABX administration. Methods: This was an IRB-approved retrospective review conducted between May 2021 and July 2021 involving adult patients across three ICUs (2 medical and 1 surgical) at an academic medical center. All patients who received a first-dose IV ABX in the ICU were included. Descriptive statistics were used to characterize the data. Mann-Whitney U test was used to compare the median times to administration between IV ABX dispensed from an automated dispensing cabinet (ADC) versus those from the pharmacy (PHARM). Results: A total of 250 first IV ABX doses (84% MICU and 16% SICU) in 90 patients were included. There were an average of 2.8 first doses of IV ABX per patient during the study period, half of which were dispensed from ADC and half from PHARM. The median time from order input to patient administration (n=211) was 68 min (40-109). The median time from order input to patient administration was longer if the IV ABX was dispensed from PHARM vs ADC [89 min (60-128) vs 54 min (29-76); p< 0.001]. Vancomycin also had a longer median time from order input to administration if dispensed from PHARM vs ADC [92 min (58-154) vs 39 min (24-71); p< 0.001]. A total of 88 IV ABX were dispensed within 60 min, with 82% from ADC vs 18% from PHARM, 81 ABX were dispensed within 60-120 min, with 65% from ADC vs 35% from PHARM, and 42 IV ABX were administered >120 min, with 59% from ADC vs 41% from PHARM (Χ2=9.42; p=0.009). Conclusions: The median time to IV ABX administration in the ICU was near recommendations from guidelines. One limitation was the inability to classify patients as having sepsis or septic shock. Delays in time to IV ABX administration were primarily observed with medications dispensed by PHARM as compared to ADC.

1207: ANTIBIOTIC ADMINISTRATION TIMES BEFORE AND AFTER ADDITION TO THE AUTOMATED DISPENSING CABINETS

Introduction: The Surviving Sepsis Campaign guidelines recommend prompt intravenous antibiotic administration within one hour for patients with septic shock or a high likelihood of sepsis. To improve timeliness of antibiotic administration, piperacillin-tazobactam and cefepime were stocked in the automated dispensing cabinets (ADCs) in five intensive care units (ICU).The aim of this study was to evaluate the time from order entry of piperacillin-tazobactam or cefepime to administration in ICU patients before and after addition to the ADC. Methods: This was a retrospective study of adult, presumed septic patients who received their first dose of piperacillin-tazobactam or cefepime in an ICU. Patients included from March 23, 2019 – March 23, 2020 received antibiotics from the inpatient pharmacy (Pre-ADC) and those from March 25, 2020 – March 25, 2021 received piperacillin-tazobactam and cefepime from the ICU ADCs (Post-ADC). The primary outcome was time from antibiotic order entry to administration. Secondary outcomes included time from order entry to pharmacy verification, in-hospital mortality, and hospital length of stay. Results: One thousand eight hundred and three patients were included with 903 patients in the Pre-ADC group and 900 in the Post-ADC group. Baseline characteristics were similar, and respiratory infection was the most common antibiotic indication (37% Pre-ADC vs. 36% Post-ADC). Additionally, more Post-ADC patients had isolation precautions at the time of antibiotic administration (15% Pre-ADC vs. 19% Post-ADC, p=0.04). The median (IQR) time (minutes) from order of antibiotics to administration was shorter in the Pre-ADC group at 57 (32-97) vs. 75 (43-126) Post-ADC (p < 0.001). Median (IQR) time (minutes) from pharmacy verification to nursing administration was 51 (28-91) Pre-ADC vs. 75 (43-126) Post-ADC, p< 0.001. Hospital length of stay and mortality were similar between the groups. Conclusions: Adding piperacillin-tazobactam and cefepime to the ICU ADCs did not result in earlier antibiotic administration in presumed septic patients. Due to the timing of this study, the COVID-19 pandemic and isolation precautions likely confounded the results. Further investigation of antibiotic administration barriers is needed to optimize patient care and meet Surviving Sepsis Campaign recommendations.

