Background One year ago, a centralised floor stock was implemented in a protected area inside the pharmacy of our psychiatric hospital (541 beds) to facilitate continuity of care. It allows nurses to get supplies of common medicines and medical devices during the closing hours of the pharmacy. This floor stock was contained in a secured automated storage cabinet, requiring nurse badge identification, and unit and patient name entry for any removal.
Purpose The aim of this study was to evaluate the main drugs and medical devices taken by nurses, and to highlight the benefits and limits of this system.
Material and methods Using the traceability software of the cabinet, all medicines and medical devices taken from the floor stock were systematically checked on the morning following removal and compared to prescriptions, during the year following its implementation.
Results Over one year, 206 drugs were taken from the floor stock. The most frequently removed drugs were cardiovascular treatments (n=54), diabetes medications (n=36), psychiatric medicines unavailable in the usual provision of units (n=30) and antibiotics (n=28). Few medical devices were taken (n=9). The care units made no request to change the floor stock composition.
The main difficulty encountered when starting implementation was nurse apprehension about using the cabinet, despite prior training and the existence of an instruction manual and a video tutorial. Picking errors were also identified, mainly confusion in the pharmaceutical form of the drugs (immediate release versus sustained release) or molecule errors (amoxicillin versus amoxicillin+clavulanic acid, confusion between existing insulins). All picking errors occurred in the first 4 months and were not repeated afterwards. Furthermore, some technical issues and manipulation errors were reported.
Conclusion A centralised floor stock in an automated storage cabinet is an interesting approach to improve continuity of care. It allows nurses to collect treatments when convenient, without having to summon the on-call pharmacist. However, the risk of picking errors requires systematic verification of removals in regard of prescriptions, and technical issues may affect the effectiveness of the system. For these reasons, the centralised floor stock must remain closely supervised by pharmacists.
References and/or Acknowledgements We acknowledge the nurses of our hospital.
No conflict of interest
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