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Journal articles on the topic 'Automated Medication Dispensing Cabinet'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Lupi, Kenneth E., Kevin M. Day, James F. Gilmore, and Jeremy R. DeGrado. "Evaluation of a Clinical Pharmacist-Led Automated Dispensing Cabinet Stewardship Program at a Tertiary Academic Medical Center." Journal of Pharmacy Practice 33, no. 5 (January 17, 2019): 576–79. http://dx.doi.org/10.1177/0897190018823471.

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Background: There is little guidance regarding the best methodology or frequency to optimize automated dispensing cabinets. Clinical pharmacists are in the unique position to make decisions regarding automated dispensing cabinet inventory to best serve their specific patient population. Objective: The purpose of this evaluation was to determine if automated dispensing cabinet optimization by clinical pharmacists would affect the number of dispenses from central pharmacy, number of stockouts, and inventory cost. Methods: A retrospective analysis was completed to evaluate the quantity of medications dispensed from a central pharmacy department over 2 separate 2-month periods, with optimization of automated dispensing cabinets occurring in between. The differences in quantity of medications dispensed and redispensed, as well as the number of stockouts and inventory cost on all automated dispensing cabinets, were compared pre- and postintervention. Results: There were 1132 medication additions, 262 medication removals, and 167 medication par level adjustments. Medications dispensed from central pharmacy were decreased by 12% from the preintervention group to the postintervention group. The number of stockouts per cabinet per day also decreased from 0.75 to 0.61 in the pre- and postintervention groups, respectively. The inventory-at-par cost level was decreased by 15%. Conclusion and Relevance: Automated dispensing cabinet optimization by clinical pharmacists led to increased medication availability on inpatient units and decreased the number of dispenses from central pharmacy. Simple yet meaningful interventions can be taken to improve multiple medication distribution metrics simultaneously.

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Vu, Tony, and Yifan She. "Automated Dispensing Cabinet Optimization in a Level 2 Trauma Center." Journal of Contemporary Pharmacy Practice 67, no. 4 (2021): 17–21. http://dx.doi.org/10.37901/jcphp20-00005.

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Introduction Opportunities have been identified regarding timely delivery of medications due to lack of ADC inventory related to stock outs or other variances in pharmacy workflow (i.e. compounding and distribution times). These opportunities for improvement impact patient care and result in both nursing and pharmacy staff frustration. Additionally, there are significant costs associated with unused medications stored in ADCs, taking up valuable real estate that would otherwise house more opportune inventory. This situation has created a need for more efficient management of the ADC inventory. Currently, research in the topic area is sparse. We hypothesize that the systematic management and oversight of ADC inventory will demonstrate a significant improvement in key performance indicators and provide insight to the current gaps in knowledge. Methods This study will be a continuous quality improvement project with a combination of retrospective data review and prospective optimization interventions of automated dispensing cabinets (Pyxis®). Interventions include review and adjustment of ADC par levels, removal of unused/stagnate medications, standardization of stock, and continual review of ADC inventory turns and associated optimization opportunities. The primary outcomes are the change in vend/fill ratio from baseline, change in medication stockout percentage from baseline. Results There was no significant difference in vend/fill ratio after the optimization phase compared with baseline [Difference 0.13 (11.56 ± 6.1 vs. 11.43 ± 5.41) respectively, (p=0.84)]. Medication stockout percentage was also found to be similar with baseline [Difference -0.05 (0.71% ± 0.12 vs. 0.76% ± 0.08) respectively, (p=0.37)]. For secondary outcomes, the change in blind stockout percentage from baseline was -0.04 [0.13 ± 0.02 vs. 0.17 ± 0.02, (p=0.004)] and the change in medications dispensed per day from baseline was 317 [2656 ± 143 vs. 2339 ± 200, (p=0.0002)]. Conclusion Optimization of automated dispensing cabinets yielded marginal improvements in vend/fill ratio and stockout percentage and significantly improved overall efficiency through an increase in the number of medications stocked in ADCs and number of medications dispensed per day from ADCs. Evaluation of more clinically significant performance indicators may better characterize the benefits from the optimization process.

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Nanni, Alexis N., Trusha S. Rana, and Daniel H. Schenkat. "Screening for expired medications in automated dispensing cabinets." American Journal of Health-System Pharmacy 77, no. 24 (October 22, 2020): 2107–11. http://dx.doi.org/10.1093/ajhp/zxaa318.

