Automated dispensing machines
Overview
Automatic dispensing machines or drug cabinets are a computerized drug storage and dispensing device used in the health care settings like hospitals and nursing homes, and are located at the point of care (the ward, ICU, ED) rather than in the central pharmacy. Much like an bank ATM, an ADM functions as a decentralized point in the hospital medication distribution system and is interfaced with the main pharmacy information system. The ADM provides proper storage, inventory control and security for pharmaceuticals, and can only be used by authorized users who are authenticated by passwords and often biometric measures such as fingerprint readers. After being validated, the clinician must select the correct patient and medication before the cabinet will open and dispense the requested medication.
Advantages
ADM have several major advantages over traditional pharmacy delivery systems. First, needed pharmaceuticals are already present at the point of care and do not need to be sent or transported from main pharmacy stores. This can save considerable time and effort in the daily workflow of nurses. Second, controlled substances remain in a secure lockbox until needed and access to the vault and secured by multi-factor authentication and audit trails. Third, patient charges and inventory control tasks are simplified in an automated dispensing system. Finally, the ADM can provide clinical decision support to improve patient safety---providing drug-allergy alerts, drug-drug interactions, advise on high risk medication (heparin, insulin) and avoid confusion with "sound alike" medications.
Disadvantages
The ADM does not prevent all drug dispensing and administration errors, and is not a panacea for ending all adverse drug administration errors. Precise adherence to standard protocols for administering medication must be followed by clinical personnel and are a final check for preventing errors. Pharmacy can still stock the wrong medication in a given drug cabinet, and clinician can still pick a "look-alike" medication from adjacent drug drawers. In addition, the ADM should ideally used as part of an eMAR system using barcodes on both the medication and the actual patient to insure the right patient is getting the right medication. In addition, the ADM is an electronic device, takes some time to access and dispense medication, and could malfunction at a critical time in a patient's care; for this reason, a separate supply of most resuscitation/critical care drugs ( e.g. epinephrine, atropine) are kept in traditional resuscitation kits (code carts) for emergency use.
Future Uses
Automatic dispensing devices, in simplified format, are already being used in the home environment to assist in correct administration of complicated medical regimens to elderly patients and those with memory impairments. This may improve compliance in this segment of the patient population. As clinical decision support improves, ADM will become more sophisticated and provide more useful assistance to patients and clinicians alike.
References
1. Paparella S. Automated medication dispensing systems:not error free. Journal of Emergency Nursing (2005) 32:74. http://www.ena.org/publications/jen/monthly_article/Documents/02-2006.pdf
2. Guideline on the interdisciplinary safe use of automated dispensing cabinets. Institute for Safe Medical Practices (ISMP). http://www.ismp.org/tools/guidelines/ADC_Guidelines_Final.pdf
Submitted by Paul Baker
