Medication errors are a universal health-care concern, and improving medication administration systems is important to enhance safety. The purpose of this study was to compare the effectiveness of an existing unit dose system using a medication cart to a new system where medications are decentralized to a locked cupboard at the patient's bedside. Quantitative and qualitative approaches were used to determine the effectiveness and efficiency of the medication administration systems. Data was collected using time studies to evaluate the efficiency of the two systems. This data included medication errors, missing doses and interruptions occurring during the medication preparation and administration process. Focus groups were conducted with nurses, pharmacists and pharmacy technicians to better understand the impact of changing systems. Study results demonstrated benefits associated with decentralizing the medication distribution to the bedside, including nurses spending more time with patients, nurses investing less time preparing and distributing medication and fewer interruptions for nurses as they prepared and distributed medication. Nurses and pharmacists associated the new system with enhanced patient safety and work satisfaction.