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Abstract Purpose Results of a study to quantify rates of identification of expired medications in automated dispensing cabinets (ADCs) are reported. Methods A pre-post analysis was conducted to determine the effect of various types of ADC audits on rates of finding expired medications in ADCs. For the experimental phase of the study, 4 ADCs at the main campus of an academic medical center were randomly assigned to receive one of 4 interventions: (1) monthly audits of all ADC pockets, (2) monthly audits of matrix (open pocket) drawers only, (3) monthly audits of unassigned pockets only, and (4) no additional intervention. Results At baseline, rates of finding expired medication doses in the 4 ADCs ranged from 0.4% to 0.7%. During the 3-month experimental period, rates of finding expired medication doses ranged from 0.1% to 0.3%. During a final audit 1 month later, the ADC targeted for monthly audits of all pockets was found to contain no expired doses, with an overall improvement in expired-dose rates for all audited ADCs observed over the course of the 4-month study. The average time to perform a full audit for an ADC with about 340 pockets was 1 hour, or 15 seconds per pocket. The average time to perform matrix drawer–only audits averaged around 45 minutes, or 11 seconds per pocket. The average time to perform audits of unassigned matrix drawers averaged 30 minutes, or 10 seconds per pocket. Conclusion Auditing of all ADC pockets on a monthly basis appears to be an effective method of reducing the rate of identification of expired medications in ADC pockets.

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Neville, Michael W. "A Training and Communications Team Develops Online Learning Modules in Response to JCAHO Standard TX 3.5.2." Hospital Pharmacy 40, no. 5 (May 2005): 415–19. http://dx.doi.org/10.1177/001857870504000508.

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Implementing house-wide training that affects multiple disciplines requires thoughtful and deliberate action. In response to JCAHO recommendations that require pharmacists to review all medication orders prior to medication dispensing, Emory Healthcare's pharmacy and nursing staff formed a coalition to improve the safety of the medication process using the Pyxis Profile automated cabinets. The Training and Communications Team (T&CT) developed online modules to inform staff members about new medication safety standards, required upgrades to the automated dispensing cabinets, and methods to avoid medication errors. Post implementation surveys indicated an overwhelming success of the education process.

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Cohen, Michael R. "Insulin Preparation Error by Physician; Should Zosyn Be Available in Automated Dispensing Cabinet Stock?; Medication List Filing Error; Institute for Safe Medication Practices Launches First Self-Assessment of Automated Dispensing Cabinet Safety." Hospital Pharmacy 44, no. 9 (September 2009): 730–32. http://dx.doi.org/10.1310/hpj4409-730.

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These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

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6

Cochran, Gary L., Ryan S. Barrett, and Susan D. Horn. "Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies." American Journal of Health-System Pharmacy 73, no. 15 (August 1, 2016): 1167–73. http://dx.doi.org/10.2146/ajhp150760.

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Abstract Purpose The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse–nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. Methods Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician’s order. Chi-square analysis and Fisher’s exact test were used to measure differences between groups of medication-dispensing procedures. Results Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). Conclusion Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs.

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Kelm, Matthew, and Udobi Campbell. "Improved Arrangement and Capacity for Medication Transactions: A Pilot Study to Determine the Impact of New Technology on Medication Storage and Accessibility." Hospital Pharmacy 53, no. 5 (March 8, 2018): 338–43. http://dx.doi.org/10.1177/0018578718757660.

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Purpose: A new-generation automated dispensing cabinet (ADC) deployment is described. Methods: A single-center retrospective-prospective pilot product performance study was conducted, and prospective nurse satisfaction survey and pharmacy technician product performance feedback survey were performed to determine the impact of new technology on medication storage and accessibility. The study measured efficiency of the 9:00 am medication pull for nursing users, assessment of nursing perceptions of medication administration pre- and postinstallation of the cabinetry, pharmacy technician perceptions of working with the cabinetry, and assessment of the efficiency of the pharmacy technician restock process. Results: In total, 2981 total nursing medication retrieval processes for the 9 am standard medication administration time (SMAT) time were analyzed: 1321 in the preoptimization phase and 1660 in the postoptimization phase. Analysis of the mean time per transaction confirmed a significant improvement from 10.5 to 10.3 seconds per transaction ( P = .026) in the postoptimization configuration. The modified assessment of nursing satisfaction survey demonstrated increased satisfaction with many aspects of the new-generation cabinetry. Pharmacy technician survey data highlighted beneficial aspects of the device, while restock data showed an increase in the time spent restocking the cabinet from 11.5 seconds in the preoptimization phase compared with 21.3 seconds in the postoptimization phase ( P < .0001). Conclusion: ADC installation and inventory optimization had a statistically significant improvement in the mean time per nursing transaction. Nursing and pharmacy technician surveys demonstrated a trend of enhanced satisfaction with the platform.

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Pazour, Jennifer A., and Russell D. Meller. "A multiple-drawer medication layout problem in automated dispensing cabinets." Health Care Management Science 15, no. 4 (February 19, 2012): 339–54. http://dx.doi.org/10.1007/s10729-012-9197-8.

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Polischuk, Emily, Carol G. Vetterly, Kelli L. Crowley, Ann Thompson, Jeff Goff, Phuong-Tan Nguyen-Ha, and Christine Modery. "Implementation of a Standardized Process for Ordering and Dispensing of High-Alert Emergency Medication Infusions." Journal of Pediatric Pharmacology and Therapeutics 17, no. 2 (October 1, 2012): 166–72. http://dx.doi.org/10.5863/1551-6776-17.2.166.

