Technology
Joey Sweeney, PharmD
Automated dispensing cabinets (ADCs) seem like simple devices, but there is an astounding number of decisions needed to enable their safety and efficiency. In August 2021, ASHP released updated guidelines on the safe use of ADCs.
“This is a thorough, comprehensive document that addresses the complexity, planning, and thought needed to help you build your system to be as safe and secure as possible,” said Ryan Cello, PharmD, pharmacy supervisor of automation, informatics, and technology at UC Davis and an author of the new guidelines.
The guidelines cover most scenarios in sufficient depth, whether a hospital is implementing ADCs for the first time, changing ADC vendors, upgrading existing ADCs, or optimizing existing ADC practices.
Quality and access control
The pharmacy department typically “owns” all ADC functions as drug supply cabinets. One of the most important facets to get correct when rolling out new devices is deciding which medications to stock in each ADC. Historical usage data derived from ADC reports can be used as a starting point for this discussion, but having a clinical pharmacy expert also weigh in is necessary.
Ongoing quality improvement in the form of appropriate inventory turns is one way the authors of the guidelines justify the cost of the ADC. Safety improvements, such as increased barcode-scanning utilization, can help prevent medical errors and corresponding litigation costs.
Monitoring for diversion of controlled substances is another crucial ADC function that requires careful vigilance by pharmacy staff, according to the guidelines. Ensuring only those users who need them can access controlled substances is an important part of initial planning and ongoing quality control, which should regularly be performed by pharmacy, nursing, and medical stakeholders.
For certain areas—like operating rooms, where specialized ADCs are often deployed—pharmacy staff should ensure high-risk (e.g., neuromuscular blockers) and look-alike/sound-alike medications are appropriately spaced to prevent inadvertent administration to a patient.
The IT ecosystem
A hospital’s ADC fleet will be connected to IT infrastructure via wired or wireless networking. Information that flows on this network will eventually reach the server (usually located within the hospital enterprise, but sometimes in the cloud). It is important for the pharmacy and IT departments to ensure the server arrangement meets both the current needs of the hospital system and any plausible future needs. This includes upgrades to the server or the ADC software loaded on the server.
An electronic health record (EHR) can interface with the majority of ADCs at a hospital. According to the guidelines, EHR and ADC vendors need to work with pharmacy operations leaders to make sure EHR, ADC, and IT infrastructures are all able to work together cohesively.
The physical ADC hardware—such as cabinets, refrigerators, and auxiliary devices—need to be carefully placed within the physical space of each unit served by an ADC. Attention should be paid to the ADC’s location and the location of other high-traffic elements (e.g., doors, sinks, etc.). This is to make sure physical movement is not unduly restricted in the spaces designated to house the ADC.
Size is also an important consideration. An undersized ADC will result in delays in care when medications run out, and an oversized ADC could mean wasted money in the form of ADC expenses.
Training, workflows, and monitoring
While ADCs are often designed to be as user-friendly as possible, an employee who uses the ADC for the first time will need to undergo training. The guideline authors share that ADC vendors usually have prebuilt modules for pharmacy, nursing, and medical educators to use for training purposes.
The authors also recommend that nursing educators explain both the technical aspects of how to use the ADC and the rationale for why these technical workflows support hospital policies.
Pharmacy and nursing departments will need to partner extensively to ensure the workflows required of both groups are appropriately served by the ADC, the guidelines say. For example, it would be unwise to schedule the ADC to be restocked during the same time as the morning medication pass.
The guidelines also state that monitoring the ADC fleet is important to do proactively. Often, vendors will provide preventative maintenance services to make sure the money spent on the ADC remains a worthy investment.
“We all have customizations, but [these guidelines are] intended to make sure you are hitting all of the bases, whether you are bringing up a new hospital, expanding, or anything else,” said Cello. These published guidelines can help any pharmacy improve its ADC strategy. ■