IMPACT OF ELECTRONIC DISPENSERS ON PATIENT SAFETY

    Current technologies are important strategies for preventing drug-related errors.

   The use of electronic dispensers is increasingly frequent in health organizations, mainly due to the optimization for pharmacists and nurses, who can now emphasize direct patient care, otimização das equipes na assistência aos pacientes, melhorias nos sistemas de saúde e para redução de custos.

 

     From the 1990s, mainly after the release of the To Err Is Human: Building A Safer Health System report, issued by the Institute of Medicine (IOM) in 1999, Brazil starts a movement in search of quality and patient safetythrough greater investment in the area and the adoption of certifications and quality standards. Ever since, patient safety and medication errors have received great attention and concern by health institutions. (Ferracini, 2010; Menezes, 2016; National Patient Safety Foundation, 2015; Cochran, 2016).

     Electronic dispensers for drugs and medical supplies are automated distribution systems that allow for the control and logistics of decentralized inventories, the “advanced stock points”, contributing to patient safety. These are improvement processes for patient care, reducing medication errors, reducing costs and bringing health providers closer to direct patient care.

    Electronic dispensers can be defined as equipment that performs the dispensing of drugs through an interface between the prescription and the equipment.

     In order for the items to be removed from the electronic dispenser, they must be linked to a prescription, which allows the proper entry to the patient’s account, medical records and billing of these items by the hospital, thereby ensuring greater stock control , reduction of disallowances, which also reflects in a better financial control.

    The implementation of the dispenser brings several benefits related to patient safety, reduction in the number of personnel involved in medication logistics, decreased stock values, greater control over the expiration of items and reduced time spent by the nursing/pharmacy teams with trips to withdraw or deliver medications, in addition to the economic impact. Reports show that the greater the workload of the nursing staff, the greater the chances of errors related to patient care.

    “An Australian article published in 2016 proved that the implementation of electronic dispensers in an emergency unit showed a 64.7% reduction in potential medication errors, when compared to another unit with no electronic dispensers”.

    There is strong evidence that the use of technologies are important strategies for the prevention of medication-related errors (Ferracini, 2010; Menezes, 2016; National Patient Safety Foundation, 2015; Cochran, 2016).

Regarding the impacts of time spent by teams, we can mention:

  • Time spent by employees on activities related to medication logistics and management,
  • Time spent daily by ordering supplies for the pharmacy and urgent requests made by the team,
  • Time that the pharmacy team takes to meet the prescriptions,
  • Time spent by nurses between the nursing station and the pharmacy, or by the pharmacy team towards the nursing station,
  • Time spent to make supply and medication returns by the nursing and pharmacy staff including the need for cyclical inventories.

     The implementation of electronic supply and medication dispensers tendsto show a reduced consumption of medications, and reduced return of supplies and medications, where there is an interface between electronic dispensers and the hospital’s computerized system and, with that, the suspensions of medications in a prescription or patient discharge are integrated in real time and managed by the electronic dispenser. Additionally, the dispensing of medications prescribed as “if necessary - now - urgent” occurs when the patient so requires, increasing safety. The time that nursing staff is involved with issues related to supplies and drugs directly interferes with the time available for direct patient care.

    Advanced stock points (Electronic Dispensers), are a health technology with the potential to reduce medication errors, and its several benefits have been measured and significantly involve increasing patient safety, including the efficiency of unit-dose dispensing of medications (Medication prescribed vs. Medication dispensed - Dose - Presentation - Route - Time - Quantity...), in addition to monitoring stock movement, greater accuracy and increasing traceability, reducing inventories, diversion of medications and increasing financial return.

    Electronic dispensers are implemented in hospital units to increase the efficiency of human resources work and the quality of routines/flows, as well as increasing safety of medication dispensing and reducing costs.

Leandro T. Ferracini

Sources:

  • Revista Brasileira Farmácia Hospitalar Serviço Saúde 2018; 9(3):e093.003 (Sabrina Beal Pizzato)
  • Borges Filho WM, Ferracini FT. Prática Farmacêutica no Ambiente Hospitalar. 2 ed, Rio de Janeiro: Atheneu, 2010:139
  • Chapuis C, Roustit M, Bal G, et al. Automated drug dispensing system reduces medication errors in an intensive care setting. Crit Care Med, 2010, 38(12): 2275-2281.
  • Zaidan M, Rustom F, Kassem N, et al. 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, 2016, 15(4): 1-8.
  • Fanning L, Jones N, Manias E. Impact of automated dispensing cabinets on medication selection and preparation error rates in an emergency department: a prospective and direct observational before-and-after study. Journal of Evaluation in Clinical Practice, 2016, 22: 156-163.

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