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OBJECTIVES Pharmacies encounter challenges when ensuring safe, timely medication dispensing to patients in the pediatric intensive care unit, when high-alert medications are needed in emergent situations. Removal of these medications from nursing stock presented challenges to providing timely administration to critical patients. The project's purpose was to develop a new method for reducing dispensing time while improving patient safety in pediatric intensive care units. METHODS A committee of physicians, nurses, a clinical pharmacist, and pharmacy administration collaborated for process development. The process established a list of compounded, ready-to-use infusions stored in the pharmacy, immediately available for dispensing. The dispensing mechanism includes ordering and dispensing processes using an “Urgent Drip Request” form. Most frequently ordered infusions (dopamine, epinephrine, norepinephrine) were added to automated dispensing cabinets in critical care units in concentrations that could be safely infused centrally or peripherally. RESULTS During the initial 4 months, 71 “Urgent Drip Request” sheets were processed. Drug utilization evaluation demonstrated a dispensing time of less than 1 minute for drip medications leaving the pharmacy after the form was received. No sheets processed exceeded the institutional 30-minute turnaround time, nor were errors or delays documented. Limited turnaround time data existed preimplementation but was not robust enough for analysis. It was not ethically feasible to perform a head-to-head comparison with the previous method, as it might have resulted in delay of therapy and negative patient outcomes. CONCLUSIONS This program allows high-alert medication infusion availability in an expedited manner, removes potential for compounding errors at the bedside, and assures clean room preparation. This has improved pharmacy efficiency in provision of safe patient care to critically ill pediatric patients.

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10

Cottney, Alan. "Improving the safety and efficiency of nurse medication rounds through the introduction of an automated dispensing cabinet." BMJ Quality Improvement Reports 3, no. 1 (2014): u204237.w1843. http://dx.doi.org/10.1136/bmjquality.u204237.w1843.

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Barra, Megan E., Sarah E. Culbreth, Katelyn W. Sylvester, and Megan A. Rocchio. "Utilization of an Integrated Electronic Health Record in the Emergency Department to Increase Prospective Medication Order Review by Pharmacists." Journal of Pharmacy Practice 31, no. 6 (October 10, 2017): 636–41. http://dx.doi.org/10.1177/0897190017735390.

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Purpose: The objective of this study is to evaluate the impact of an integrated medical record system on prospective medication order verification by pharmacists in the emergency department (ED) of a level I trauma center. Methods: This was a single-center retrospective analysis comparing medication orders verified by a pharmacist during a 7-day period in 2013 (phase I) versus 2015 (phase II). Outcome measures include the percentage of medication orders reviewed by a pharmacist prior to administration and time from order entry to each of the following: pharmacist review, medication procurement from an automated dispensing cabinet (ADC), and medication administration. Results: In total, 5450 medication orders were included in the study. The percentage of medication orders reviewed by a pharmacist prior to administration increased from 51.8% to 94% in phase I versus phase II, respectively ( P < .001). Median time from order entry to pharmacist verification decreased from 13 to 4 minutes in phase I versus phase II, respectively ( P < .001). Time from order entry to ADC dispense increased from a median of 9 minutes in phase I to 15 minutes in phase II ( P < .001). Time from order entry to nursing administration increased from a median time of 15 minutes in phase I to 23 minutes in phase II ( P < .001). Conclusion: Implementation of prospective pharmacist order verification in the ED increased the percentage of medications reviewed by a pharmacist prior to administration and improved pharmacist efficiency in the medication verification process. This increase in pharmacist review was associated with a marginal increase in time to medication procurement and administration.

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Helmons, Pieter J., Ashley J. Dalton, and Charles E. Daniels. "Effects of a direct refill program for automated dispensing cabinets on medication-refill errors." American Journal of Health-System Pharmacy 69, no. 19 (October 1, 2012): 1659–64. http://dx.doi.org/10.2146/ajhp110503.

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Pedersen, Craig A., Philip J. Schneider, Michael C. Ganio, and Douglas J. Scheckelhoff. "ASHP national survey of pharmacy practice in hospital settings: Dispensing and administration—2020." American Journal of Health-System Pharmacy 78, no. 12 (March 23, 2021): 1074–93. http://dx.doi.org/10.1093/ajhp/zxab120.

