Automated drug dispensing systems in the intensive care unit: a financial analysis

Medical Errors

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Nurses play a key role in promoting quality and safe care. Patient safety is a major priority among nurses worldwide as it promotes the quality of life. Medical errors and adverse drug events from the wrong medication are among one of the mistakes that cause patient harm. Medical errors are mostly errors of omission or commission and include misdiagnosis, surgical injuries and wrong-site injuries, improper transfusions, mistaken patient identities, suicides and much more. More so, medical errors affect not only the patient but also the caregivers involved and the institution as it can cause hospitalizations, increase the cost of healthcare, morbidities and even death. There are many reasons that lead to medical errors and adverse drug events such as the situation, say in emergencies, distraction or not following drug dispensing process, fatigue, labelling of prescriptions, drug abuse, misdiagnosis, patient’s level of understanding, age of the patient and the severity of the condition. There are multiple evidence-based interventions that have been proposed and are used to curb the problem of medical errors such as adopting EHR systems, automated drug dispensing machines, training and educating nurses, educating patient, involving pharmacists, reduce reliance on memory, and adjusting the work environment, communications and schedules. This paper aims to focus on the use of automated dispensing machines as a way to distribute medications and reduce the risk of medical errors and will review several articles using their annotated bibliographies.

Annotated Bibliography

Zaidan, M., Rustom, F., Kassem, N., Al Yafei, S., Peters, L., & Ibrahim, M. I. M. (2016). Nurses’ perceptions of and satisfaction with the use of automated dispensing cabinets at the Heart and Cancer Centers in Qatar: a cross-sectional study. BMC nursing, 15(1), 4.

This study by Zaidan et al., (2016) take on a study to assess the response and the perception of nurses on automated dispensing cabinets that were implemented in Heart Hospital and National Center for Cancer Care and Research in 2011 and 2012 respectively. The systems work to control the storage of medication, dispense, and keep tabs of medication at the point of care in care units. The nurses within those institutions provide first-hand information on the automated system based on the perspectives of job satisfaction, their perception of the system, ease of use and their sociodemographic and practice characteristics. The survey is relevant to my research as it sheds light on the importance of technology in improving quality and safety, and how it ought to be implemented with the involvement of nurses as they are the majority within any healthcare setting and interact with the systems frequently. From the survey the authors did find that the drugs dispensing system increased the levels of safety, reduced medication waiting time, nurses had the opportunity to administer prescriptions safely, and the overall satisfaction among nurses was high at 91%.

Chapuis, C., Bedouch, P., Detavernier, M., Durand, M., Francony, G., Lavagne, P., … & Payen, J. F. (2015). Automated drug dispensing systems in the intensive care unit: a financial analysis. Critical Care, 19(1), 318.

Clinical institutions are at times ran like a business, and with the implementation of any evidence-based interventions, the economic aspect has to be assessed to avoid wastage of resources. In this study, the researchers get to investigate the economic impact of the newly adopted automated dispensing systems versus the cost of the traditional floor stock system. The comparative study included costs before and after the adoption of the new system and considered aspects such as time used by caregivers on medical-related processes, expired drugs, stock inventories and an all-round financial analysis. From the 3 ICUs used, the study shows that the new dispensing systems saved the nurses’ time on medical-related activities, the costs of storage and expired drugs were also reduced. The system does also have a positive return on investments and net present value. This study will be useful in my capstone project to demonstrate the financial modelling of the intervention, its running costs and time saved to improve quality of care.

Cheung, K. C., Van Den Bemt, P. M., Bouvy, M. L., Wensing, M., & De Smet, P. A. (2014). Medication incidents related to automated dose dispensing in community pharmacies and hospitals-a reporting system study. PloS one, 9(7), e101686.

The authors do acknowledge that the use of automated dose dispensing units was a great intervention to check medical errors and save time and resources. Though everything has its positive sides, the downside is also inevitable. The authors observe that a new form of medical errors are introduced despite having the new system among hospitals and pharmacies in the Netherlands. The study observed that most medical errors occurred among the elderly patients aged 65-80 years as most of them suffer from polypharmacy and with the immediate problem being a frequent change in prescription regimens and relocation. The other problems observed that could cause adverse drug outcomes occurred during filling the ADD bag and entering of prescriptions into the system of which both are human errors. This article is significant to my research as it shows some of the limitations with the automated drugs dispensing system, which may help to develop awareness and provide more solutions to improve care outcomes.

Keers, R. N., Williams, S. D., Cooke, J., Walsh, T., & Ashcroft, D. M. (2014). Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review. Drug safety, 37(5), 317-332.

The choice of this article is because it’s a systematic review of probable interventions that can be used to check medical errors and adverse drug events to improve patient care and safety. The authors critically review different methods and appraise them based on their effectiveness, those sampled include nurse education training and use of medication technology such as barcoding, electronic prescribing and automated dispensing. The authors do acknowledge that the interventions taken for medical errors depend on the source of errors and that no current intervention can be recommended. This study will add to my research as it proposes the need to focus on streamlining the available interventions as they have some level of weakness. Currently, the best intervention to curb medical errors and adverse drug events is to use multiple approaches so as to limit the number of sources for medical errors.

Noparatayaporn, P., Sakulbumrungsil, R., Thaweethamcharoen, T., & Sangseenil, W. (2017). Comparison on human resource requirement between manual and automated dispensing systems. Value in health regional issues, 12, 107-111.

