Background and importance The pillbox preparation is an error prone act for the nursing staff and interruption is a contributing factor. Automated dispensing cabinets (ADC) have the potential to reduce error rates, but only limited evidence is available.

Aim and objectives The aim of this work was to evaluate the impact of ADC on the dispensing error rate, number of interruptions and pillboxes preparation time in a large scale real life study.

Material and methods This was a prospective observational study in 16 wards of two departments (medicine and surgery). We compared eight wards with an ADC (Pyxis Medstation, BD) and eight wards with a traditional dispensing cabinet (TDC) involving manual picking of drugs. Observations were made by a single observer using the disguised observation technique during the preparation hours of the pill dispensers. A picture was taken of each pillbox and the contents were compared with the information contained in the patient‘s electronic chart. The proportion of errors was calculated by dividing the number of doses with errors by the total number of opportunities for errors. The observer chronometered the time taken to prepare the pillboxes and noticed any interruptions. Wards participating and not participating in the ‘more time for the patient’ (Lean management) project were compared.

Results 2924 opportunities for error in 570 pillboxes made by 132 nurses were observed. We measured significant decreases in error rates (1.0% vs 5.0%, p=0.0001), number of interruptions per hour (3.15 vs 5.72, p=0.008) and preparation time in seconds per drug (32 vs 40, p=0.0017) between the ADC and TDC groups, respectively. There was a significant decrease in the error rate (1.4% vs 4.4%, p=0.0268) and a non-significant decrease in the number of interruptions per hour (3.80 vs 5.06, p=0.0802) between services participating in the ‘more time for the patient’ project and those not participating in this project, respectively. No error resulted in patient harm.

Conclusion and relevance ADCs reduced dispensing errors, interruptions and time when preparing pillboxes. Services that implemented a Lean management approach had a lower error rate in comparison with non-participating services.

Conflict of interest No conflict of interest