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Abstract Purpose Results of the 2020 ASHP national survey of pharmacy practice in hospital settings are presented. Methods Pharmacy directors at 1,437 general and children’s medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from the IQVIA hospital database. Results The response rate was 18.7%. Almost all hospitals (92.5%) have a method for pharmacists to review medication orders on demand. Most hospitals (74.5%) use automated dispensing cabinets (ADCs) as their primary method for drug distribution. A third of hospitals use barcodes to verify doses during dispensing in the pharmacy and to verify ingredients when intravenous medications are compounded. More than 80% scan barcodes when restocking ADCs. Sterile workflow management technology is used in 21.3% of hospitals. Almost three-quarters of hospitals outsource some sterile preparations. Pharmacists can independently prescribe in 21.1% of hospitals. Pharmacist practice in ambulatory clinics in 46.2% of health systems and provide telepharmacy services in 28.4% of health systems. Conclusion Pharmacists continue their responsibility in their traditional role in preparation and dispensing of medications. They have successfully employed technology to improve safety and efficiency in performance of these duties and have employed emerging technologies to improve the safety, timeliness, and efficiency of the administration of drugs to patients. As pharmacists continue to expand their role to all aspects of medication use, new opportunities highlighted in ASHP’s Practice Advancement Initiative 2030 have been identified.

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Cohen, Michael R. "True Allergy or Other Symptom?; Too Much Hydromorphone; Patient Safety Increased in Obstetrics; Medication Patch Slips into Incorrect Automated Dispensing Cabinet Pocket; Volume Control Set Safety." Hospital Pharmacy 44, no. 8 (August 2009): 654–56. http://dx.doi.org/10.1310/hpj4408-654.

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These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

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Rochais, Élise, Suzanne Atkinson, Mélanie Guilbeault, and Jean-François Bussières. "Nursing Perception of the Impact of Automated Dispensing Cabinets on Patient Safety and Ergonomics in a Teaching Health Care Center." Journal of Pharmacy Practice 27, no. 2 (October 15, 2013): 150–57. http://dx.doi.org/10.1177/0897190013507082.

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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.

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Thompson, R. Zachary, Brian Gardner, Thomas Carter, Aric Schadler, Joye Allen, and Abby Bailey. "Decreasing the Time to Oral Antibiotics in a University Hospital Pediatric Emergency Department." Journal of Pediatric Pharmacology and Therapeutics 22, no. 4 (July 1, 2017): 272–75. http://dx.doi.org/10.5863/1551-6776-22.4.272.

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OBJECTIVES To compare time to administration of oral antibiotics in the pediatric emergency department (ED) when antibiotics are stored in the pediatric ED versus when they were dispensed by central pharmacy services within an academic medical center. METHODS This was a retrospective review of patients who received a one-time dose of oral antibiotics within the pediatric ED and were subsequently discharged home. Two 3-month time periods were compared to determine the metrics of providing oral antibiotics before and after these medications were stocked in the pediatric ED automated dispensing cabinet (ADC). The primary outcome was to compare the time to administration. Secondary outcomes were to assess wastage of stocked medications and time to ED discharge. RESULTS In the ADC time period (n = 74), the median time to administration was 17.5 minutes versus 57 minutes in the central pharmacy time period (n = 34) (p < 0.001). The ED length of stay during the ADC time period was 188.5 minutes versus 228.5 minutes (p = 0.094). 35.4% of doses from the ADC expired resulting in a wholesale acquisition cost of $53.14 wasted. CONCLUSION Stocking commonly used oral antibiotics in the pediatric ED led to a significant decrease in the time to medication administration. This decreased time to administration has the potential to lead to improved patient and nursing satisfaction. Routine surveillance is needed after implementation to ensure compliance and to minimize wastage.

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Le, Trihn, Michelle C. Mercado, Scott M. Mark, Karl F. Gumpper, Yeruk A. mulugeta, and Heidi J. Dalton. "IMPROVING SAFETY OF HIGH ALERT MEDICATION DISPENSED FROM AUTOMATED DISPENSING CABINETS IN A PEDIATRIC INTENSIVE CARE UNIT." Critical Care Medicine 32, Supplement (December 2004): A63. http://dx.doi.org/10.1097/00003246-200412001-00233.

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Bazzell, Brian, Deb Wagner, Karin M. Durant, and Brian Callahan. "Insights on developing a field hospital formulary and medication distribution process in preparation for a second surge of COVID-19 cases." American Journal of Health-System Pharmacy 77, no. 21 (July 24, 2020): 1763–70. http://dx.doi.org/10.1093/ajhp/zxaa232.

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Abstract Purpose The coronavirus disease 2019 (COVID-19) pandemic has caused health systems across the country to plan for field hospitals to care for patients outside of traditional healthcare settings in the event of a second surge. Here we describe key considerations for the implementation of pharmacy operations and a field hospital formulary at an offsite location within a 2-week time frame. Summary Development of an offsite field hospital formulary is first dependent on the location and patient population defined for the field hospital. Creation of a limited formulary for a planned field hospital in Michigan involved reviewing physical space limitations and drug distribution workflows, assessing current prescribing trends, creating drug categories, and creating formulary guidelines to limit formulary options in each therapeutic category. Ultimately, our institution developed a 140-medication field hospital formulary, a process to enable appropriate use of nonformulary drugs, and a mixed operations model including automated dispensing cabinets and a manual cart-fill process. Although the institution did not have to open the field hospital, the process used for developing the formulary and determining distribution models will allow for an immediate implementation if a second surge occurs. Conclusion A methodical approach to developing limited formularies and pharmacy operations in a field hospital setting will allow health systems to establish efficient and effective medication distribution services in the event of a second surge of COVID-19 cases.

