Automated Dispensing Cabinets: Getting It Right in the Age of Automation

Barbara L. Olson, MS, RN-BC, FISMP


July 10, 2009

In This Article

Promoting Medication Safety

The "5 rights" of medication administration, a set of objectives well-known to nurses and other frontline clinicians, are often used to describe medication safety goals. When used to their greatest potential, ADCs can increase the reliability of the "5 rights": the right drug, the right dose, the right patient, the right route, and the right time. The mirror image of each medication right is a wrong -- wrong drug, wrong dose, wrong patient, wrong route, and wrong time -- representing a risk point that a strong system design can help to avert.

However, sophisticated, accessible drug storage systems alone do not guarantee safety. Selection, design, implementation, and monitoring of ADCs are also important to mitigate the risk associated with medication use.

In 2008, the Institute for Safe Medication Practices published Guidance on the Interdisciplinary Safe Use of Automated Dispensing Cabinets to help organizations and individuals understand and adopt practices that maximize the safety of ADCs.[2] Twelve distinct core processes that promote safest practices and secure handling of drugs are addressed in this document. While these guidelines do not represent standards of care, they do provide organizations and frontline users with measures for each stage of ADC implementation, from deciding how the technology will be used to staff education and long-term monitoring.

The ISMP guidance document, coupled with other relevant literature and reports of error and near-miss events associated with ADC use, inform the recommendations provided below. These quick-read recommendations are by no means inclusive, but may serve to bridge understanding between executive decision makers, medication safety experts, and frontline clinicians during high-stakes decision processes that involve resource allocation, work-flow, and patient safety. Teams charged with ADC implementation or re-evaluation as well as those interested in defining pharmacy-specific processes to enhance ADC safety are advised to consult ISMP's complete document.[2]