Automated dispensing cabinets (ADCs) have been utilized in direct patient care areas since the 1990s, with studies since then evaluating its efficacy in medical error reduction and subsequent cost savings. One previous study using the McLaughlin Dispensing System observed lowered error rate compared to use of doses dispensed from a satellite pharmacy (10.6% vs 15.9%) over a two-week trial period, while another which utilized the Baxter ATC-212 automated dispensing system found daily cart filling time to be significantly reduced, but overall time savings was not significant (<0.5 full-time equivalent), and drug costs were increased due to the acquisition prices for bulk drugs used by the automated dispensing system. In a more recent study, ADCs were observed to reduce overall error rate, but errors of greater severity increased. Though a positive financial impact was observed based on both operation and investment costs, these findings were based on nurses’ time gained, and findings were presented in 2015 Euros. Overall, insufficient evidence is available to determine the extent of dispensing accuracy in patient care areas, necessitating further studies. [1], [2], [3]
A 2014 review examined the clinical and economic impacts of decentralized automated dispensing devices (ADDs), such as Pyxis and Omnicell, in hospital settings. The review explores how use of ADDs in ICUs, general medicine wards, surgical units, or a combination of these locations affect medication management processes, patient safety, and healthcare costs. Within the eight papers included for analysis, ADDs appear to have a benefit in medication storage errors reduction and controlled substance inventory management; however, there was a lack of evidence to support whether ADD use resulted in staff time savings, whether patient harm was reduced as a result of ADD use, or whether costs overall were reduced. Additionally, findings were specific to Canadian hospitals, and applicability to domestic hospitals is uncertain. [4]
A 2015 BD article describes a single institution's implementation of the BD™ Pyxis™ Enterprise solution (ES) in Saudi Arabia, which is a program to convert cart-fill pharmacy distribution of medications to the Pyxis automatic dispensing cabinet (ADC). The ADCs were installed on 31 different units, including operating rooms, labor and delivery units, recovery units, and catheter labs. The formulary was standardized and integrated into the ADC, which assessed the minimum quantity needed for each drug and allowed for timely refills. In the results, the authors found that medication turnaround time was reduced by ~57% while dispensing of the wrong medication was reduced by ~42%, and dispensing to the wrong location was reduced by ~85%. Improvements to clinical workflow were cited as a major benefit that lowered the need for medication preparation, medication checking, and medication delivery to nursing units. No formal cost-saving analysis was performed. Cost savings may be observed by the optimization of inventory use and storage in the APC. [5]
A 2013 simulation study assessed different medication distribution models in an effort to find an alternative to the hospital’s existing hybrid distribution model (64% of doses dispensed via cart fill and 36% via ADCs; see Table 1). Relative to the base case (hybrid model), a simulation modeling of different distribution scenarios, one involving no use of cart fill, one involving no use of ADCs, and one heavily dependent on ADC dispensing (Decentralized; 89% via ADC and 11% via cart fill), showed that the calculated pharmacy technician labor requirements decreased in a decentralized medication distribution system which involved greater use of ADCs (-671.37 min no cart fill vs. -291.50 min no ADCs vs. 211.02 min Decentralized) but only at the expense of the nursing staff workload (859.21 min vs. -706.59 min vs. 977.16 min). Given the higher labor cost of the nurses than that of pharmacy technicians, the projected human resource opportunity cost of transitioning from the existing hybrid system to a suggested decentralized system was estimated to be $229,691 per annum. A more ADC-dependent model resulted in an unfavorable shift in staff skill mix and corresponding human resource costs at the medical center. [6]