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Merchan, Cristian, Joshua Soliman, Tania Ahuja, Serena Arnouk, Kelsey Keeley, Joanna Tracy, Gabriel Guerra, Kristopher DaCosta, John Papadopoulos, and Arash Dabestani. "COVID-19 pandemic preparedness: A practical guide from an operational pharmacy perspective." American Journal of Health-System Pharmacy 77, no. 19 (June 16, 2020): 1598–605. http://dx.doi.org/10.1093/ajhp/zxaa212.

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Abstract Purpose To describe our medical center’s pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic. Summary The leadership of a department of pharmacy at an urban medical center in the US epicenter of the COVID-19 pandemic proactively created a pharmacy action plan in anticipation of a surge in admissions of critically ill patients with COVID-19. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non–intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs. Teamwork was crucial to ensure staff safety, develop complete scheduling, maintain adequate drug inventory and sterile compounding, optimize the electronic health record and automated dispensing cabinets to help ensure appropriate prescribing and effective management of medication supplies, and streamline the pharmacy workflow to ensure that all patients received pharmacotherapeutic regimens in a timely fashion. Conclusion Each hospital should view the COVID-19 crisis as an opportunity to internally review and enhance workflow processes, initiatives that can continue even after the resolution of the COVID-19 pandemic.

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Fanning, Laura, Nick Jones, and Elizabeth Manias. "Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study." Journal of Evaluation in Clinical Practice 22, no. 2 (September 7, 2015): 156–63. http://dx.doi.org/10.1111/jep.12445.

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Cohen, Michael R. "Look-Alike Names and Packages Are at the Root of Most Stocking Errors in Automated Dispensing Cabinets Use Caution when Reconstituting Synagis (Palivizumab) Intrathecal Vincristine Fatal Once More Fellowship in Medication Safety Medication Safety Videos Available Free via the Internet." Hospital Pharmacy 38, no. 4 (April 2003): 312–13. http://dx.doi.org/10.1177/001857870303800402.

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These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them in your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the USP Medication Errors Reporting Program, which is presented in cooperation with the Institute for Safe Medication Practices. If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800–233–7767 (800–23-ERROR). Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

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22

Worrall, Mary, Elizabeth Devlin, and Moninne Howlett. "P58 Managing access to ‘Out Of Hours‘ medications in a tertiary paediatric hospital." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e36.2-e37. http://dx.doi.org/10.1136/archdischild-2020-nppg.66.

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AimsMany UK and Irish hospitals provide a Monday to Friday pharmacy service; automated dispensing cabinets and hospital-wide information systems remain uncommon. Locating and accessing out of hours (OOH) medications can be a significant workload for nursing staff. In an Irish 230-bed tertiary paediatric hospital processes involve: nursing staff contacting other wards by telephone to source items; completion of an ‘Out of Hours Requisition’; and either transferring stock between wards or contacting nursing administration staff (NAS) to access stock from the Pharmacy Department. A quality improvement project was undertaken to: measure current levels of OOH medications; identify areas for improvement; implement and assess impact of new processes.Methods‘Out of Hours Requisition’ data were entered into a custom-built database and analysed for the period January - December 2018. The findings were discussed with nursing staff and NAS. Improving processes for locating medications was identified as a key area for improvement. The ‘Out of Hours Requisition’ form was amended to provide clearer instructions for completion. Using data from clinical area stock lists, a searchable Medicines Locator Database was developed and made accessible to all staff in the pharmacy department, clinical areas and the NAS office in December 2018 enabling staff to remotely identify the location of all medications stocked in the hospital. Data for ‘Out of Hours Requisitions’ for the period January - May 2019 were collated, analysed and compared with data from the same time period in 2018 (January - May). Microsoft Excel® was used for data collection, analyses and development of the Medicines Locator Database.ResultsA total of 1747 OOH medications were accessed by NAS from pharmacy in 2018, 746 during the period January - May 2018. Anti-microbial agents (36%) were most common, with requests originating from 16 clinical areas. Request from the paediatric intensive care units (36%) and the surgical/orthopaedic ward (36%) were most frequent. 515 medications were accessed in the first 5 months after the introduction of the Medicines Locator Database (January - May 2019). This represents a 35% reduction in the number of medications dispensed in the same time period in 2018. No changes to the types of medications were identified, but some differences in clinical areas were found.ConclusionThis significant reduction (35%) in numbers of medications accessed out of hours, and the corresponding reduction in workload for NAS, demonstrates the benefits of reviewing medication management processes. Further substantial time savings for nursing staff locating stock at ward level are likely. Readily-available technology can be successfully employed to improve processes in the absence of more sophisticated technological solutions. A staff survey is planned to evaluate awareness and usability of the database and identify further areas for improvement.