Optimizing Medication Distribution in Automated Dispensing Cabinets: Dashboard Implementation and Evaluation

Purpose: To determine the impact of a business intelligence dashboard tool to optimize automated dispensing cabinets (ADCs). Methods: A pre-post implementation design was used to evaluate key performance indicators (KPI) before and after the implementation of a dashboard tool to optimize ADCs. Eleven ADCs were optimized in 2 phases according to dashboard recommendations: (1) removal of unused medications over 90 days, (2) adjusting periodic automatic replenishment (PAR) levels, and (3) addition of commonly dispensed medications. The KPI measures that were assessed included inventory cost, no. of stocked medications, stockout percentage, vend to refill ratio, and missing dose messages from nursing. An interrupted-time-series regression was used to quantify the impact of ADCs on the means of measured KPIs. Results: Differences in mean distribution of all KPIs, except missing dose, between the pre- and post-ADC periods during the Phase 1 period were statistically significant: inventory cost (54.2 vs 56), stockout percentage (1.55 vs 1.12), vend to refill ratio (6.83 vs 6.14), and missing dose messages (221 vs 229). Only the mean ADC utilization (57.3 vs 64) and missing dose (228 vs 179) were statistically different between the pre- and post-ADC periods in Phase 2. The interrupted-time-series analysis showed that Phase 1 optimization significantly reduced the cost of inventory (β = −$1.238.00, P < .01), no. Stocked medications (β = −8.2, P < .01), percent stockout (β = −.49%, P < .01), vend-to-refill ratio (β = −1.29%, P<.01) and ADC utilization (β = −.2, P < .01). Conclusion: Automated dispensing cabinets optimization, through the use of a dashboard tool, had a positive impact on almost all measured KPIs.

Adjusting vasopressin availability and formulation: A cost-savings initiative.

The increase in vasopressin price has required many healthcare systems to consider cost-saving strategies. To combat rising medication costs, our institution changed formulations from 50 units/250 mL to 20 units/100 mL and removed vasopressin from automated dispensing cabinets (ADCs). This retrospective review occurred at a 545-bed academic medical center with 97 adult intensive care unit beds. Adult patients receiving a continuous vasopressin infusion were included with no exclusion criteria. A 1-month period was assessed before and after changing the formulation (pre and post groups, respectively). Duplicate bags compounded by pharmacy and bedside teams were also assessed in the pre group. The primary outcome was the estimated annual cost savings due to formulation change with a secondary outcome of estimated annual cost savings due to removal of vasopressin from ADCs. Each 20-unit vial of vasopressin cost $183.21 (wholesale acquisition cost) at the time of the study. In the pre group, 39 patients requiring a vasopressin infusion were allocated an average of 2 bags each costing $1,099.26 per patient. In the post group, 41 patients required an average of 4 bags each costing $732.84 per patient. With respect to the primary outcome, a savings of $366.42 per patient and an average of 40 patients per month would lead to an annual cost savings of $175,881.60. Secondary outcome analysis identified 9 duplicate bags prepared in the pre group; therefore, removal of vasopressin from ADCs is estimated to provide additional cost savings of $59,360.04. The estimated annual cost savings from both initiatives is $235,241.64. Changing the vasopressin formulation and removing it from ADCs resulted in a significant cost savings to the health system.

Guidelines aim to improve automated dispensing cabinet safety

Automated dispensing cabinets (ADCs) seem like simple devices, but there is an astounding number of decisions needed to enable their safety and efficiency. In August 2021, ASHP released updated guidelines on the safe use of ADCs.

Issues Facing the Pharmacy Technicians While Maintaining the Automated Dispensing Cabinets (ADCs) and How to Overcome Them in the National Guard Health Affairs (NGHA) in Riyadh: A Qualitative Study

Issues Facing the Pharmacy Technicians While Maintaining the Automated Dispensing Cabinets (ADCs) and How to Overcome Them in the National Guard Health Affairs (NGHA) in Riyadh: A Qualitative Study

Challenges of Digital Commons: A Qualitative Study of an Automated Dispensing Cabinet in a Paediatric Intensive Care Unit.

Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses' use of an ADC in a paediatric intensive care unit with 54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses' information needs, patients' medication needs, and ADC design. Running out of medications was a 'tragedy of the commons'. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign.

Evaluation of an Automated Dispensing Cabinet in Paediatric Intensive Care - Focus on Controlled Medications.

Evidence is limited of automated dispensing cabinets (ADCs) impact on effectiveness and efficiency of controlled drugs' (CDs) governance processes. We carried out a mixed-methods study of an ADC in an intensive care unit. We found ADC improved effectiveness and efficiency of governance of CDs through secure storage, alerts and automated recording of transactions. Limitations were associated with ADC design and 'fit' between ADC and some types of CDs.