How automation changed medication distribution

Then, since 1990, the automated dispensing machine was invented. So, this high-technology machine can automatically dispense medication and record medication use. And the medication distribution system started to be changed again. In Taiwan, we use automated dispensing machine which can connect to hospital information system, receive computerized prescription, and dispense unit dose package of medication. In other western countries, they use Automated Dispensing Cabinet, as known as ADC, which is a point-of-care medication storage device. ADC is usually located in patient care areas. The design is like Floor Stock System and Unit Dose System, but it is invented to reduce errors and to make the working process more efficient.

For example, ADC is controlled by computers and it can connect to hospital system, so it can set access passwords, only authorized staffs can use specific cabinets based on the patients’ prescriptions from hospital system. Thus, ADC provides proper storage and security. The ADC also can automatically manage the inventory control. So, pharmacists can store the most commonly used medications in the cabinet. The pharmacy also can control access via a computerized interface to the pharmacy information system. Thus, the ADC could be well managed by the pharmacy.

The advantages of ADC is that they provide more efficient order filling, but the pharmacy still can control the medication use system. Pharmacists can control access through linking to the pharmacy drug profile. Another advantage is that waste is reduced with ADC because the nurse only needs to remove a dose from the cabinet if it is needed. This provides more accurate patient charges and minimizes the working process because the drug is automatically credited while it is administered. The major disadvantage of the ADC system is that it is similar to the Floor Stock System, it reduces pharmacy supervise the medication use. So, some experts indicate that this may increase medication errors compared to the Unit Dose System.

However, no much evidence could support this statement. Another disadvantage is that it increases drug inventory on patient care areas and some of the workloads of medication use are back to the nurse. However, through linking ADC with pharmacy information system, some of these disadvantages could be prevented. Because ADC can be controlled by pharmacists at computer terminals, so pharmacists can supervise the medication use based on updated patient specific profile. Nurses can only get access to specific medications for specific patients at the time of administration by their personal password or bio-ID scanning of fingerprints to log into the system. Nurses simply follows the computer’s guidance on the ADC system and get medications that matches the patient’s prescriptions from the cabinet.

After nurses take a drug and close the cabinet drawer, the patient is automatically charged for the dose and the inventory is also recorded and updated simultaneously. So the working process of patient billing and drug inventory is more accurate and efficient.

In our pharmacy, we use automated dispensing machines rather than ADC for most oral medication dispensing. Each unit dose package are dispensed by automated dispensing machine, and printed the patient information and drug name and dosage. Our pharmacists dispense the rest of medications according to the patient drug profile. And put all unit dose medications into the medication carts.

This is our patient drug profile. Pharmacists dispense medications according this drug profile. A Patient Summary such as diagnosis, allergy history and the latest lab data are printed on it. This profile record the drug name, dosage, and duration, and the mark for dose adjustment. We have establish a full drug information database and integrate into our pharmacy information system.

So, this patient drug profile will show the L or K marks, it means this medication need dose adjustment for patient with renal or liver dysfunction. Pharmacists can therefore recheck patients’ lab data and the dose. Currently, we are developing a new inpatient dispensing system. In the future, we will implement paperless dispensing procedure. By using this user friendly dispensing system, pharmacists can use iPad to receive the latest daily prescriptions, check patient full information, dispense prescriptions, and perform double checks.