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Glover,, Darryl G. "Automated Medication Dispensing Devices." Journal of the American Pharmaceutical Association (1996) 37, no. 3 (May 1997): 353–58. http://dx.doi.org/10.1016/s1086-5802(16)30206-6.

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TALLON, ROBERT W. "Automated Medication Dispensing Systems." Nursing Management (Springhouse) 27, no. 8 (August 1996): 45–46. http://dx.doi.org/10.1097/00006247-199608000-00014.

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O’Neil, Daniel P., Adam Miller, Daniel Cronin, and Chad J. Hatfield. "A comparison of automated dispensing cabinet optimization methods." American Journal of Health-System Pharmacy 73, no. 13 (July 1, 2016): 975–80. http://dx.doi.org/10.2146/ajhp150423.

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McCarthy, Bryan C., and Michael Ferker. "Implementation and optimization of automated dispensing cabinet technology." American Journal of Health-System Pharmacy 73, no. 19 (October 1, 2016): 1531–36. http://dx.doi.org/10.2146/ajhp150531.

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Rhodes, James A. M., and Bryan C. McCarthy. "Automated dispensing cabinet technology limitations compromise patient safety." American Journal of Health-System Pharmacy 76, no. 18 (August 7, 2019): 1372–73. http://dx.doi.org/10.1093/ajhp/zxz153.

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Paparella, Susan. "Automated Medication Dispensing Systems: Not Error Free." Journal of Emergency Nursing 32, no. 1 (February 2006): 71–74. http://dx.doi.org/10.1016/j.jen.2005.11.004.

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van den Bemt, P. M. L. A., J. C. Idzinga, H. Robertz, D. G. Kormelink, and N. Pels. "Medication Administration Errors in Nursing Homes Using an Automated Medication Dispensing System." Journal of the American Medical Informatics Association 16, no. 4 (July 1, 2009): 486–92. http://dx.doi.org/10.1197/jamia.m2959.

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Gordon, Jenny O., Ronald S. Hadsall, and Jon C. Schommer. "Automated medication-dispensing system in two hospital emergency departments." American Journal of Health-System Pharmacy 62, no. 18 (September 15, 2005): 1917–23. http://dx.doi.org/10.2146/ajhp040481.

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Moroshek, Jacob. "Improving outpatient primary medication adherence with physician guided, automated dispensing." ClinicoEconomics and Outcomes Research Volume 9 (January 2017): 59–63. http://dx.doi.org/10.2147/ceor.s114416.

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Tkachenko, Olha, and Vladyslav Plisenko. "Some Aspects of Robotization of Automated Medication Dispensing in Pharmacies." Digital Platform: Information Technologies in Sociocultural Sphere 3, no. 1 (June 25, 2020): 33–46. http://dx.doi.org/10.31866/2617-796x.3.1.2020.206103.

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Barker, Kenneth N. "Ensuring safety in the use of automated medication dispensing systems." American Journal of Health-System Pharmacy 52, no. 21 (November 1, 1995): 2445–47. http://dx.doi.org/10.1093/ajhp/52.21.2445.

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Shirley, Kara Lee. "Effect of an automated dispensing system on medication administration time." American Journal of Health-System Pharmacy 56, no. 15 (August 1, 1999): 1542–45. http://dx.doi.org/10.1093/ajhp/56.15.1542.

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Suryadinata, Haryman Utama. "The benefits of automated dispensing machine for hospital pharmacy in Indonesia: situation, implementation, and feasibility." GHMJ (Global Health Management Journal) 1, no. 1 (June 22, 2017): 15. http://dx.doi.org/10.35898/ghmj-1188.

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Background: Pharmacy as the main core of hospital is responsible for the quality and safety of medicines.Yet the numbers of medication errors are still high. Automated Dispensing Machine (ADM) is one of the solutions to reduce the dispensing errors in pharmacy. Many countries had studied and proved that the use of ADM gives more benefit than liability. However, ADM is considered as something new, a “nice to have” product.Aims: This study will explain the benefits of ADM especially in Indonesian hospital pharmacy.Methods: Systemic Review with PRISMA method uses 5 databases as Scopus, Springerlink, Google Scholar, Science Direct and ProQuest, with keywords Automated Dispensing Machine, Automated Dispensing Device, Automated Dispensing System, Automated Drug Dispensing System, or Robotic Dispensing System. The inclusion criteria are all the studies that showed any impact in minimum of one aspect ofADM in hospital.Results: There are 13 studies that explained ADM benefits such as increase staff satisfaction for the nurse and pharmacist, reduce dispensing errors about 35% or up to reducing all dispensing errors, time saving until 50% in peak hours and cost analysis and effectiveness. The cost anaylsis such as inventory stock reduction, increases the cost saving.Conclusion:In Indonesia, it needs many considerations to implement ADM but it had already installed in 1 Indonesia Hospital. This hospital had proved that ADM can reduce dispensing errors and can solve some pharmacy problem such as the human resources problems and the long waiting time.With the proven benefits of ADM, it is justified for Indonesian hospital to implement ADM and information system in their pharmacy. The effectiveness will perceive the pharmacy andpositively affect to all related departments in hospital. Keywords: Automated dispensing machine, automated dispensing system, automated dispensing device, robotic dispensing system, automated drug dispensing system

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Cooper, L., M. Barron, C. Gallagher, and J. Sciarra. "Automated anesthesia medication dispensing systems: single-issue, limited-access drawers may reduce medication errors." European Journal of Anaesthesiology 24, Supplement 39 (June 2007): 190–91. http://dx.doi.org/10.1097/00003643-200706001-00711.

