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he number of prescription drugs available in its ever-growing market ballooned over 500 percent in the last decade¹. Keeping track of medications to avoid adverse drug events compounded with ever increasing patient loads is a constant issue not only affecting hospitals but extended care settings as well². First introduced as a means to control access to drugs and prevent supply theft, automated systems expanded into inventory management to prevent waste, reduce costs, and more accurately capture patient charges³.
       A more recent shift in the automated drug dispensing systems (ADDS) market promotes patient safety and reduces potential patient care failures that may lead to litigation. While ADDS are not new on the healthcare scene, managers continue to explore and debate their use³.
       Steve Short, Director of Business Development for MedDispense LLC in Alpharetta, Georgia, says capacity is usually the first concern of a facility looking to implement an ADDS. In the extended care setting, the base 45-drawer unit is especially popular, while in acute care the base 64-drawer unit works best to handle more drugs and supply volume. MedDispense works to provide high quality, value priced products, making pharmacy automation feasible for any facility type, large or small.
       MedDispense provides decentralized automated medication dispensing systems for healthcare facilities nationwide at a low total cost of ownership (TCO). The affordability makes purchasing or leasing a system feasible for other healthcare settings outside of large hospitals. The system allows staff access to medications with pharmacy control via a centralized server. The product reduces medication errors, eliminates missing doses, eliminates manual charge functions with interface functionality, ensures accurate dispensing with profile interface, and enables freestanding functionality when network connectivity is not feasible.        MedDispense workstations are controlled through a 15-inch touch screen display. Dispensing cabinets that utilize touch screen control, called base units, are available in either a 64-drawer unit or 45-drawer unit. Drawers of all hardware units measure 3.5 inches wide and are configurable to hold up to six different medications. Two adjacent drawers may be replaced with a single 7-inch drawer in order to accommodate larger items⁴.
       The ADDS can interface to any HL7 compliant pharmacy management system to help reduce costs associated with drug wastage. Drugs dispensed by the pharmacy and not used by the patient are considered “wasted.” A 2003 Texas Department of Health study found the prevalence of drug wastage is approximately four percent of drug costs. An ADDS potentially can reduce drug wastage in two ways. First, medications needed for short-term conditions, such as mild pain relief and diarrhea, are dispensed in only the amount needed, rather than a full prescription that may be partially wasted if the patient’s condition improves. Secondly, because the system dispenses only the amount of a drug needed at one pass, switching or discontinuing a particular drug’s use will not waste a full prescription. Reducing drug wastage results in lowered prescription drug costs for Medicare patients and represents the most potential for measurable savings to the Medicaid program².

Admission, Discharge, and Transfer Billing
       Another benefit of system integration is billing automation. An admission, discharge, and transfer (ADT) billing interface allows the ADDS to interact with patient accounting software. The interface automatically bills patient accounts for medications and issues credits for dispensed medications that are returned. This eliminates manual billing procedures, reduces medication costs to the patient, increases facility revenue, and frees staff to focus more time on patient care⁴.

Patient Profile Interface
       A patient profile interface displays pharmacist-approved medication orders accessed from the facility’s pharmacy management software. The profile contains an overview of the patient including all approved medications for the patient, drug interactions, known allergies, times for the drug to be administered, and patient history⁴.

System Reports
       As medications are loaded into the ADDS by the pharmacy and dispensed to the patient, data is collected to compile comprehensive reports in five categories: inventory, operators, patients, transactions, and charges/override. The generated data gives staff information otherwise unavailable through manual drug dispensing. The data can be utilized not only by the pharmacy staff but also by administration, nursing, accounting, and material management, establishing greater accountability of medications from the time it enters the pharmacy to when it is dispensed to a patient⁴.

Real World Application
       Based on prior success with ADDS at another facility, a Select Specialty facility in Dallas, Texas, used automation to eliminate cart fill, taking the automated dispensing model a step further. This change gave the nurses 24-hour access to practically all medications in stock. It took time to streamline the procedures related to pulling morning medications and increased demand for time on the equipment, but once a routine was established, eliminating cart fill was found to be an approach that works⁵.
       Nancy Carey, RN, Director of Nursing at Butler Co. Care Facility in Hamilton, Ohio, says she sees improvement to their medication delivery system in the three weeks since installation of the MedDispense system. “Our previous medication storage was like a tool box with pills. With the new machine we have more accountability over who takes what.” Prior to the ADDS installation, some staff members were concerned about how they would adapt to the new technology. They found the touch screen technology user friendly and inventory reports simple to print out and understand⁶. Butler Co. Care is a 121-bed skilled nursing facility providing full-time care and adult day services including community outings, speech therapy, and emergency nursing care, all in a home-like environment.

Precautions
       While an ADDS can improve documentation, reduce medication errors, and enhance patient care and security, it can indirectly contribute to human errors when it creates complacency. Development and implementation of appropriate policies and procedures and oversight through quality assurance and continuous quality improvement programs, are required for the safe and effective use of automated pharmacy systems. Automation is only one component of a human-machine relationship, and the education and training required for the human component must not be neglected⁷.
       In the wake of the recent announcement by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requiring hospitals to develop a strategy to implement barcode scanning by 2007, many vendors are scrambling to quickly roll out their products.8 Whether to invest in this technology is an on-going debate, mainly because most drugs are not bar-coded. Currently, about 30 to 35 percent of drug packages have National Drug Code (NDC) bar coded labels⁸.
       MedSelect, a sister company of MedDispense, offers a Scanner Module that utilizes barcode technology to eliminate dispensing errors caused by incorrect restocking. The scanner performs two verification processes. First, the person restocking the medication scans the barcode, then the appropriate Unit Dose Module LED light blinks or the appropriate storage drawer opens to guide the re-stocker to the correct storage location. Secondly, after a medication is dispensed, it is scanned to verify it is the correct medication. Medications that are not bar-coded may be visually verified and the visual verification is recorded in the database for reporting.
The scanning unit is mounted above the display terminal touch screen to provide easy access, and hands-free use⁹.
       The abundant number of available medications, coupled with staffing shortages and increased patient loads, present opportunities for adverse drug events. Automated drug dispensing systems purposefully reduce the risk of healthcare errors and simultaneously have reported gains in nurse satisfaction, retention, and productivity¹⁰. Although ADDS are not new, their implications are tied to future technology, namely barcode scanning, and will add another line of defense to further protect patients.