Category: Professional Posters
Purpose: The Institute of Medicine (IOM) in its report “Crossing the Quality Chasm”, called for Information Technology to take a central role in the redesign of the healthcare system to improve quality, increase efficiency, and reduce errors The American University of Beirut Medical Center (AUBMC) leadership launched the “2020 vision” to transform the healthcare in Lebanon. In 2017, the Pharmacy Department took the lead role in the implementation of Automated Dispensing Cabinets (ADC) to decentralize the medication distribution before the launch of the AUBHealth System (Epic) in November 2018 to meet the strategic goal of Integrated, closed-loop solution for medication management. The objectives are to describe the challenges and compliance with the Institute for Safe Medication Practices (ISMP) guidelines.
Methods: AUBMC is a 380 beds hospital with 24/7 pharmacy services that dispenses around 3300 unit dose items per day with Parenteral Admixture Service. The ADC implementation represents a major change for both professional and technical staff. A Coordinating Committee composed of executive management, pharmacy director and leads of the various working groups was appointed to oversee and manage the overall project by eliminating all the barriers, and ensuring meeting the project milestones were achieved. The multidisciplinary working groups were in charge of mapping the current processes, deciding on the optimal model, developing the implementation plan and timeline to meet the 12 core processes of the ISMP guidelines on the Interdisciplinary Safe Use of Automated Dispensing Cabinets, and reporting to the coordinating committee. ADCs rolled out in three phases. Profiled for inpatients, non-profiled for the Emergency Department and Anesthesia (kits) before Epic and profiled for the ambulatory areas post-Epic.
Results: The major challenges were the installation, configuration, and training, but the adaptation of the software to the hospital procedures, and integrating it with the homegrown systems (patient profile, inventory management, Admission/Discharge/Transfer, labeling and bar-coding) - The compliance scores with the ISMP guidelines at implementation using the self-assessment tool was 90% (402/445). Despite the success to provide “real-time” medication profile based on Pharmacy order entry system, the major deficiency was the inability to link the administration of medications to their scheduled time. - Reducing waiting time for first dose delivery. The goal to have ≥75% of non-compounded items dispensed from the ADCs was reached in the second month after optimization of the types of medications stocked in the ADCs (75% vs 58%) - Major concerns with the cart- fill distribution system included accumulation of drugs at units’ level because of 24 h dispatch as opposed to a need basis. With the implementation of the ADCs, the optimization of the inventory was reflected by a 300% decrease in the number of items sent to the pharmacy for refund (7000 compared to 25000) - The results of the pre and post-implementation surveys for the nurses’ perceptions of and levels of satisfaction with the ADC in relation to the efficiency and availability were significantly higher 3 months after complete implementation. The mean scale score for the safety was not statistically significant (p=.168)
Conclusion: The process of switching into an automated system may have multiple challenges, which can be circumvented through a carefully developed strategic plan.ADS technology increases nurse’s satisfaction.