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Vo, Peter, Daniel A. Sylvia, Loay Milibari, John Ryan Stackhouse, Paul Szumita, Megan Rocchio, Michael Cotugno, et al. "Management of a parenteral opioid shortage using ASHP guidelines." American Journal of Health-System Pharmacy 78, no. 5 (January 20, 2021): 426–35. http://dx.doi.org/10.1093/ajhp/zxaa425.

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Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

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Novek, Joel, Sharon Bettess, Kathleen Burke, and Patricia Johnston. "Nurses' Perceptions of the Reliability of an Automated Medication Dispensing System." Journal of Nursing Care Quality 14, no. 2 (January 2000): 1–13. http://dx.doi.org/10.1097/00001786-200001000-00003.

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Hussey, Aaron P., Bryan M. Cook, Adam D. Quane, Stephen R. Sweet, and Paul M. Szumita. "Implementation of an Automated Dispensing Cabinet Stewardship Program at a Tertiary Academic Medical Center." Journal of Pharmacy Technology 30, no. 6 (September 23, 2014): 191–94. http://dx.doi.org/10.1177/8755122514551560.

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Cooper, L., M. Barron, and B. Dollar. "Automated anesthesia medication dispensing systems: current technology and design do not prevent intraoperative medication errors." European Journal of Anaesthesiology 23, Supplement 37 (June 2006): 249. http://dx.doi.org/10.1097/00003643-200606001-00896.

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Smith, Bradley L., Monica G. Griffin, Alexander Heyliger, and Brianne M. Ritchie. "Assessment of hospital emergency medication kit use at a large academic medical center with automated dispensing machine technology." American Journal of Health-System Pharmacy 77, Supplement_1 (January 21, 2020): S8—S12. http://dx.doi.org/10.1093/ajhp/zxz294.

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Abstract Purpose Hospital emergency medication kits (HEMKs) are used to provide certain critical medications in emergent situations, despite many technological advancements for patient safety and medication distribution. We sought to evaluate HEMK usage and analyze associated costs to identify and recommend process improvements. Methods Mayo Clinic in Rochester, MN, is a large multisite academic medical center with 2 hospital campuses and many ambulatory clinics. All documentation of the approximately 250 HEMKs in circulation was analyzed from January to November 2017. The primary outcome was HEMK use. Secondary outcomes included individual medication usage and associated costs. These data were then used to recommend process improvements. Results Of 880 HEMKs evaluated, 675 (76.7%) were used, resulting in expiration 23.3% of the time. A total of 1,024 emergency medications were used, most commonly for hypoglycemia. Many of these medications are also available in automated dispensing machines for patient care use. Cost analysis revealed an average annual cost of nearly $200,000 associated with HEMKs. The results of our analysis indicated little added benefit of HEMKs in the setting of automated dispensing machine optimization. Steps for HEMK retirement are described. Conclusion HEMKs offered little added benefit considering technological advancements that have been made in patient safety and medication distribution since their inception. Retirement of HEMKs is anticipated to increase pharmacy operational efficiency by using automated dispensing machine technology and appropriate emergency response protocols to ensure optimal patient care.

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Lester, Corey A., Liyun Tu, Yuting Ding, and Allen J. Flynn. "Detecting Potential Medication Selection Errors During Outpatient Pharmacy Processing of Electronic Prescriptions With the RxNorm Application Programming Interface: Retrospective Observational Cohort Study." JMIR Medical Informatics 8, no. 3 (March 11, 2020): e16073. http://dx.doi.org/10.2196/16073.