In my study, the focus is mainly on the impact of automated dispensing systems as a measure to curb medical errors, though it is worth to note that no system operates independently without some form of human resource. The study by Noparatayaporn et al. (2017) aimed to assess and compare the level and intensity of human resource required between the traditional manual systems and using the modified automated drug dispensing machines. The study was conducted in a 2100-bed university hospital in Thailand, whereby one inpatient ward was used to pilot the automated dispensing machine while the average of the other wards was used to oversee the manual system. The outcomes of the study show that the automated system reduced the workload of nurses and redesigned the work process as more time from pharmacists was required, but it resulted in comprehensive care, quality outcomes and reduced errors.

Rochais, É., Atkinson, S., Guilbeault, M., & Bussières, J. F. (2014). Nursing perception of the impact of automated dispensing cabinets on patient safety and ergonomics in a teaching health care center. Journal of pharmacy practice, 27(2), 150-157.

This study by Rochais et al., (2014) pays a crucial part in my research as it focuses on the opinions and perspective of the main majority user of all technology adopted in healthcare; that is, the nurses. This study correlates with that of Zaidan et al., (2016) on getting the opinions of the users of technology to get a better picture of it. The study by Rochais et al. (2014) sought to understand how nurses felt about the use of automated dispensing cabinets. Majority of the nurses admitted that the use of technology reasoned their work, reduced medication errors. More so, nurses were pleased that it reduced narcotic drugs abuse. However, they had a problem with how medications were delayed and inconveniences caused by stopping the medication administration record, yet the patient needs it. Use of technology minimize the number of hands handling medication hence minimizing the likelihood of errors. The use of this study is that it acknowledges the use of nurses as change agents hence appreciate their perspective

Roman, C., Poole, S., Walker, C., & Dooley, M. J. (2016). A ‘time and motion’evaluation of automated dispensing machines in the emergency department. Australasian Emergency Nursing Journal, 19(2), 112-117.

Automated dispensing machines have been implemented in the majority of hospitals in America and have proven to securely store medications, efficiently track and record drugs usage and restrict access. Some regions are progressive as they integrate new systems within such as electronic prescribing. While the automated dispensing machines have given benefits, it is best to understand its functionality, especially in settings such as emergency departments and ICU where the majority of medical error cases are recorded. This article by Roman et al., (2016) did aim to assess the efficiency of the intervention in medications retrieval, the time used, and the perception of nurses in an emergency setting. The study found that automated dispensing machines did slow the amount of time used to retrieve less restricted and unscheduled medication as they are in a system unlike before in shelves. Retrieval time for highly restricted medications decreases as with a new system recording is automated no need to sign and record manually. Overall the nurses believe that automated dispensing machine save time and increase safety, especially when they are many and nurses need not queue to access services. This study is beneficial as it shows some of the areas of the technology that need to be improved.

Tsao, N. W., Lo, C., Babich, M., Shah, K., & Bansback, N. J. (2014). Decentralized automated dispensing devices: systematic review of clinical and economic impacts in hospitals. The Canadian journal of hospital pharmacy, 67(2), 138.

The healthcare department has seen the introduction of varied technologies as it is the current and future trend to make the process of care efficient. But with the shift towards quality care, there is great concern on limited resources, and there is the need to improve patient safety and save costs, an aspect that my study need to observe. The literature review study by Tsao et al. (2014) seeks to assess the economic impact of implementing an automated dispensing device in a clinical setting. From the studies collected, there was evidence that automated dispensing systems reduce the effects of narcotics and controlled substances and reduce storage errors. The study recommends healthcare institutions to review the process of integration of technology and its cost and benefits. This study is significant to my capstone project as it stipulates on factors to consider in adoption of new technologies and evidence-based interventions.

Uy, R. C. Y., Kury, F. P., & Fontelo, P. A. (2015). The state and trends of barcode, RFID, biometric and pharmacy automation technologies in US hospitals. In AMIA Annual Symposium Proceedings (Vol. 2015, p. 1242). American Medical Informatics Association.

The adoption of technology to improve safe medication cannot be actualized unless the tech observes the major five rights of administering medication which are checking time, route, dosage, the right patient and drug. The use of technology has mostly been supported as it reduces much interference of human factors in the process of handling drugs. This study by Uy, Kury & Fontelo (2015), seeks to understand how different methods used to curb medical error cases have been adopted in different hospitals and institutions in the United States. The study shows that the rate of technology adoption has been positive. The adoption of automation in the pharmacy has been positively embraced as the numbers jumped from the rate of 2.08% – 81% between 2008 and 2012. The adoption of the HITECH Act of 2009 has been used to affirm this change, which shows that technologies are also functional in real-life settings in bringing the desired change.

Hamilton-Griffin, K. (2016). Developing improvement strategies on the use of Automated Dispensing Cabinets to reduce medication errors in a hospital setting (Doctoral dissertation, Capella University).

This study is key to my capstone project as it specifically focuses on automated dispensing devices, which are technologies adopted to check costs and likelihood of errors in medication. The concern is that there are still limitations with the likelihood of medication errors in the implemented interventions. The study is important as it may shed on probable solutions that may be implemented to improve the dispensing system and process. This study by Hamilton-Griffin did also capitalize on responses and experiences from nursing and pharmacy staff with the majority of them being satisfied with the new systems. The shows that medical errors occur due to discrepancies between nursing care units and the inpatient pharmacy department despite using the automated dispensing cabinets. The discrepancies cause a delay in treating the patient caused by medication shortage and delay.

References

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Essay
Number of Pages	10 Page(s)/2750 words
Sources	6
	APA
Spacing	Double Spaced

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Automated drug dispensing systems in the intensive care unit: a financial analysis

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