Table 3

How an automated dispensing cabinet (ADC) may support or challenge governance of controlled drugs (CDs) in hospital wards

CD governance activityADC supportADC challenge
Safekeeping/Controlling accessAccess control by fingerprinting/username and password
Double lock drawers (two users/fingerprints to access)
No requirement for keys
Not all CDs ‘storable’ in the ADC. Parallel use of ADC and safe and registers required.
Access to CD in the fridge only partially controlled, leading to a hybrid system of ADC for storage and paper registers for documentation. Workaround needed to give access to CD in the fridge and alert nurses of the different workflow.
Parallel use of ADC by different users, for different transactions, not supported, leading to potential queues to access medications.
Documenting transactionsDocumentation synchronous to removal/supply/count of CDs
Automatically recorded data for most transactions, through fingerprinting and item selection on screen
Automated alerts of potentially incorrect remaining stock balances recorded
Users perception of efficiency and completeness of documentation
Reduced flexibility in amending records compared with paper.
Returning CDs to the ADC more complex than with safe and registers.
MonitoringCounts of stock levels blind to documentation of balance
Remote monitoring potentially in real-time, through reporting functionalities and remote access to ADC data
Users perception of efficiency and greater control
Data recording only partially automated; some data entered by users may not be accurate (eg, reason for discarding a CD), thus affecting monitoring activities.
Reporting and investigatingEasier to identify discrepancies near the time of their occurrence, making it easier to investigate and resolve
Investigations involving interviewing staff can be limited to staff that had access to the ADC in the period of interest
Access to CDs in the fridge by unregistered users (while others are still logged in), not detected by the ADC, is possible.
Possible risk of illusion of completeness of records.