From their inception in the early 1990s, automated dispensing systems continue to assist health institutions to manage their operating costs and enhance patient safety by providing increased control over controlled substances and floor stock medications in patient-centered settings.
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The systems have also been noted to not only increase productivity and sustain competitiveness, but also improve charge capture and documentation accuracy, and reduce personnel labor costs. However, serious concerns have been raised about the efficacy of the automated dispensing devices to reduce or completely erase medication errors, with some analysts suggesting that these devices may indeed introduce much potential for medication errors.
This policy directive seeks to provide a workable remedy to this serious challenge by suggesting that health institutions need to:
- purchase adequate number of the automated dispensing systems to ensure availability of sufficient single-dose dispensing units;
- fast-track their compliance with government regulations requiring the linking of pharmacy computer systems to drug cabinets operated by the automated dispensing devices;
- update their systems with software that limits open access to all medications in the system’s drawer, and;
- provide adequate training on the use of automated dispensing devices to the nursing personnel.
The convergence of technology witnessed in the 21st century has enabled many health institutions worldwide to adopt technology solutions which inarguably assist in the management of operating costs and enhancement of patient safety.
Automated dispensing systems (ADS) are one such solution that, since their inception in the early 1990s, have enabled health institutions to manage operating costs over time, open new markets for the modern pharmacy, and promote patient safety by providing increased control over controlled substances and floor stock medications in patient-centered settings.
In addition to the mentioned benefits, many health institutions are now using ADS for storing and dispensing practically all scheduled medications thereby eradicating manual dispensing and delivery processes (Brown, 2006).
The eradication of manual medication dispensing techniques through the employment of automated systems has been noted to not only increase productivity and sustain competitiveness but also to improve charge capture and documentation accuracy as well as curtail personnel labor costs (Dumitru & Grumpper, 2009).
As observed by industry players, “…automated dispensing devices are increasingly incorporating bar code labeling and scanning into the replenishment process, thus improving restocking accuracy and potentially improving medication safety” (Brown, p. 333).
Despite the above named gains, serious concerns have been raised about the efficacy of ADS to reduce or completely erase medication errors, with a certain section of stakeholders in the health industry arguing that majority of automated dispensing devices found in the market may indeed introduce much potential for medication errors (Oswald & Caldwell, 2007).
Indeed, some critics argue that the potential for dispensing devices to introduce medication errors is one key factor why these noble technological innovations may fail to achieve their objectives
Research into automated dispensing devices demonstrates that most medication errors occur due to one or several of the following factors:
- Health institutions purchasing an inadequate number of automated dispensing systems, which precludes the facility’s capacity to maintain a “well-controlled, Single-dose access” drug dispensing system resulting in a much higher possibility for medication selection, administration and management inaccuracies (Brown, 2006);
- In spite of sustained pressure from government and other regulatory bodies, a sizeable number of health institutions are yet to link their pharmacy computer systems to cabinets in such a manner that limits nursing personnel from acquiring doses that are not explicitly ordered for patients (Brown, 2006);
- Nursing personnel retrieving an erroneous medication or dosage primarily because of open access to all medications in the ADS drawer (Dumitru & Grumpper, 2009).
- Carelessness or lack of verification of drug labels by the nursing personnel due to a perceived conviction that the system is automated and, therefore, not as vulnerable to inaccuracies (Oswald & Caldwell, 2007);
- Medications stored on the wrong cabinet either because one or more dosages unintentionally fell into the incorrect slot or due to a pharmacy replenishing mistake (Brown, 2006).
These challenges are already eating into gains made so far by ADS because medications errors are feared to put the safety of patients into jeopardy. It is imperative to note that the provision of erroneous medications to patients is a leading case of low satisfaction to the services on offer in a particular health institution (Oswald & Caldwell, 2007).
To ameliorate these challenges facing the efficient implementation of ADS in healthcare settings, this policy directive proposes the following:
- Health institutions need to purchase an adequate number of automated dispensing devices and, in particular, ensure the availability of adequate single-dose automated dispensing units. These units should be well labeled to avoid medication errors;
- Health institutions need to fast-track their compliance with government regulations requiring the linking of pharmacy computer systems to drug cabinets operated by automated dispensing devices. This measure is specifically aimed at synchronizing and aligning drug dispensing procedures across the health institution;
- Health facilities already using these automated systems are encouraged to update their systems with software that limits open access to all medications in the ADS drawer. This software requires a password to access the medications drawers, hence will curtail retrieval of erroneous medication by nursing personnel, and;
- Adequate training on the use of automated dispensing devices needs to be provided to the nursing personnel to enable them efficiently handle the devices and reduce medication errors. The training should particularly focus on demonstrating how the devices are replenished and the importance of verifying drug labels before dispensing.
Health facilities are requested to comply with this policy directive with immediate effect. It is expected that quantifiable outcomes in the reduction of medication errors and the enhancement of patient safety will be achieved in the short-term.
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Brown, T.R. (2006). Handbook of institutional pharmacy handbook. Bethsda, MD: ASHP Publications
Dumitru, D., & Grumpper, K. (2009). The pharmacy informatics primer. Bethsda, MD: ASHP Publications
Oswald, S., & Caldwell, R. (2009). Dispensing error rate after implementation of an automated pharmacy carousel system. Journal of Health-System Planning, 64(13), 1427-1431. Retrieved from Academic Search Premier Database