Medication errors are a leading cause of injury and avoidable harm in healthcare systems globally, according to the World Health Organization, with the cost associated with medication errors estimated at $42 billion annually. Children especially are at risk of medication overdose because often medications for adults are kept in the same dispensing cabinets as medications for children. And while it may seem like an easier practice to keep large quantities of medications within an automated dispensing cabinet (ADC) to reduce restocking requirements, managing medication this way increases the risk of overdose to pediatric patients. So, if you do not have a dedicated pediatric ward, at least keep a second ADC set aside for your pediatric medications.
According to the ASHP guidelines on the Safe Use of Automated Dispensing Cabinets, ADC use has become widespread in healthcare institutions, with 93% of hospitals using ADCs in their medication-use systems, and 70.2% using ADCs as a primary method of maintenance dose distribution. When a profiled ADC interfaces with the pharmacy information system, medications display on the ADC profile after the order is verified by a pharmacist. This functionality allows the staff administering the drug to be made aware of any potential duplicate therapy, contraindications, unsafe dosing, allergic reactions, and other significant drug information prior to administration of the medication. This is a key safety measure that should be essential to any ADC.
Once authenticated, it is important that you can give your users’ controlled access by permissions. No two facilities will have the same idea of controlled workflow, so spend some time looking at this feature when considering your next ADC to makes sure that it is flexible enough to be customized to your needs. For the greatest level of safety and efficiency nurses or technicians accessing the cabinets should be given permission based on their role. So, they can have access to only see their patients or maybe access to patients on their floor or ward. For example, a respiratory tech doesn’t need access to controlled substances so your ADC should be able to limit their access to those drugs. Similarly, you might want your pharmacy technician’s permissions to be set so that they cannot dispense medications or modify configurations. If your system cannot customize user controls upon sign-on to the system, consider another option.
For more on access control and the variety of ways to set this up, schedule a consultation with one of our medication dispensing experts at TouchPoint Medical. Whether you decide to go with one of our solutions or not, we can help you understand the pros and cons of the different forms of permissions that can be used on an ADC.
Medication set up and restocking of your ADC should also be safe, controlled, and easy. As a pharmacist, you should be able to set up your cabinet by selecting your medications directly from the HIS formular, assign it to a drawer and set up inventory levels so that you are flagged when inventory levels are low for that particular drug. Because you have set your permissions and access so that only you as the pharmacist can control inventory and stocking, no one should be able to change these parameters. If flexibility is important to you, make sure that your ADC supports multiple stocking modes so that you can have single item, mixed and linear drawers.
Now that the cabinet is stocked, medications are ready to be dispensed. Most ADCs will make it easy for the nurse or staff member to access the machine through single sign-on but what varies is how the medication is dispensed. For the ultimate in safety, you can have a cabinet with single dose steel compartments that ensure access only to the medication needed—one dose at a time. This is different than single item drawers, where you can have multiple doses of the same item in one drawer. Single item drawers require the nurse to count out what she needs and inventory it in the system. With single dose, once the dose is taken from the drawer, it is automatically inventoried from the system. This additional control should be considered for controlled or high value medications.
Medication needs to be kept secure no matter what type of facility you manage. In environments such as a pediatric, psychiatric or hospice ward, where medications need to be under tight control, these medications should be in cabinets that allow you to customize access and dispensing privileges based on user. In smaller facilities such as a hospice or ambulatory surgery centers where space is precious, you can find an ADC with single dose dispensing (providing the highest level of security and control) in a smaller footprint like a tabletop unit capable of holding a sufficient number of medications to manage patients efficiently. And if your cabinet is not offering you the level of safety, efficiency and flexibility that you need, maybe it’s time to consider an upgrade to something that can grow as your needs grow.