Automated Drug Dispensing System Reduces Medication Errors in an Intensive Care Setting

Claire Chapuis, PharmD, MSc; Matthieu Roustit, PharmD, MSc; Gaëlle Bal, MSc; Carole Schwebel, MD, PhD; Pascal Pansu, PhD; Sandra David-Tchouda, MD, PhD; Luc Foroni, PharmD; Jean Calop, PharmD, PhD; Jean-François Timsit, MD, PhD; Benoît Allenet, PharmD, PhD; Jean-Luc Bosson, MD, PhD; Pierrick Bedouch, PharmD, PhD

Disclosures

Crit Care Med. 2010;38(12):2275-2281. 

In This Article

Abstract and Introduction

Abstract

Objectives: We aimed to assess the impact of an automated dispensing system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. We also evaluated the clinical significance of such errors and user satisfaction.
Design: Preintervention and postintervention study involving a control and an intervention medical intensive care unit.
Setting: Two medical intensive care units in the same department of a 2,000-bed university hospital.
Patients: Adult medical intensive care patients.
Interventions: After a 2-month observation period, we implemented an automated dispensing system in one of the units (study unit) chosen randomly, with the other unit being the control.
Measurements and Main Results: The overall error rate was expressed as a percentage of total opportunities for error. The severity of errors was classified according to National Coordinating Council for Medication Error Reporting and Prevention categories by an expert committee. User satisfaction was assessed through self-administered questionnaires completed by nurses. A total of 1,476 medications for 115 patients were observed. After automated dispensing system implementation, we observed a reduced percentage of total opportunities for error in the study compared to the control unit (13.5% and 18.6%, respectively; p < .05); however, no significant difference was observed before automated dispensing system implementation (20.4% and 19.3%, respectively; not significant). Before-and-after comparisons in the study unit also showed a significantly reduced percentage of total opportunities for error (20.4% and 13.5%; p < .01). An analysis of detailed opportunities for error showed a significant impact of the automated dispensing system in reducing preparation errors (p < .05). Most errors caused no harm (National Coordinating Council for Medication Error Reporting and Prevention category C). The automated dispensing system did not reduce errors causing harm. Finally, the mean for working conditions improved from 1.0 ± 0.8 to 2.5 ± 0.8 on the four-point Likert scale.
Conclusions: The implementation of an automated dispensing system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.

Introduction

Drug therapy safety relies on many parameters, making drug complications a major cause of medical injury. Adverse drug events, defined as injuries caused by medical treatment, represent a major health issue.[1] Certain adverse drug events are considered as medication errors (MEs), defined as any preventable event that may lead to inappropriate medication use or patient harm.[2] According to available data, MEs harm more than 1.5 million people and cause 7,000 deaths annually in the United States.[3]

In the past 15 years, many studies have described MEs in drug preparation and administration in medical and surgical units.[4–7] Others have specifically assessed the incidence of MEs in medical intensive care units (MICUs).[8–14] Highly unstable critically ill patients are more vulnerable to MEs, and the risk of errors is increased in these patients because of the number of drugs they receive and the way they are administered (i.e., intravenous infusions).[1] In most cases, MEs reached the patient.[8,9,12,13]

Therefore, reducing errors is crucial to improving patients' outcomes. Information technology and automated systems have been introduced to improve the medication use process: computerized physician order entry systems,[15] unit dose drug distribution,[5] bar-coded medication administration,[16] and automated dispensing systems (ADSs), which are computer-controlled dispensing units providing secure storage and drug distribution in care units. ADSs have improved medication use in surgical and medical units, with an impact on administration time errors, omissions, and work activities.[17–20]

A recent report showed that ward-based ADSs can reduce costs while reducing error rates.[21] However, their clinical impact in intensive care units (ICUs) remains to be determined.

Besides technological advances, the quality of medication use relies on interactions between care providers, patients, information, and technology. The majority of MEs are a direct consequence of the intrinsic complexity of these interactions.[22] To be successful, users must be involved in the implementation of new technologies and be able to express perceived benefits, or disadvantages, of the new system.

Consequently, we aimed to assess the impact of ADS implementation on the incidence of MEs related to picking, preparation, and administration of drugs in the MICU. We also evaluated the clinical impact of errors and user satisfaction as secondary objectives.

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