Key outcomes of the studies (n=30) applying automation in the drug distribution process
| Outcomes | Sub-themes | Key outcomes by distribution system | ||
| Centralised system (n=6) | Hybrid system (n=5) | Decentralised system (n=19) | ||
| Safety | Impact on medication errors | UDS combined with medication carts reduced MEs and UDS reduced MAEs1 41
UDS combined with pharmacy-based ADC and BC scanning and CDT improved accuracy34 40 The centralised daily dispensing system did not change significantly the frequency and severity of errors28 Fewer missing drugs in UDS compared with traditional manual dispensing system41 UDS reduced ADEs21 | ADDSs (both single-dose and electronic prescribing combined with ADCs) and UDS combined with ADC reduced MAEs3 26
Automation and UDS combined with ADC reduced MEs3 17 26 UDS combined with ADC reduced severity of ME effects3 All error types reduced26 UDS with cartfill and ward-based ADCs increased requests for missing doses33 CPOE reduced ADEs17 | ADCs reduced MAEs30 31
ADCs had no significant effect on MAE rates2 ADDS increased MAEs27 Decentralised automated dispensing devices and ADCs reduced MEs13 14 29 35 MAEs persist in units with automated prescribing and ADCs36 ADC reduced all error types but did not affect error severity29 Decentralised automated dispensing devices did not show evidence that systems reduced MEs resulting patient harm14 ADC: Fewer missing drugs due to unavailability on wards25 30 ADC did not reduce the most frequent error types (eg, wrong administration technique)36 ADC improved ADE reporting38 ADDS reduced ADEs.27 |
| Pharmacists' clinical activity | UDS supported clinical pharmacy practice41 | Not reported | ADC combined with drug trolleys allowed pharmacists more time to review prescriptions and detect errors24 | |
| Impact on medication-use process | UDS and CDT improved processes: improved medication management and efficiency in dispensing21 40
The new distribution system, UDS combined with medication carts, revealed risks in the medication-use process1 | Automation and thrice-daily cart-fill process improved medication-use process17 33 | ADCs combined with drug trolleys, ADDS and decentralised automated dispensing devices improved medication dispensing process: standardised process, improved efficiency, accuracy and quality2 14 16 23 24 27 32 39
ADCs indicated risks in medication-use process8 23 36 ADM improved healthcare staff knowledge of medications37 ADC and ADC combined with drug trolley improved the quality of prescriptions24 30 | |
| Other safety aspects | Security improved by UDS alone and UDS combined with medication carts: restricted access to medication and fewer missing drugs on wards1 41
UDS with individual medication doses reached improved hygiene21 Individual unit-dose packages contained all the necessary patient and drug information21 28 | UDS combined with ADC improved medication safety26 | Security improved with ADCs and ward-based MVS: restricted access to medication and less drug administered from unlocked areas22 31
ADMs, ADCs and decentralised automated dispensing devices improved narcotic drugs management14 35 37 ADCs and ADCs combined with drug trolleys improved patient safety16 22–24 30–32 35 ADCs caused more documentation discrepancies because nurses did not correct missing medications to the eMAR when drug was administered31 | |
| Time | Time and labour | CDT reduced the amount of technician labour40
UDS had the same dispensing time as in manual dispensing21 In the centralised dispensing system healthcare staff experienced satisfaction with drug delivery time28 UDS required extra staff41 | Thrice-daily cart-fill process reduced interval between beginning of the cart-fill process and medication administration33 | ADCs decreased medication-related logistic tasks2 16 25
ADMs, ADCs and ADCs combined with drug trolleys increased medication-related logistic and clinical tasks (eg, ward pharmacy services, retrieving medications)24 30 37 With more cabinets installed, nurses reported less waiting time to access the distribution system32 Time spent on drug administration round decreased by ADC30 Medication process became slower with ADCs16 35 Medication process became faster with ADCs31 With ADCs, nurses had more time for patients31 32 Nurses thought ADMs and ADCs saved time13 37 Decentralised automated dispensing devices, ADCs and ADCs combined with trolleys needed extra pharmacy staff, e.g. to manage the dispensing system, delivering and screening medications14 24 25 30 32 39 Extra nursing staff were needed with ADCs39 No definitive evidence that nurses or pharmacists spent more time with patients with the help of decentralised dispensing devices14 |
| Work-related factors | Nurses reported less workload with UDS combined with medication carts and centralised dispensing system1 28 | Centralised dispensing system combined with ADCs had optimal nursing staff workload compared with decentralised distribution system18 | ADCs improved working conditions and work was considered easier13 35 | |
| Costs | Medication costs | Centralised dispensing system slightly improved cost control28
CDT reduced inventory costs40 UDS did not change medicines costs21 | Centralised dispensing system combined with ADCs was optimal in cost effectiveness (eg, staff workload required)18 | ADCs and ADDS reduced medications costs25 27
Decentralised automated dispensing devices did not show evidence of cost reduction14 |
| Other | Medication storage | With UDS smaller warehouses at wards were needed21
With UDS unused drugs returned to the pharmacy41 | Thrice-daily cart-fill process reduced waste and the number of medications returned to the pharmacy33
Automation improved inventory control17 | Decentralised automated dispensing devices, ADCs and ward-based MVS improved storage: drug storage reduced, improved stock control, MEs decreased13 14 22 25
Expired drugs eliminated with ADC25 |
| Technology | Healthcare staff had positive opinions on the centralised dispensing system, UDS and UDS combined with medication carts1 28 41
Computer system rated negatively in centralised dispensing system28 BC connected to a centralised system decreased MEs34 Technology needs comprehensive personnel training34 | Errors reduced with BCMA17 | Negative opinions (eg, frustration) by healthcare staff on the ADCs and ADCs combined with drug trolleys23 24
Positive opinions by healthcare staff on the ADCs, ADCs combined with drug trolleys and ward-based MVS13 16 22 24 35 Decentralised automated dispensing devices and ADCs combined with drug trolleys was related with technical problems14 24 Other technologies recommended (eg, eMAR, BCMA) to be combined with the decentralised dispensing system8 | |
ADC, automated dispensing cabinet; ADDS, automated drug dispensing system; ADE, adverse drug event; ADM, automated dispensing machine; BC, barcode; BCMA, barcode medication administration; CDT, carousel dispensing technology; CPOE, computerised physician order entry; MAE, medication administration error; ME, medication error; MVS, medicines vending system; UDS, unit-dose system; eMAR, electronic medication administration record.