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Background Medication errors are pervasive. Electronic prescriptions (e-prescriptions) convey secure and computer-readable prescriptions from clinics to outpatient pharmacies for dispensing. Once received, pharmacy staff perform a transcription task to select the medications needed to process e-prescriptions within their dispensing software. Later, pharmacists manually double-check medications selected to fulfill e-prescriptions before dispensing to the patient. Although pharmacist double-checks are mostly effective for catching medication selection mistakes, the cognitive process of medication selection in the computer is still prone to error because of heavy workload, inattention, and fatigue. Leveraging health information technology to identify and recover from medication selection errors can improve patient safety. Objective This study aimed to determine the performance of an automated double-check of pharmacy prescription records to identify potential medication selection errors made in outpatient pharmacies with the RxNorm application programming interface (API). Methods We conducted a retrospective observational analysis of 537,710 pairs of e-prescription and dispensing records from a mail-order pharmacy for the period January 2017 to October 2018. National Drug Codes (NDCs) for each pair were obtained from the National Library of Medicine’s (NLM’s) RxNorm API. The API returned RxNorm concept unique identifier (RxCUI) semantic clinical drug (SCD) identifiers associated with every NDC. The SCD identifiers returned for the e-prescription NDC were matched against the corresponding SCD identifiers from the pharmacy dispensing record NDC. An error matrix was created based on the hand-labeling of mismatched SCD pairs. Performance metrics were calculated for the e-prescription-to-dispensing record matching algorithm for both total pairs and unique pairs of NDCs in these data. Results We analyzed 527,881 e-prescription and pharmacy dispensing record pairs. Four clinically significant cases of mismatched RxCUI identifiers were detected (ie, three different ingredient selections and one different strength selection). A total of 546 less significant cases of mismatched RxCUIs were found. Nearly all of the NDC pairs had matching RxCUIs (28,787/28,817, 99.90%-525,270/527,009, 99.67%). The RxNorm API had a sensitivity of 1, a false-positive rate of 0.00104 to 0.00312, specificity of 0.99896 to 0.99688, precision of 0.00727 to 0.04255, and F1 score of 0.01444 to 0.08163. We found 872 pairs of records without an RxCUI. Conclusions The NLM’s RxNorm API can perform an independent and automatic double-check of correct medication selection to verify e-prescription processing at outpatient pharmacies. RxNorm has near-comprehensive coverage of prescribed medications and can be used to recover from medication selection errors. In the future, tools such as this may be able to perform automated verification of medication selection accurately enough to free pharmacists from having to perform manual double-checks of the medications selected within pharmacy dispensing software to fulfill e-prescriptions.

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Ward, Michael J., Jeremy S. Boyd, Nicole J. Harger, John M. Deledda, Carol L. Smith, Susan M. Walker, Jeffrey D. Hice, Kimberly W. Hart, Christopher J. Lindsell, and Stewart W. Wright. "An automated dispensing system for improving medication timing in the emergency department." World Journal of Emergency Medicine 3, no. 2 (2012): 102. http://dx.doi.org/10.5847/wjem.j.issn.1920-8642.2012.02.004.

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Mathru, M. "Automated drug dispensing system reduces medication errors in an intensive care setting." Yearbook of Anesthesiology and Pain Management 2011 (January 2011): 178–80. http://dx.doi.org/10.1016/j.yane.2011.01.076.

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Lehtonen, Anne, Marja Airaksinen, and Saija Leikola. "Acute medication changes during automated dose dispensing – Nurses and practical nurses' perceptions." Research in Social and Administrative Pharmacy 13, no. 3 (May 2017): e9-e10. http://dx.doi.org/10.1016/j.sapharm.2017.02.085.

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Klein, Eric G., Julie A. Santora, Peter M. Pascale, and Jack G. Kitrenos. "Medication cart-filling time, accuracy, and cost with an automated dispensing system." American Journal of Health-System Pharmacy 51, no. 9 (May 1, 1994): 1193–96. http://dx.doi.org/10.1093/ajhp/51.9.1193.

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Radparvar, Sara, Justin Tesch, Lorie Gull, and Elizabeth Isaac. "1202: APPLICATION OF LEAN METHODOLOGY TO MEDICATION STANDARDIZATION IN AUTOMATED DISPENSING MACHINES." Critical Care Medicine 44, no. 12 (December 2016): 376. http://dx.doi.org/10.1097/01.ccm.0000509876.34535.dd.

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Chapuis, Claire, Matthieu Roustit, Gaëlle Bal, Carole Schwebel, Pascal Pansu, Sandra David-Tchouda, Luc Foroni, et al. "Automated drug dispensing system reduces medication errors in an intensive care setting." Critical Care Medicine 38, no. 12 (December 2010): 2275–81. http://dx.doi.org/10.1097/ccm.0b013e3181f8569b.

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Kim, Kyung Hee, Sun Ah Kim, and Sandy Jeong Rhie. "Improvement of Night Pharmacy Service by Automated Dispensing Cabinet System Implementation in Emergency Medical Center." Korean Journal of Clinical Pharmacy 28, no. 1 (March 31, 2018): 51–56. http://dx.doi.org/10.24304/kjcp.2018.28.1.51.

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Villanueva, E. M., A. Couriel, O. O. Eshleman, D. E. Wilson, S. Varghese, T. Huerta, E. Barrera, and O. Oriakhi. "Use of Lean, Six Sigma Methodology to Optimize Expiration Dating in the Automated Dispensing Cabinet." Research in Social and Administrative Pharmacy 15, no. 10 (October 2019): e38. http://dx.doi.org/10.1016/j.sapharm.2019.08.016.

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