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3. CHAPTER 12

4. AUTOMATED DISPENSING CABINETS (ADCs) - is a computerized point-of-use medication management system that is designed to replace or support the traditional unit-dose drug delivery system. - the devices require staff to enter a unique logon and password to access the system using a touch screen monitor or by using finger print identification.

5. The Rationales behind the wide acceptance of this technology are the following: Improving Pharmacy Productivity Improving Nursing Productivity Reducing Costs Improving Charge Capture Enhancing Patient Quality and Safety

6. IMPROVING PHARMACY PRODUCTIVITY - the streamlining of the dispensing process due to the reduced number of steps from filling each patients individual medications bins to filling a centralized station. - it also has the potential to reduce time needed to obtain missing medications.

7. Improving Nursing Productivity - the time spent gathering or obtaining missing medications can be reduced. - the turnaround time in obtaining newly ordered medications is decreased.

8. Reducing Costs - increased pharmacist and productivity, which fees them from consuming processes and allowing patient and clinical interactions. -there reduction in inventory and containment in associating administered medications.

9. Improving Charge Capture - ADCs that are faced with the accounting department allows the capture of all patient charges associated administered medications.

10. Enhancing Patient Quality and Safety - ADCs have built-in decision support systems the users on drug-drug interactions, drug-lab interactions (requires laboratory interface), drug-drug duplication and so forth (Cardinal Health,2003)

11. The development of workarounds for ineffective or inefficient systems can be devastating to patient safety. The interactions between a nurse and technology is very important and often is not considered when various forms of automation, including ADCs, are purchased, installed, and employed on the nursing unit. Overrides usually are needed with medications used in emergency situations. Unfortunately, ADCs that allow overrides also serve as an extended pharmacy in order to obtain and administer medications prior to delivery by the pharmacy.

12. Regardless of an organizations steps to purchase or implement ADCs, the following issues should be considered to ensure safe medication practices: Consider purchasing a system that allow for patient profiling so pharmacist can enter and screen drug orders prior to their removal and administered. Carefully select the drugs that will stocked in the cabinets. Consider the needs of each patient care unit as well as the age and diagnoses of patients being treated on the units. Place drugs that cannot be accessed without pharmacy order entry and screening in individual matrix bins.

13. Use individual cabinets to separate pediatric and adult medications. Periodically reassess the drugs stocked in unit-based cabinet. Develop a check system to assure accurating of the cabinets. Routinely run and analyze override reports, help track and identify problems

14. SMART Infusion Pump Delivery System - are primarily used to deliver patients medications through IV or epidural lines and is found in a variety of clinical settings ranging acute-care and long-term care facilities, patients in physicians offices. - Infusion pumps with dose calculations software, is refferred to as smart pumps, could reduce medication errors, improve workflow, and provide a source of data for continuous quality improvement ( CQI) by identifying and correcting pump-program errors.

15. Implementation of Technology Implementing any form of technology into a health organization can be an imposing task. Many organizations have purchased various forms of automation, and little or inadequate planning and/or preparation, which can lead to errors as well as the development of serious problems.

16. In addition, to identify an interdisciplinary team of key individuals who collaborate on an effective and realistic plan for implementation, including front-line clinical staff. The multidisciplinary implementation team will need to address the following: Outlining goals for the type of automation to be implemented(e.g., to improve safety, decrease costs, eliminate handwritten orders). Developing a wish list of desired features and determining which one, given budgetary constraints, are practical.

17. Investigating systems that are presently available. Analyzing current workflow and determining what changes are needed. Identify the required capabilities and configuration of the new system. Sell the benefits and objectives of automation to staff. Development of an implementation plan.

18. Once the system has been implemented into the organization, there are still many issues that need to be considered. As soon as the system installed, it is important to commit in a meaningful way to its continual monitoring and improvement.