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Currently submitted to: JMIR Medical Informatics

Date Submitted: Sep 23, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

The Experiences of Implementation of Automated Dispensing Cabinet Systems and Impact on Medication Administration by Nurses

  • Yi-Chen Wang; 
  • Chin-Yuan Tsan; 
  • Meng-Chun Chen

ABSTRACT

Background:

Since 2003, the Joint Commission on Accreditation of Healthcare Organizations has included "to promote medication administration safety" as one of its key projects to improve patient safety. A technology that has been implemented widely at the administration stage in American hospitals is the automated dispensing cabinet (ADC), which has been shown to reduce nurse medication administration errors and reduce the time that nurses spend administering medication. The eMAR system currently in use at the studied hospital includes daily overall dose medication trolley, which is restocked and dispensed from during a 24-hour interval, unlike the UDD system used overseas.

Objective:

This study investigates the opinions and satisfaction of nurses concerning the implementation of the ADC systems. The ADC system was primarily to promote drug-use safety by integrating drug prescription with dispensing. Hope the technology was also expected to reduce the time spent by the nursing and head nurse on managing the inventory of the drug and to improve urgent care performance.

Methods:

A longitudinal study was designed using an effective survey for nurses. The survey was conducted using a clinical observation and questionnaire survey administered in May 2018 at the hospital. The observational method was used to understand the time differences in drug preparation, delivery, and returns at the inpatient ward by nurses before and after using ADC. Medication errors were investigated spanning the year before and the year after ADC implementation recorded by the Medical Incident Events system. And an anonymous questionnaire survey for nurses.

Results:

The medication preparation times of the three units for the average medication preparation time for each patient all increased. A paired t-test was found that all three units showed p<0.005. But the drugs return time was only one unit showed increased. Most urgent medications were included in the ADC. During the study period, a total of 20 ADEs were reported. Most (n=19, 95%) adverse events occurred during the drug administration phase, only one events (5%) occurred during the drug dispensing phase. The statistical analysis results of the questionnaire's overall average score was 3.90. The "Nurses' perceptions" overall average score was 3.89. The "Accessibility" overall average score was 3.90.

Conclusions:

The ADC was found to improve the efficiency of the medicines-use process, but had little meaningful effect on medication administration error rate. The ADC systems used by the hospital has no configuration to use bar-codes, nurses cannot use bar-code scanning for secondary confirmation when administering drugs, and must use the naked eye to identify the medication name matches the eMAR. However, it could be anticipated that additional benefit with regard to reducing medication administration errors may be demonstrated if the ADC was used in combination with other IT systems, such as bar-codes. Clinical Trial: The research ethics committee has approved this study of the research institution, and the subject's informed consent form has been waived — the research ethics committee No: 201807025RINA.


 Citation

Please cite as:

Wang Y, Tsan C, Chen M

The Experiences of Implementation of Automated Dispensing Cabinet Systems and Impact on Medication Administration by Nurses

JMIR Preprints. 23/09/2020:24542

URL: https://preprints.jmir.org/preprint/24542

Per the author's request the PDF is not available.