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Decentralized automated dispensing machines

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Currently, there are several available automation technologies throughout the medication-use process. In the prescribing phase, we just introduce you to the CPOE,
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which is the second one: computerized prescriber order entry. And also in the ordering process, if the CPOE system could also have clinical decision support system software, that will even better serve the prescribing process. The second phase is the dispensing process. In the dispensing phase, there are several technologies. One is carousel technology, the second is centralized robotic dispensing and inventory tracking devices, decentralized automated dispensing devices, intravenous and total parenteral nutrition compounding devices. Among four of them, we will introduce carousel technology and decentralized automated dispensing devices later in more detail. Around the dispensing phase,
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there are two available technologies: they are pneumatic tube delivery system and unit dose medication repackaging system. For the administration phases, bar code medication administration technology, which we have briefly introduce you, we will have more detail later. And also clinical decision support-based infusion pumps also are very common and important technology used in hospitals right now. Last one for monitoring; there are electronic clinical documenting system and web-based compliance and disease management tracking systems. So, for the Drug Distribution and Dispensing System, decentralized automated dispensing devices is a very common automation technology in United States. In Taiwan, there are several hospital has started using this device in hospital, especially in the nursing ward to improve the medication distribution system.
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It also referred as automated dispensing cabinets (ADC), or automated dispensing machines (ADM), or automated dispensing units (ADU),
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also somebody call it: unit based cabinet (UBC) because the cabinet is located in the nursing unit.
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So, that’s why people call it: unit based cabinet. These cabinet or these devices could store and electronically dispense medications in locations remote from a centralized or satellite pharmacy. And actually, it located in the nursing ward or nursing unit. So, the nurse could immediately access to the medication at the point of use without requiring a visit to a pharmacy, and this is also a briefly or simplify the whole distribution process. Nurses could access the machine by means of user identifiers and passwords. Currently, even we require biological identify, for example, the finger print, or even other more than identifier. The primary focus of decentralized automated dispensing devices is to provide prompt, real-time availability of medications for the nurses and patients.
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And actually, the direct user is nurses. The nurses could obtain the medication from the device, could either through the verified order or if there is an emergency, the nursing staff, they could access to medication with override functionality, which is without physician orders in the computer. But, this will be recorded as a special event, and need to be reviewed later. And secondary benefit of the device is to improve controlled substance accountability. This device, we could design it to have second person or witnesses to access the controlled medication at the same time. So you have two people check each other and remove the medication from the cabinet.
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Also, it could increase productivity because the devices at the point of care, so the nurses could go to the devices directly without waiting for the medication of central pharmacy, so this will increase productivity. Also, this device could improve charge capture and documentation accuracy.
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Before There are several experiences or several reports before the hospital use the device. They had a lot of charge lost because nurse, when they give medication, they didn’t document it or they forget to document it. Through the device, the charge capture could reach 90% and even higher. And also the secondary benefit include reduce pharmacy and nursing labor costs. With this device, because there is no medication delivery, so the pharmacy doesn’t need to send out medication to the nursing ward and without this process, they no longer call each other or looking for the medication, the location of the medication has been sent.
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Around that time, the delivery person, sometimes may send the medication to the wrong place, and the nurse and pharmacy, they have to spend time to look for it. And through this device, there is no need to look for medication anymore. The medication is there, in the cabinet. So, the decentralized automated dispensing devices could store and dispense nearly all scheduled doses, eliminating the manual medication cart fill and delivery process in the traditional unit dose system. The impact on medication errors is less clear because the device actually is in the middle of the route that the medication sends to the patients’ ward. The nurses pick up the medication and then there are still further steps, several steps, to reach the patient.
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Therefore, the impact on medication error is not so clear. Some literature says the improvement could be significant, but other literature may show there is no obvious improvement. The decentralized automated dispensing cabinet or device also improve safety by incorporating bar code labeling and scanning into the replenishment process, and this is a strong recommendation that any hospitals want to use decentralized automated dispensing device, and it also provide the bar code labeling and scanning functionality.
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Also, decentralized automated dispensing device could improve patient medication use safety if these devices could free pharmacists’ time to direct patient care activities, and this is another very important goal for the decentralized automated dispensing device because the pharmacists could use their time, use their knowledge to provide direct patient care activities. And this way, it’s really improving the patient medication safety.

Chiang will give a list of automation technologies that have been applied to the medication-use process. For this step, he will focus on explaining decentralized automated dispensing machines (ADM).

Key points

Decentralized ADMs are very in the United States. It also known as automated dispensing cabinets (ADC), or automated dispensing machines (ADM), or automated dispensing units (ADU). It is located in the nursing unit, hence some also call it unit-based cabinet (UBC).

ADCs store and electronically dispense medications in the nursing ward or nursing unit. Offering the nurse could immediately access to medication at the point of use, simplifying the distribution process. Allowing prompt, real-time availability of medications for the nurses and patients.

Below are some secondary benefits of ADCs:

  • Record who had accessed the medication, improving controlled substance accountability.

  • Increase productivity by decreasing trips to the central pharmacy.

  • Improve charge capture and documentation accuracy.

  • Reduce pharmacy and labor costs.

However the impact of ADCs on medication error is not defined. Incorporating bar code labelling and scanning into the replenishment process overcomes this uncertainty. Most importantly, these devices free pharmacists to direct patient care activities, improving quality of healthcare service provided.

Share and learn

Does your hospital/clinic use ADCs?

If yes, how does it impact your workload?

If no, who carry out these tasks manually instead?

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Good Pharmacy Practice: Pharmaceutical Services

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